Everything about Ovarian Cysts and its Treatment

What are Ovarian Cysts?

Ovarian cysts, in most cases, are tiny fluid-filled sacs that may develop inside or on the surface of your ovaries during the process of ovulation. They are quite common in women of reproductive ages and usually go away on their own within the next 2-3  menstrual cycles. Interestingly, tiny sized ovarian cysts typically remain asymptomatic and do not cause any problems except a little bloating or a certain fullness around your pelvic area. But, the problem begins when the cyst does not break open naturally and rather starts enlarging.

Ovarian cysts larger than 2.5 cm start causing an abnormal swelling around the abdomen, acute pelvic pain, severe nausea, vomiting, and pain in passing bowels. You might also experience irregular periods, a sudden weight loss, and strange pain during sex. This is when surgical removal of this enlarged cyst becomes necessary.

If not diagnosed/ treated on time, the ovarian cyst can also start to affect ovulation, contribute to PCOD (a health condition where the woman’s ovaries have multiple tiny cysts on its surface) and make conception really difficult. In adverse cases, they also run the risk of ovarian rupture, that is- the bursting of the ovaries, or in some stances, ovarian torsions, that is- the twisting of the cysts around its blood supply.

How do they form?

Though ovarian cysts are usually a result of hormonal imbalances, pregnancy, endometriosis or pelvic infections, different types of ovarian cysts form differently. For example,

1. Functional Cysts: Functional cysts, as the name suggests, are formed as a result of the basic functioning of ovaries. They are of two kinds and are usually benign (non-cancerous) and asymptomatic.

2. Follicular cysts: Follicular cysts are the most common kind of ovarian cysts. They get formed as a result of ovulation and range from the size of a pea to the size of an orange.

Typically, in a woman’s normal reproductive cycle, her ovaries release around five to twenty eggs (oocytes) enveloped in tiny fluid-filled structures called- follicles. Then, every month as one of these eggs matures, the follicle bursts open, luteinises, and the egg funnels towards the fallopian tube to aid conception. But, the problem begins when this egg-producing follicle does not break open and rather, the ovum inside it slowly degenerates and starts disappearing. Here, while the egg ceases to exist, the sack keeps luteinising and swelling with the fluid. When this fluid-filled sack keeps enlarging instead of breaking open, it forms a follicular cyst.

These cysts usually remain tiny and dissolve naturally within 2-3 menstrual cycles and bear no symptoms or harm. But sometimes, they can grow exponentially and enlarge up to 8cm or more, causing acute pain, nausea and compromising fertility adversely.  This makes the surgical intervention (cystectomy) an absolute necessity.

3. Corpus Luteum Cysts: Typically, once the follicle releases the matured egg, it starts producing estrogen and progesterone to help fertilisation. Because of its luteum production function, it is then called- a corpus luteum. But, sometimes, due to some abnormal changes in the follicle, while the egg breaks open, the opening end seals close, and the luteum hormone keeps accumulating. This makes the cyst grow abnormally large and forms- corpus luteum cyst.

However, these too, are extremely common in women of reproductive ages and typically go away naturally within 2-3 menstrual cycles.  But, in rare cases, when they do not get dissolved naturally, they can grow as large from about 8cm to 12 cm and turn extremely painful. Then, surgical removal remains the only solution.

4. Pathological Cysts: Pathological cysts, as the name suggests, get formed as a result of certain pathologies or abnormalities in the normal function of ovaries. They are primarily of 3 types and typically go away only through a surgical removal (ovarian cystectomy).

5. Dermoid Cysts: Dermoid cysts, also known as teratomas (monster tumors), are one of the most common types of pathological cysts and are usually present from birth. Their average size runs between 12cm to 40 cm.

Typically, in a normal pregnancy, when a woman’s oocyte (primary germ cell) fertilises with sperm and forms a zygote, its cell multiply and form different tissues and organs of the body. However, not all tissues differentiate into separate kinds and some, rather retain their original ability to turn into any human tissue at any point in time.

