Pique the Geek 20120318: Ovarian Cysts

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Ovarian cysts are an extremely common condition in women of childbearing age, and not uncommon in women past menopause.  In fact, most women of childbearing age have ovarian cysts that produce no symptoms.  However, when the cysts become large or inflamed pain is often experienced.

There are several types of ovarian cysts, and they can cause different symptoms.  Diagnosis is made by ultrasonic, MRI, or CT methods.  Often a combination of techniques is used to obtain a more definitive diagnosis, and rarely laproscopic procedures are used.  Ovarian cysts are divided into two broad categories:  functional cysts and nonfunctional cysts.  Functional cysts are those that are not associated with any disease process, whilst nonfunctional cysts are definitely associated with a disease process.

The most common type of ovarian cyst is the follicular cyst.  This functional cyst results from the normal menstrual cycle, particularly betwixt menstruation when an ovum is supposed to be released by the ovary.  Either the ovum is not released properly or the follicle containing the ovary involutes and then fluid accumulates.  In some cases the cyst can be as large or larger than the ovary itself, but it is almost all fluid with a very thin wall.

If these cysts are on the large side and rupture, a sudden onset of very severe pain can occur on the side of the affected ovary.  Fortunately, it is rare for this to be a medical emergency except for pain mitigation.

A corpus luteum cyst can form after the release of the ovum and is also a functional cyst.  The corpus luteum normally is what is left of the follicle after release of the ovum and is important for maintaining pregnancy.  If the ovum is not fertilized, the corpus luteum normally disintegrates.  Sometimes it does not, and can become filled with fluid.  These cysts are typically asymtomatic and are rarely are even seen unless examination for other conditions is conducted.

Another functional cyst is a hemorrhagic cyst.  It is similar to a follicular cyst except instead of clear fluid blood is inside.

The nonfunctional cysts are of a more serious nature.  One fairly common kind is the endometriomas cyst, caused by the pathological condition endometriosis.  In this condition, tissue that normally is restricted to the interior of the uterus begins to grow elsewhere in the body (the ovaries are only one place where this can occur) and, since it behaves like the uterine lining, is subject to cyclical growth and disintegration just like the uterine lining.

Dermoid cysts differ from most other cysts in that they are not fluid filled.  They can also get rather large, up to 15 cm.  These are the ones that you see on TeeVee that have fat tissue and sometimes bone, teeth, and hair in them.  Because of their large size they are apt to cause ovarian torsion, a twisting that can cut off the blood supply to the ovary and obviously serious consequences.

There is another nonfunctional cyst called polycystic-appearing ovary where the ovary is enlarged and contains numerous small cysts.  This is not uncommon and usually is not very serious.

Another kind of nonfunctional cyst is a cystadenoma and these are cysts filled with mucus rather than clear fluid.  They can get really large, up to 30 cm.

The cause of ovarian cysts is not well defined, although there are some factors that are statistically related to cysts.  A history of previous cysts is associated with future cysts, as are irregular menstrual periods.  It is extremely difficult to find a causal relationship, because it is sort of a chicken and egg situation.  Early onset of menarche is related, as is infertility.  Once again, it is not known if these are causal or just part of the process.

Symptoms are highly variable and for small cysts are usually not present.  As cysts become larger, pressure exerted by them on the surrounding pelvic tissues can cause pain (often referred to as a fullness or a pressure in the abdomen), which may increase during ovulation or menstruation.   Other symptoms sometimes include pain upon urination and or defactation, exertion, or intercourse.  None of these symptoms are diagnostic because they can be caused by any number of other conditions.

Any woman with these symptoms should contact her gynecologist for examination.  There is one notable symptom that requires immediate attention at the emergency department:  if sudden, very sharp, and sustained abdominal pain occurs.  This most often is caused by a follicular cyst, especially a large one, ruptures.  That is not in itself particularly dangerous, but there are two life threatening conditions that present with the same pain in essentially the same location.

The first is an infected appendix.  If an infected appendix rupture, infection is spread throughout the abdominal region and this can lead to sepsis.  If the appendix can be removed before it ruptures, the chances of a full recovery are essentially 100%, but if sepsis occurs aggressive measures to fight infection, usually IV antibiotics and a lengthy hospital stay are usually required and the prognosis is not nearly as good.

