Are Ovarian Cysts Normal? Here Are Some Telltale Signs You Should Get It Checked

Ovarian cysts are common gynaecological disorder, occurring in 10-20% of women.

Ovarian cysts are common, yet often misunderstood. For many women, the presence of ovarian cysts can be alarming, leaving them uncertain about the implications for their health. But by understanding ovarian cysts, their symptoms, and when to seek medical advice, it can help in managing this condition. Knowing when to consult a gynaecologist makes all the difference in effective management, preventing complications, and ensuring your overall reproductive health. 

What are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that develop in or on the ovaries. The ovaries are part of the female reproductive system, responsible for producing eggs, and hormones. They can form during the menstrual cycle as part of normal ovarian function, but they can also develop due to other conditions, some of which may require medical attention.

While most ovarian cysts are harmless, and can resolve on their own, some can cause discomfort or lead to serious health issues if left unchecked. It is essential to differentiate between normal, and potentially problematic cysts to avoid unnecessary panic or overlook potential risks. In fact, early detection, and diagnosis can reduce the risk of complications such as cyst rupture, torsion or infections.

Are ovarian cysts common?

It should be noted that ovarian cysts are quite common, especially during the reproductive years. It is estimated that 1 in 10 women [1] will develop ovarian cysts at some point in their lives. In Singapore, the rates align with global statistics, though many women remain unaware of their condition until they seek medical advice for symptoms like pelvic pain or irregular periods. 

Understanding Ovarian Cysts

Ovarian cysts are not all the same. In fact, they can vary widely in terms of their cause, size, and the symptoms they produce. Some cysts are a normal part of the menstrual cycle, while others may result from underlying health conditions. To better understand ovarian cysts, it is important to distinguish between the different types, and learn how they develop.

Types of Ovarian Cysts

Functional Cysts

Functional cysts [2] are the most common type, and are generally harmless. These cysts form as part of the normal menstrual cycle, and usually disappear on their own without treatment. There are two main types, which are:

• Follicular cysts – follicular cysts form when the follicle, which is supposed to release an egg during ovulation, fails to rupture. The fluid inside the follicle builds up, causing the cyst to form.
• Corpus luteum cysts – after the follicle releases an egg, it becomes the corpus luteal cyst, which typically resorbs after some time.

Pathological Cysts

Meanwhile, pathological cysts [3] are less common. Be that as it may, they can sometimes lead to complications. Some of the types of pathological cysts are:

• Dermoid cysts – dermoid cysts contain various tissues, such as hair, fat, and even teeth, making them a unique type of cyst.
• Endometriomas – endometriomas are associated with endometriosis. These cysts form when tissue, similar to the uterine lining, grows on the ovaries.
• Cystadenomas – cystadenomas develop from cells on the outer surface of the ovary, and can grow large. They may need to be surgically removed if they become symptomatic. 

Polycystic Ovary Syndrome (PCOS)

PCOS is a common condition that results in the development of multiple small cysts within the ovaries. It is often accompanied by hormonal imbalances, leading to irregular periods, weight gain, and difficulty in conceiving. While PCOS can affect ovarian function, it does not always cause significant symptoms and these “cysts” do not require surgical intervention. 

How Ovarian Cysts Develop

Ovarian cysts typically form as part of the normal menstrual cycle [4], when the ovaries produce, and release eggs. However, factors such as hormonal imbalances, endometriosis or other underlying conditions can interfere with the normal process. This ultimately encourages cyst formation.

Most cysts that develop during the menstrual cycle are functional, and harmless. However, if they grow too large or do not resolve as expected, they may lead to discomfort or other complications.

When Should I Visit a Gynaecologist for Ovarian Cysts?

Although many cysts may not cause noticeable symptoms, certain signs warrant a visit to a gynaecologist. If you experience any of the following, it’s essential to seek medical attention:

Persistent or severe pelvic pain

If you notice that the pelvic pain you experience is more frequent, intense or sharp than usual, it could indicate that an ovarian cyst is growing larger, having internal bleeding (hemorrhage), leaking/ruptured or undergoing torsion. The above are termed as “ovarian cyst accident”. Persistent pain should be checked by a gynaecologist.