These undifferentiated cells usually head to ovaries in women (in the female fetus) or testes in men (in the male fetus), to eventually develop into egg or sperm in later years. But the problem begins when they stop being passive, and rather, start to mature and enlarge. Now, since they are composed of the primary germ cell, they can grow exponentially (almost an inch every year) and form fat, skin, hair, tooth, bone, eye- in fact, almost every other human tissue in the body, right inside their sac.

They also contain a sebaceous fluid in them that is thick, sticky, and foul-smelling. Though just like other ovarian cysts, tiny dermoid cysts do not cause many symptoms and can be treated conservatively, however, their abnormal growth can cause severe pelvic pain, nausea and vomiting. Also, unlike functional cysts, pathological cysts do not shrink/dissolve naturally and almost always require surgical removal (ovarian cystectomy).

6. Endometriomas Cysts: Endometriomas is one of the most common pathological types of cyst that develops as a result of a condition, called- endometriosis. In this condition, the uterine tissues that usually develop inside the uterine walls start to develop outside it, that is- on the outer wall of the uterus, fallopian tubes, ovaries, or precisely, any and everywhere around the uterus. These abnormal growths on the ovaries are then called- endometriomas and are typically composed of blood. Thus, earning its name- ‘chocolate cysts’.

These cysts, just like others, are harmless when tiny, but dangerously infectious and painful when large. Large endometriomas cysts are almost always treatable only by surgical cyst removal and require immediate medical attention.

7. Cystadenomas: Cystadenomas are liquid or mucous-filled ovarian cysts.

8. Hemorrhagic ovarian cyst: Hemorrhagic ovarian cyst, as the name suggests, gets formed when an ovarian cyst ruptures and bleeds. This usually forms while an egg-producing follicle struggles to break open and release its eggs. Typically, the outer wall of a follicle is very thin. Sometimes, especially in the corpus luteum, the wall ruptures in the process of ovum expulsion.

This causes bleeding and the formation of a haemorrhagic ovarian cyst. This, too, like other cysts, is harmless when tiny but acutely painful when large. But, the difference is, unlike functional cysts, haemorrhagic cysts are extremely stubborn and usually cannot be resolved without surgical removal (cystectomy).

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Types of Ovarian Cysts

• Corpus luteum cysts
• Dermoid Cyst
• Endometriomas
• Cystadenomas
• Hemorrhagic ovarian cyst

Causes - Ovarian Cyst

• Hormonal problems

• Pregnancy

• Endometriosis

• A severe pelvic infection

• A previous ovarian cyst

Symptoms - Ovarian Cyst

• Pelvic pain

• Abdominal swelling

• Regular bloating

• Nausea and vomiting

• Increase in the urgency & frequency of urination

• Pain emptying your bowels

• Sudden weight loss

• Irregular periods

• Pain during sex

• Difficulty getting pregnant

Diagnosis - - Ovarian Cyst Treatment

Tests

Some of the tests your doctor may prescribe you are:

1. Blood Tests: Blood tests use your blood sample to check for any abnormalities. Here, the blood test may help your doctor track any abnormal hormonal levels or also the nature of your ovarian cyst.
2. Imaging Tests: Imaging tests are those medical tests that help paint an image of your internal organs, tissues and blood flow using high-frequency sound waves. They can help confirm the presence, location, shape, size and composition of your cyst. Typically a simple pelvic ultrasound is the first step to support the confirmation of the ovarian cyst. However, in some rarer cases, other imaging tests such as MRI, CT Scan or sonography might also have to be considered.
3. Laparoscopy: Laparoscopy is one of the most advanced types of pelvic tests. It uses a special medical instrument, called a laparoscope to understand the precise location and size of your ovarian cyst. Here, your doctor first numbs your body through anaesthesia and then, once you fall unconscious, one very small keyhole sized incision is made near the site. Through this, the doctor inserts the laparoscope- a tiny instrument attached with a camera and light on its end. This camera helps your surgeon understand the exact location and size of your ovarian cyst and marks an accurate diagnosis.
4. CA 125 blood test:  If your doctor suspects ovarian cancer, CA 125 blood test may be suggested. Basically, CA is a cancer antigen. If a woman has this in a higher amount, it can indicate cancer. However, note that the results are not always absolute. Some other parallel health conditions, such as endometriosis, uterine fibroids, pelvic infections, heart failure and liver.

