Ovarian Cysts

Ovarian cysts are fluid-filled sacs that can develop within the ovaries. Many women in Singapore experience ovarian cysts at some point in their lives. These cysts are often detected through pelvic ultrasound scans. However, not all of them require treatment.

There are various types of ovarian cysts; these are:

• Follicular cysts: these occur when the follicles that release eggs during your menstrual cycle do not open properly. Usually, these cysts resolve independently without treatment; birth control pills might help prevent their formation.
• Corpus luteum cysts: after releasing an egg, the follicle becomes a corpus luteum that produces hormones. Sometimes, fluid accumulates in this structure, forming a cyst. Generally, these cysts resolve naturally, but in rare instances, they might cause pain or bleeding. Birth control pills can also reduce the risk of these cysts.
• Dermoid cysts: these cysts form from early cells and can contain various tissues like hair, teeth, and sebum. They are usually benign and rare.
• Endometriosis cysts: also called “chocolate” or “blood” cysts, these are linked to endometriosis, where uterine lining tissue grows outside the womb. They might lead to painful periods and fertility issues.
• Cystadenomas: these cysts usually contain watery or mucous material and are generally non-cancerous.
• Polycystic ovary syndrome (PCOS): characterised by numerous small cysts in the ovaries, PCOS  is related to irregular periods and fertility problems.
• Ovarian cancer: these cysts are typically more complex and may have multiple compartments and solid areas with increased blood flow. Some ovarian cancers lead to abdominal fluid buildup (ascites), causing symptoms like bloating, discomfort, weight loss, or reduced appetite.

Ovarian cysts form as fluid-filled sacs on the ovaries. Common causes include hormonal imbalances during the menstrual cycle, follicle development issues, and endometriosis. Polycystic ovary syndrome (PCOS) can also lead to cysts. Most cysts are usually benign and often resolve on their own without treatment. Sometimes, some cysts can result from abnormal cell growth, leading to more complex situations.

If you experience pelvic pain, bloating, or changes in menstrual patterns, consult your doctor. They can perform tests such as ultrasounds to diagnose the type and nature of the cyst. Most cysts are harmless, but if they grow large or cause discomfort, your doctor may recommend monitoring, medications or, in some instances, surgical removal.

The symptoms of ovarian cysts include:

• Pelvic pain or discomfort
• Bloating or abdominal swelling
• Irregular menstrual cycles
• Changes in bowel habits
• Urinary urgency or frequency
• Fullness or pressure in the abdomen

Big ovarian cysts might not show any symptoms or might only lead to minor discomfort. In certain cases, they can rupture, bleed, or cause the ovary to twist, a situation known as an ovarian cyst accident. This could bring about intense pain, nausea, vomiting, and even fainting. Engaging in strenuous activities could heighten this risk. If left untreated, ovarian torsion might obstruct blood supply to the ovary, potentially causing tissue death.

Certain factors can increase the risk of ovarian cysts for women in Singapore. While anyone can develop cysts, these risk factors may make you more susceptible:

• Age: ovarian cysts are more common during your reproductive years but can occur at any age.
• Hormonal imbalances: hormonal fluctuations during your menstrual cycle can contribute to cyst formation. Polycystic ovary syndrome (PCOS) is linked to hormonal imbalances and cyst development.
• Endometriosis: this condition involves tissue from the uterus growing outside it, potentially leading to cysts called endometriomas.
• Pregnancy: sometimes, cysts can form during early pregnancy as part of the normal process.
• History of cysts: if you have had cysts before, you may be more prone to developing them in the future.
• Family history: a family history of ovarian cysts can increase your risk.

If you suspect you have ovarian cysts, it can be diagnosed through various methods:

• Physical examination: your doctor may feel your abdomen and pelvis to detect abnormalities.
• Blood tests: blood tests measure hormone levels to help identify any hormonal imbalances that could contribute to cyst development.
• Imaging tests: ultrasounds, magnetic resonance imaging (MRI), or computed tomography scan (CT-scan) may be used to determine the size, location, and type of cyst. 
• Laparoscopy: if the cyst appears complex or potentially cancerous, a surgical procedure called laparoscopy may be performed, involving inserting a small camera through a small incision to get a closer look. 

Surgery is typically suggested when the ovarian cyst is sizable or raises suspicion of cancer. This often involves a laparoscopic “keyhole” ovarian cystectomy, which removes the cyst from the ovary. However, depending on age and cancer risk, it might also entail an oophorectomy (ovary removal), laparotomy (open surgery), or other procedures.

While it is not feasible to prevent most ovarian cysts, staying attentive to your menstrual cycles and bodily symptoms and maintaining regular appointments with your gynaecologist can ensure early identification and appropriate treatment if necessary.