Abdominal bloatedness 

A sensation of fullness, bloating or swelling in the abdomen, particularly when accompanied by other symptoms like pain or discomfort, can suggest the presence of a cyst. 

Menstrual irregularities

Ovarian cysts, especially those that are larger or functional in nature, can affect the menstrual cycle. These symptoms may include irregular periods, heavier bleeding or spotting between cycles. As such, if you notice changes in your period, it is worth speaking to your gynaecologist for a check-up.

Unusually painful periods 

Experiencing more pain than usual during your period can potentially be linked with the presence of ovarian cysts, particularly endometriosis cysts. If your periods are getting more painful/crampy, this could be a sign that further investigation is needed.

When to Get Immediate Medical Attention

In the event you are experiencing sudden or severe symptoms, then you should seek immediate medical attention. This is because some symptoms, such as sharp pelvic pain, fever or vomiting, can be indicative of ruptured cysts or ovarian torsion – both are categorised as medical emergencies:

• Ruptured cyst – when a cyst ruptures, it can cause severe pain, internal bleeding, and infection. As such, immediate treatment is necessary to prevent such complications, which can become life-threatening [5].

• Ovarian torsion – ovarian torsion occurs when the ovary twists, cutting off its blood supply [6]. It leads to sudden, severe pain, nausea, and vomiting. It typically requires urgent surgical intervention to save the ovary, and prevent further complications such as a permanent loss in ovarian function..

Can Ovarian Cysts Be Treated?

Treatment for ovarian cysts varies depending on the size, type, and severity of the symptoms. In many cases, the cysts resolve on their own without any intervention. However, if a cyst becomes problematic or causes pain, then medical treatment may be necessary. Currently, some of the common treatment options are:

Medical Management

For women who experience symptoms or have recurring cysts, hormonal treatments can help prevent further cyst formation [7]. This may include medications such as birth control pills or progesterone, which are known to regulate the menstrual cycle, and help shrink cysts by preventing ovulation. These treatments may also help manage symptoms associated with conditions like PCOS.

On the other hand, your gynaecologist may also recommend a “watch, and wait” approach if the cyst is small, and asymptomatic. In such cases, regular monitoring through ultrasound or physical examinations can help track the cysts’ size, and ensure it does not cause any problems.Depending on the type of ovarian cyst that is suspected, a follow up pelvic ultrasound scan may be scheduled in certain times of your menstrual cycle for better monitoring. 

Surgical Interventions

If the cyst is large, persistent or causing significant pain, then surgical intervention may be required. There are two primary surgical options, which are:

• Laparoscopy – a laparoscopy is a minimally invasive procedure. The procedure involves small incisions, and a camera, known as a laparoscope, is used to remove the cyst. It is the preferred method for most cases due to its shorter recovery time, and lower risk.

• Laparotomy – a laparotomy is a more invasive surgery, typically reserved for larger cysts or more complicated cases. It requires a larger incision, and may result in a longer recovery time.

• Ovarian Cystectomy – an ovarian cystectomy involves the removal of the cyst while leaving the ovary intact. It is often performed when the cyst is benign, but large enough to cause problems.

• Oophorectomy – an oophorectomy may be necessary in some cases. This includes if the cyst is cancerous or is significantly affecting the ovary, in which the entire ovary may need to be removed. This procedure may be more commonly undertaken in older women/completed family or those with a family history of ovarian cancer.

Supportive and Holistic Therapies

Aside from medical or surgical treatments, your gynaecologist may also recommend lifestyle changes, and holistic therapies. This is to help manage symptoms caused by ovarian cysts more effectively. The therapies may include:

• Dietary management – a healthy diet that is rich in fruits, vegetables, and whole grains may help reduce inflammation, and support hormonal balance.