Self Diagnosis

An accurate self-diagnosis is usually quite difficult, especially in tiny sized ovarian cysts.

However, your specific symptoms in cases of enlarged cysts, such as acute pelvic pain, swelling around ovaries, frequent bloating, nausea, irregular periods, pain during sex, or difficulty in conception despite one whole year of timed and unprotected sex, may indicate an ovarian cyst. Another factor that can give you this hunch is your age bracket. If you are a woman in your reproductive years, these symptoms have a strong indication of functional cysts. However, do not delay the tests even if you are experiencing these symptoms at any other stage. The truth is, dermoid cysts are present by birth and other pathological cysts, too, are not limited to any age timeline. This is why, they can occur in postmenopausal women too and if found, have high chances of being cancerous. Here, surgical removal becomes necessary and both ovarian cystectomy (surgical removal of ovarian cysts) and oophorectomy (surgical removal of the ovary/ ovaries) can turn helpful.

Diagnosis by doctor

Typically, your doctor can diagnose the presence of an ovarian cyst through your explained symptoms, a physical check-up for the swelling around ovaries and regular routine pelvic exams. However, despite the strongest of indications, your doctor must prescribe you imaging and blood tests to confirm the exact location, size, nature and composition of the cyst. Based on the sum of both, your doctor suggests the appropriate treatment- conservative/ surgical.

Severity - Ovarian Cyst

Type 1 | Size |

Typically, cysts larger than 5 cm are considered severe and demand surgical removal.

Type 2 | Number |

Bilateral or multilateral cysts are typically considered severe and require cystectomy.

Type 3 | Component |

Solid, semi-solid, or blood-filled cysts are usually considered dangerous and have high chances of being malign (cancerous).

Risks & Complications - Ovarian Cyst Treatment

During the surgery

1. Bleeding: Sometimes, as a rare case scenario, the cyst or the surrounding tissue may burst open because of an operative error, leading to internal bleeding.
2. Infection:  An infection may occur if the cyst breaks open and its internal composition (follicular fluid/ blood/ mucous/ other tissue cells/ sebaceous fluid) splatters to the surrounding tissues. It can also be the result of negligence in the surgical procedure or the body’s inherent reaction to certain metals/chemicals.
3. Reoccurrence: Women who have had an ovarian cyst before have high chances of redeveloping it again.
4. Removal of one or both ovaries: Though ovarian cystectomy is targeted to only remove the cyst and never the ovaries, at times, ovary removal might seem the only option with your surgeon.  However, this happens only in the rare case scenarios where the woman either has ovarian cancer or the cyst has led to severe gynecological emergencies. In these cases, oophorectomy (surgical removal of the ovaries) must be performed, leading to a permanent compromise on a woman’s fertility as well as her natural hormone production.
5. Damage to other organs: In some rare cases, the surrounding organs, too, may get damaged. This may happen either because of the severity of the case, that is, ovarian rupture/torsion or operative negligence.

