The question of cysts

While ovarian cysts are not always a problem, you shouldn't ignore those which cause pain and bleeding as these symptoms could point to something that requires medical treatment or surgery.

As a woman's 'egg basket', the ovaries are responsible for producing eggs during each menstrual cycle, making female sex hormones that support fertility, and mental and cardiac health. Sometimes, a cyst - a small fluid­ filled sac - may form within the ovaries. While it sounds worrying, ovarian cysts are actually very common and occur at all ages, and are especially common in women of childbearing age, typically from age 20 to 40.

Types of ovarian cysts

The most common and benign type of ovarian cyst is the functional cyst. This forms during the menstrual cycle. During ovulation, before the ovaries release a mature egg, several small follicles grow. One will grow to be the dominant one and release an egg during ovulation. When the follicle does not dissolve or when the egg is not released, a cyst is formed. Another type of functional cyst is a corpus luteum cyst. These appear after ovulation. The corpus luteum is what is left of the follicle after the ovum has moved to the fallopian cubes.

Of more concern are non-functional cysts, which result from ovulation problems.

Endometriosis occurs when tissue from the uterus lining grows in other areas of the body such as the ovaries. This causes abnormal menstruation and pain, and may affect fertility.

Cystadenomas are fluid-filled cysts that form from the cells on the surface of the ovary. The fluid-filled sacs are either serous (filled with clear fluid) or mucinous (filled with mucus).

Dermoid cysts are a type of cyst that is formed from cells that are meant to produce a foetus. It may contain tissue similar to that of hair, skin or teeth.

Polycystic ovaries are a mass of multiple follicles that form in the ovaries. Called polycystic ovary syndrome (PCOS), the follicles in which the eggs normally mature do not open and form cysts instead. These growths do not go away on their own and may continue to grow, causing complications.

Diagnosing and treating ovarian cysts

Small cysts that are under 5cm in diameter are less likely to cause any symptoms. When they become larger, they can cause abdominal swelling and/or pelvic pain. This pain can range from a dull throb to a sudden and sharp ache.

Sometimes the cysts may also cause changes in the menstrual cycle. When a large cyst puts pressure on the bladder and bowels, there may also be changes in the frequency of urination or bowel movements (constipation). Ovarian cysts can sometimes be detected during a routine pelvic examination and a pelvic ultrasound is the best way to confirm the diagnosis and identify the nature and origin of the growth.

Treating cysts

If a functional cyst is suspected, a course of oral contraceptives or simple hormonal treatment may solve the issue. The type of treatment for non-functional cysts depends on the type of cyst, the age of the patient and the desire for future fertility. In some cases, surgical removal of the cyst (cystectomy) can be done via a small incision (laparoscopy) for a small cyst or a larger incision (laparotomy) for a larger one. In some women with PCOS, medication can be used to control reproductive hormone or insulin levels. Surgical treatment is sometimes recommended for women with infertility caused by PCOS who do not start ovulating in response to medication. Surgery to reduce the number of small cysts is aimed at improving ovarian function.

Ovarian cysts or cancer?

Most ovarian cysts are harmless unless they bleed, rupture, become twisted or infected. Because the symptoms of a problematic ovarian cyst are very similar to that of ovarian cancer, it is important to monitor any changes in your menstrual cycle and seek medical advice should these occur.

Tumours in the ovaries can form from any of the cells in the ovaries and cancer of the ovaries tends to occur in the post-menopausal years. Because there are no specific symptoms, detection of this type of cancer is often in its late stages. Risk factors for ovarian cancer include menopause, smoking, obesity, not having had children and not breastfeeding. Excessive use of hormones or one's own hormonal imbalances may be linked to a higher risk of ovarian cancer. Other risk factors include a family or personal history of ovarian, breast or colorectal cancer, as well as the BRCA gene.

Finally, as a female health screening test for ovarian cysts, a pelvic ultrasound should be performed at the same time as a pap smear to maximise the effectiveness of the gynaecological review by your gynaecologist.


Dr Ann Tan
Dr Ann Tan, PBM
Obstetrician & Gynaecologist
MBBS (S'PORE), MRCOG (LONDON),
M MED (O&G) FAM (SINGAPORE)
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