• Pain management – over-the-counter pain relievers, like ibuprofen or paracetamol, can help alleviate discomfort from cysts.

• Stress management – as stress can sometimes exacerbate hormonal imbalances, it is encouraged to practice yoga, meditation or deep breathing exercises to manage your stress levels more efficiently. 

When Should You Be Concerned About Ovarian Cysts?

While many ovarian cysts are harmless and resolve on their own without treatment, some may lead to serious complications. Recognizing when a cyst could pose a health risk — especially if it causes sudden or severe symptoms — is crucial. Being aware of these warning signs can help you seek prompt medical attention and prevent potential health issues.

Signs of Potential Ovarian Cyst Complications

Most ovarian cysts do not result in major complications. But in certain cases, they can become problematic. Some of the signs of potential complications that warrant immediate medical attention are:

• Bloating or abdominal distention.
• Dizziness or fainting episodes.
• Fever or chills.
• Nausea or vomiting episodes.
• Pain during intercourse. 
• Severe or sudden pelvic pain.
• Unexplained weight loss.

The Link Between Ovarian Cysts and Ovarian Cancer

While most ovarian cysts are benign and non-cancerous, certain types can raise concerns [8]. Ovarian cysts are sometimes misinterpreted as ovarian cancer due to similarities in symptoms and findings. This is why a proper diagnosis is crucial.

• Simple ovarian cysts – simple ovarian cysts are typically fluid-filled, and do not usually present a cancer risk. These cysts often resolve on their own, and cause minimal or no symptoms.

• Complex cysts – complex cysts may contain solid areas, multiple fluid-filled sections or a nodule on the surface. They can potentially be linked to an increased risk of ovarian cancer. 

• Solid masses – solid masses that are found on the ovaries are generally associated with a higher risk of cancer.

In Singapore, ovarian cancer is the sixth most common cancer among women. While the majority of ovarian cysts are harmless, certain cysts, especially complex ones, can increase the risk of developing ovarian cancer. As such, it is crucial to monitor ovarian cysts, and remain vigilant about any changes, especially those who are at a higher risk of developing the disease:

• Age – women who are 40 years old [9], and older are at a higher risk for developing ovarian cancer.
• Family history – women with a family history [10] of ovarian or related cancers significantly raises the risk.
• Genetic mutations – women with inherited mutations like BRCA1 or BRCA2 [11] can increase the risk of ovarian cancer.
• Menstrual history – women who started menstruating at an early age [12] or who experience delayed menopause may face a higher risk.
• Other health conditions – women who are diagnosed with conditions such as endometriosis [14] may be more at risk of developing ovarian cancer.

Taking these risk factors into consideration, it goes without saying that staying proactive about ovarian health can help in early detection, thereby reducing the risks associated with ovarian cancer. This step may include:

• Ovarian cancer risk – complex cysts should be monitored closely, particularly in postmenopausal women. Although the risk remains relatively low, cysts that do not resolve or continue to grow may warrant further investigation.

• Importance of regular screenings – regular pelvic exams, ultrasounds, and other diagnostic tools play an essential role in detecting any changes in the ovaries. These screenings can help catch potential concerns early, and facilitate timely intervention if necessary.

Seek Specialised Care

If you are experiencing symptoms or suspect that you may have an ovarian cyst, seeking specialised care is crucial. It should be stressed that early intervention is key to preventing complications, and ensuring the best possible treatment for your condition.

FAQs on Ovarian Cysts

Are ovarian cysts common during pregnancy?
Yes, ovarian cysts can develop during pregnancy, but most are harmless, and tend to resolve on their own. However, regular monitoring by a gynaecologist is recommended.

Can ovarian cysts affect fertility?
While some cysts do not affect fertility, others like PCOS/endometriotic cysts can have adverse implications on fertility, and may require medical management for those trying to conceive.

How can I prevent ovarian cysts?
Although ovarian cysts cannot always be prevented, maintaining a healthy lifestyle, managing hormonal imbalances, and seeking regular check-ups can help reduce the risk of developing cysts.

References

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