If left untreated

1. Rapid growth and stretching: If left untreated, ovarian cysts can continue to grow, enlarge and swell with their internal components. Depending on its type, the cyst could grow even as large as 40 cm-42 cm! Now, because this is an abnormal growth on a functioning part of the body, it could lead to an added pressure on the ovary and the surrounding organs, thus, leading to its abnormal functioning, pain, and compromised fertility.
2. Rupture/ burst of the cyst: Enlarged ovarian cysts have a very thin mucous membrane. When fully stretched, they carry the risk of bursting open and spilling their fluid around. Now, depending on the nature of its components (follicular fluid/ blood/ abscess/ tissue types/ oily, thick fluid), the event could trigger sepsis (infection) and worsen the health condition.
3. Haemorrhage & Internal bleeding into the cyst: Sometimes, in the process of oocyte expulsion, the thin walls of the cyst may break open and bleed. This could cause internal bleeding and at times, haemorrhage, thus leading to painful haemorrhage cysts.
4. Ovarian Torsion: Sometimes, the heavyweight of the ovarian cyst may cause the cyst to twist around its ovaries and block the blood supply. This is an extremely serious condition and can be resolved only through surgical intervention. If left untreated, it could lead to unbearable pain and death of the ovarian tissue- thus, permanently damaging a woman’s ability to reproduce.

Prevention - Ovarian Cyst

Sadly, there is no particular or definitive way that can prevent the formation of an ovarian cyst as it is either by birth/ side effect of the normal functioning of the ovaries. However, there are a few lifestyle changes that you can adopt to reduce the risk of its enlargement or its effect on fertility. These are:

1. Walk, walk, walk! Walk at least 30 minutes daily. An active lifestyle and controlled BMI  is an answer to half the diseases. Exercise helps regulate our blood flow, pump in extra oxygen and helps balance out hormones. This is why a 30-minute walk is usually the first prescription of every doctor online/ otherwise. There are multiple reports that prove how a simple, regular act of walking reduced the adversities caused by PCOS in thousands of women and not only helped them balance their hormones, but also helped turn conception less difficult.
2. Well balanced diet: There is a saying- ‘You are what you eat.’ This cannot be more true. A disciplined, healthy, and well-balanced diet can at times do wonders magicians can’t! This is why we encourage you to eat balanced proportions in small intervals and at uniform times. This would help your body set to a disciplined biological clock, thus helping digestion and balancing of imbalanced hormones- one of the primary reasons for ovarian cysts. Also, fibre rich foods help curb the reabsorption of estrogen in the body. Therefore, eating fruits like whole grains, lentils, apples, pears and dry fruits can help greatly. Secondly, drink enough water! Sip in a little water throughout the day and stay hydrated, so that, your body is always nourished and prepared to fight the worst-case scenarios at any given time.
3. Quit Smoking: Smoking cigarettes is never a great idea. Cigarettes and their nicotine affect both ovarian functions and hormones. They also run the risk of causing ovarian cysts, cancer and emphysema. Therefore, quitting cigarettes can be a great first step to prevent ovarian cysts.
4. Fertility drugs: Sometimes, your gynecologist may prescribe you fertility drugs to help ovulation, especially during the procedures of IUI or IVF. Though these drugs do help you release more ovum, they also, as a side effect increase the chances of follicular cysts. This is why you and your doctor must keep periodic imaging tests and look out for their presence, size, composition and associated risks (in cases of enlarged cysts).

When to consult a doctor?

You should consider immediate medical help in the following three conditions:

On symptoms: If you are experiencing acute pelvic pain, swelling around your ovaries, nausea, vomiting and fever, chances are you have an enlarged ovarian cyst/ have recently undergone its rupture or infection. This is where you must contact your gynecologist immediately and seek emergency help.

Difficulty in getting pregnant: In case you have been trying but failing to conceive naturally for more than a year, there are chances that you could have specific ovarian cysts or may be PCOD. And since reproduction and all its matters are also age-restricted, you must visit your gynecologist without delay and take timely treatment to avoid compromised fertility.

Regular pelvic exams: A general rule of thumb- as a woman approaches puberty, she must visit her gynaecologist at least once a year and take regular body checkups. It can curb multiple gynecological emergencies in their budding stage. For example, most ovarian cysts are asymptomatic and very hard to diagnosis with just their external symptoms alone. Here, regular pelvic exams can help detect any abnormal growth and their nature. An early diagnosis could help initiate a wait-full watch and reduce the risk of severe complications.

