The ovarian cyst is a bag filled with fluid that develops on or in the ovary. Many women suffer during their existence from an ovarian cyst. Ovarian cysts, often painless, are very common and rarely serious .
The vast majority of ovarian cysts are said to be functional and disappear over time without treatment. However, some cysts can break, bend, swell a lot and cause pain or complications.
The ovaries are on either side of the uterus. At each menstrual cycle, an egg emerges from an ovarian follicle and goes to the fallopian tubes to be fertilized. In the ovary, once the egg is expelled, the yellow body forms, producing a large amount of estrogen and progesterone in preparation for conception.
The different types of ovarian cysts
Functional ovarian cysts
These are the most common. They occur in women between puberty and menopause because they are linked to menstrual cycles: 20% of these women have such cysts if an ultrasound is performed. Only 5% of menopausal women have this type of functional cysts.
Functional cysts tend to disappear spontaneously within a few weeks or after two or three menstrual cycles: 70% of functional cysts regress in 6 weeks and 90% in 3 months. Any cyst persisting for more than 3 months is considered no longer a functional cyst and must be analyzed. Functional cysts are more common in women with progestin-only contraception (without estrogen).
Organic ovarian cysts (non-functional)
They are mild in 95% of cases. But they are cancerous in 5% of cases. They are classified into four types :
- Dermoid cysts can contain hair, skin or teeth because they come from the cells that produce the human egg. They are rarely cancerous.
- Serous cysts ,
- Mucous cysts
- Serous or mucinous cystadenomas come from ovarian tissue.
- Cysts related to endometriosis (endometriomas) whose contents are haemorrhagic (these cysts contain blood).
The polycystic ovary syndrome
Polycystic ovary syndrome occurs when the woman has multiple small ovarian cysts.
Can an ovarian cyst get complicated?
Cysts, when they do not go away spontaneously, can cause many complications. The ovarian cyst can:
- Rupture , in which case the liquid spreads in the peritoneum causing severe pain and sometimes bleeding. It takes surgery.
- Bending (twisting cyst), the cyst turns on itself, causing a rotation of the trunk and a pinch of the arteries, so a decrease or a stop of the circulation causing a very strong pain and a lack of oxygen for l ‘ovary. It is a surgical emergency to untangle the ovary to prevent it from suffering too much or becoming necrotic (in this case, its cells die for lack of oxygen). This phenomenon occurs especially for large cysts or cysts with a very thin pedicle. The woman experiences a sudden, strong and persistent pain, often associated with nausea and vomiting.
- Bleeding : This may be intracystic hemorrhage (sudden pain) or extracystic peritoneal hemorrhage (resembling cyst rupture). It is also necessary to use a surgical procedure by laparoscopy a priori.
- Compress neighboring organs . This occurs when the cyst grows a lot. This can lead to constipation (intestinal compression), frequent urination (compression of the bladder) or vein compression (edema).
- To become infected . This is called ovarian infection. It can occur following a cyst rupture or following a cyst puncture. Surgery and antibiotic treatment are necessary.
- Require to perform a caesarean section in case of pregnancy. During pregnancy, complications of ovarian cysts are more common.
How to diagnose an ovarian cyst?
Since cysts are usually painless, cyst diagnosis is often made during a conventional gynecological examination. Some cysts can be palpated when they are vaginally touched when they are large enough.
An ultrasound allows you to visualize it and determine its precise size, shape and location.
A radiograph can sometimes see calcifications related cyst (in case of dermoid cyst).
An MRI is essential in case of large cyst (more than 7 cm).
A laparoscopy makes it possible to see the appearance of the cyst, to puncture it or to perform an excision of the cyst.
A blood test is performed , especially to detect is pregnant.
An assay of a protein, CA125, can be performed, this protein being more present in certain cancers of the ovaries, in uterine fibroma or in endometriosis.
How many women suffer from ovarian cysts?
According to the French National College of Gynecologists and Obstetricians (CNGOF), 45,000 women would be hospitalized each year for a benign tumor of the ovary. 32,000 have been operated on.
Symptoms of the ovarian cyst
The ovarian cyst often causes no symptoms when it is small. Sometimes, however, it has symptoms such as:
- a feeling of heaviness in the small pond,
- tugging in the small pelvis,
- of pelvic pain
- anomalies of the rules
- urinary problems (urinating more frequently or difficulty emptying the bladder completely)
- abdominal pain
- nausea, vomiting
- pain during intercourse (dyspareunia)
- a feeling of bloating or abdominal fullness
In case a woman presents some of these symptoms, it is advisable to consult a gynecologist .
Can we prevent an ovarian cyst?
Estrogen / progestogen contraception reduces the risk of functional ovarian cyst, provided that the dosage of ethinyl estradiol is greater than 20 mcg / day. Progestin-only contraceptives also increase the risk of ovarian functional cysts (contraceptive implant, hormonal IUD, desogestrel microprogestative pill such as Cerazette or Optimizette).
Treatment of the functional cyst:
Once the cyst is detected, if it is a functional cyst, the doctor proposes an appointment one to three months later to ensure that the latter has disappeared. Estrogen / progestogen treatment has no effect and should not be used to seek to remove the cyst because it is so likely to disappear spontaneously without treatment.
Treatment of organic cyst (non-functional)
- Laparoscopic cystectomy . By laparoscopy, the surgeon uses an endoscope to look in the peritoneum and see the cyst. He can take and operate the cyst by this way. In a menopausal woman or a large cyst, the surgeon may decide to remove the cyst and ovary, or even the trunk.
- Surgery by laparotomy (opening of the belly) is practiced when one suspects the cyst to be cancerous or if it is very big. It is sometimes performed when a laparoscopy reveals that it is an ovarian cancer.
- The case of endometriosis : in the case where there are many cysts, a hormonal treatment putting the ovaries at rest for 6 to 9 months makes it possible to obtain a reduction in the size of the cysts. Only then is an operation performed to remove the cysts.
When a surgeon removes a cyst by laparoscopy or open surgery, he routinely sends the specimen to the laboratory for analysis.
What to do if the cyst breaks?
If the cyst breaks, bursts, twists or bleeds, an ibuprofen-type pain treatment may be offered. More powerful painkillers, such as morphine, are sometimes needed. And surgery is necessary.