The other condition is an ectopic pregnancy.  In this condition, a fertilized ovum begins to develop outside of the uterus, often in a Fallopian tube.  Since only the uterus has the capacity to enlarge to accommodate a developing zygote, eventually the zygote gets so large that the tube ruptures and the woman bleeds out.  Death can occur in a matter of hours or minutes, so immediate medical attention is essential.  The only treatment is surgery to remove the zygote and repair the damage.  It is not possible to save the zygote in the event of an ectopic pregnancy.  Those advocating “personhood” laws from the time of conception should think twice.

When ovarian cysts are suspected, there are a number of diagnostic tools that can be used.  The most common one is ultrasonic examination, and the endovaginal kind is more accurate than the external procedure because the ovaries can be imaged from a closer proximity.  Other techniques that provide even more detail include magnetic resonance imaging (MRI) and computed tomography (CT) scans.

The purpose of these imaging techniques is to discover the size and makeup of the cyst.  These factors in turn determine the course of treatment.  Treatment can range to doing nothing to laproscopic surgery to invasive surgery.  The treatment depends on several factors, and normally for all but the functional cysts some testing is done to check for ovarian cancer.

For small functional cysts that only cause discomfort for the most part, nonsteroidal anti-inflammatory drugs (NSAIDS) are used to manage pain.  Functional cysts rarely persist for more than a few menstrual cycles and resolve on their own.  When pain is severe, narcotics are often prescribed.  Most of the time the condition is just monitored, usually by ultrasound, until the cyst resolves.  It is unusual for surgery to be performed on functional cysts unless they are very large, there are lots of them, or if they fail to resolve in a reasonable amount of time.  Generally laproscopic surgery is sufficient.

For nonfunctional cysts, surgery is often required.  Laproscopic surgery is often sufficient, but sometimes laparotomy is necessary, and this involves a larger incision.  Ovary torsion almost always requires surgery to correct it, regardless of the cause.

There is one medical rather than surgical treatment for functional cysts, and that is to administer oral contraceptives.  Since conventional oral contraceptives suppress ovulation, the main cause for functional ovarian cysts is also suppressed.  This is not a 100% cure, but in many cases prevents future cysts in women who are prone to them and can actually shrink existing ones.  Other than surgery to remove cysts, that is really about the only treatment except for drugs for pain management.

There is another method for pain management that works for some women.  Hot compresses may give some pain relief in some patients.  In others, and ice bag padded with a towel also give some pain relief.  Still in others, cycling from hot to cold may give relief.  There is no danger of injury doing that (unless subfreezing ice is used that causes frostbite), so those are worth a try.  If they do not help, just stop using them.

Most of this discussion has been concerned with cysts in premenopausal women.  In this population, well over 95% of cysts are not malignant, but certainly a physician will carefully evaluate each case.  The situation is different for postmenopausal women, because functional ovarian cysts (almost always nonmalignant) are associated with ovulation.  If a postmenopausal woman begins to ovulate, something is definitely wrong.  Biopsy for ovarian cancer is usually conducted in this demographic group, especially if there is a family history or the cysts are of significant size.

As with all of my pieces about health issues, this is not intended to offer professional services nor it intended to diagnose, treat, or prevent any medical condition.  This piece is mere for educational purposes.  If you suspect that you have any medical condition, seek the advice of a trained and licensed medical professional.

Well, you have done it again!  You have wasted many more einsteins of perfectly good photons reading this watery piece.  And even though Newt Gingrich realizes that the one delegate that he picked up in Puerto Rico yesterday will NEVER help him become President when he reads me say this, I always learn much more than I could possibly hope the teach by writing this series.  Therefore, please keep the comments, questions, corrections, and other feedback coming.  Tips and recs are also always appreciated.  Remember, no science or technology issue is off topic here, so please do not limit your comments to this one subject.

I shall remain here tonight for Comment Time as long as comments warrant.  I shall return tomorrow evening around 9:00 Eastern for Review Time.  Remember the rules:  I can not look anything up on this topic tonight, and have to shoot from the hip.  That assures that I have studied the topic sufficiently in depth to speak somewhat authoritatively about it.  For other subjects, this rule does not apply tonight and even for the current topic it does apply for Review Time tomorrow.

Warmest regards,

Doc, aka Dr. David W. Smith

Crossposted at

The Stars Hollow Gazette,

Daily Kos, and



  1. a fluid subject?

    Warmest regards,


  2. I very much appreciate it.

    Warmest regards,


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