Questions to ask your doctor about Ovarian Cyst

• Could I know your specialisations or read any patient track record?
• Is there any conservative line of treatment possible?
• What is the size/ location, and composition of my ovarian cyst?
• Is the ovarian cyst benign or cancerous?
• What are the different surgical methods available?
• What is the difference between laparoscopic cyst removal and open-cut cyst removal? What is better?
• What are some of the risks/ complications associated with the surgery?
• Are there any chances of ovarian damage/ compromised fertility?
• Should I freeze my eggs before the surgery?
• What are the payment options, and would it be covered under insurance?
• How should I prepare for the surgery?
• How long would the surgery take? Would I need a hospital stay?
• What would be the recovery period like? Would I need help doing chores at home?
• How should I take care of myself post-surgery?
• Are there any dietary restrictions?

Ovarian Cyst Treatment Options & Cost

Non-Surgical

Enlarged ovarian cysts usually have no other cure than surgical intervention. But yes, the very formation of follicular cysts can be helped contained through hormonal medicines such as birth control. The principle is simple. No ovulation= no follicular cysts.

Surgical

Surgically, we have two treatment options-

1. Ovarian cystectomy (ovarian cyst removal)
2.  Oophorectomy (ovary removal).

Typically, cystectomy, that is, the surgical removal of only the ovaries is always the first surgical option. And only if the procedure gets complicated because of the severity of its case and the complication itself demands the removal of ovaries, or if the cysts are cancerous and the ovary removal is the only option would your doctor go for oophorectomy (ovary removal). At times, or in certain cases, it is also an acceptable option in the case of postmenopausal women. Here, the principle is, since women have already exhausted their ovarian reserve by the time of menopause, ovary removal might be considered. This is done especially because the growth of cancerous cells in ovarian cysts are extremely common in the woman of older ages and ovary removal could help cancel the risk of cancer. However, here too, oophorectomy is always the last line of treatment as ovaries are also the storehouse of a woman’s natural hormones and their removal could trigger multiple changes and demand external hormone therapy.

Types of Ovarian Cyst Surgery

Surgery Preparation

A few things that would help  you prepare better for the surgery are:

1. Discuss all your current medicines, health conditions, supplements and herbal potions elaborately with your doctor. Your doctor might have to ask you to stop certain medicines, especially ibuprofen, insulin or blood thinners. They hamper the surgery and risk excessive bleeding during the procedure.
2. Check for your BP and sugar levels: Just like any other surgery, cystectomy too, cannot be performed if you have imbalanced BP or sugar levels. This is why they must first be brought down and in control. The same holds true in the recovery period too.
3. Quit smoking/ drinking and use of recreational drugs at least two weeks before the surgery.
4. You might want to freeze your eggs as an added step to preserve the chances for further childbearing.
5. As the surgery is performed under anesthesia, you are recommended to not eat/ drink (even water)  at least 6-8 hours before the surgery. This is why, in most cases, the surgery is performed in the early morning hours on an empty stomach.

What to expect during the ovarian cyst surgery

1. You will be asked to change in a loose surgery gown before the surgery.
2. Your medical attendant will take a few regular tests before the surgery to record your BP and blood sugar levels.
3. Both surgeries, whether laparoscopic cystectomy or open cut cystectomy, are performed under general anaesthesia and are hence completely minimal pain. So rest assured, neither will hurt during the procedure.
4. The surgery is a short procedure and is usually completed in less than 60 minutes. However, adding up the preparation time, anaesthesia, the procedure itself, the time for anaesthesia to wear off and a little rest, your total time in hospital from entry to exit may take you a little more than 3-4 hours.
5. Sometimes, in the rarest of rare cases, your surgeon might have to remove your ovaries. However, this happens only in the cases of extreme cases of severity or risk of ovarian cancer. This is why, if the woman desires future childbirth, freezing of eggs is suggested to the woman before operation.

After the ovarian cyst surgery

1. You will be in a state of unconsciousness right after the surgery. It may take you roughly about 30-40 minutes to completely recover from anaesthesia.
2. Then, you will be transferred to the general ward and recommended rest for a few hours.
3. Depending on the nature of your surgery, you might experience slight to moderate pain, itch and pull on your incision site. For the same, your doctor will prescribe you painkillers, antibiotics, and multivitamins.
4. In a few cases, your doctor might also recommend your hospital stay for a day/2 for post-surgery monitoring.

Before and after ovarian cyst surgery

1. Before surgery: You would have an abnormal swelling around your ovaries, suffer from acute abdominal pain and experience abnormal urgency and frequency in urination. You might also be a patient of nausea, vomiting, fever and bloating.
2. After the surgery: You would experience a very obvious relief. Your stomach would be pain-free, smoother and free of bloating. However, depending on the nature of your surgery, you might also have a few scars. That is, a few keyhole sized,  hardly visible incisions in case of laparoscopic cystectomy, and around 6-12 inch scar in case of open-cut ovarian cyst removal.Another obvious effect would be regular periods, balanced ovulation and increased chances of healthy conception.

Insurance Coverage - Ovarian Cyst Treatment

Yes, most insurance providers in India cover ovarian cyst removal surgery under their medicare as ovarian cyst surgeries are always done to relieve the patient of acute suffering and are considered medical necessities. However, there might be a disease capping on the maximum amount that can be covered.

Recovery rate - Ovarian Cyst

Your recovery rate and healing time primarily depend on the technique of surgery you opt for.

• Since open-cut surgeries mark a larger cut, the healing is slower and longer.  It may take roughly 15-20 days for complete recovery.
• Whereas laparoscopic surgery (keyhole surgery) marks a faster recovery time because of its minimal and precise keyhole incisions. Here, you may resume work right after 4-5 days of rest.

Facts and Statistics around Ovarian Cysts

If you are looking for an experienced gynecologist, an advanced gyne- hospital or wondering what surgery is better- Laparoscopic cystectomy/ open cut laparotomy, Pristyn Care can be a great choice! We are not just another hospital but a full-stack health care provider. Some of the reasons that make us one of the best in health care are:

1. Highly Experienced and specialised OB-GYN surgeons: Our OBGYNs are some of the most experienced and well-reputed across India. All our surgeons have performed more than thousands of surgeries and track excellent patient records. This is why rest assured your surgery is in the safest of hands and complication risks- minimum.
2. Covid safe vicinities: All our hospitals follow the highest level of covid safety protocol, and our vicinities are extremely hygienic and bacteria-free. Therefore, when entering a Pristyn Care associated hospital, rest assured, your safety is completely taken care of.
3. Most advanced and USFDA approved technology: We do laparoscopic surgeries that are the most advanced, precise and USFDA approved. Because of the laparoscope, your surgery becomes extremely accurate, minimally invasive and offers the fastest of recovery.
4. Insurance Assistance: We offer end to end assistance through your insurance policy and the entire surgery experience. We have a dedicated team to assist you for insurance approval within 30 minutes. In case you do not have insurance and are looking for easier methods of payments, you can also opt for the ‘no cost EMI’ option Pristyn Care provides through all surgeries.
5. Free transportation: To make your surgery experience seamless, we offer you a free pick up and drop facility across town on the day of your surgery. Our cab would reach your residence, take you to the assigned hospital and drop you and your friend/ family back to your place safely post-operation.

Book your appointment

You can speak to us directly by calling us on the number provided at our website. You could also book your appointment by clicking on the ‘Book Appointment’ tab right next to our number. It will take you to a small form with your four basic details-’your name’,  ‘contact number’, ‘disease’ and ‘city’. Fill in these details and press ‘submit’. Now, just relax, and let our medical coordinators call you back and answer all your queries in detail.