My patients tell me that they've had an ovarian cyst. "What kind?" I ask. "I don't remember," is the common answer. Well, that's not a helpful answer. Show Two Types of Ovarian CystsOvarian cyst comes in two flavors, functional cysts and nonfunctional cysts. Functional cysts are usually the good kind. They arise from the function of the ovary. A woman who ovulates makes a cyst about one inch in diameter every month. And there are a lot of smaller cysts every month that go along for the ride. These functional cysts come in two types. Follicular cysts that have the eggs and corpus luteum cysts that the follicular cyst turns into after ovulation. Now the Follicular cyst is filled with clear fluid, doesn't have much of a blood supply, and occasionally can get pretty big, as big as four inches. Getting that big isn't common, but it happens. And unless there's a lot of pain with this big cyst, the important thing is to leave it alone. These cysts go away after a few weeks. How do you know if you have one? Well, every woman with functional cysts has these, and they usually don't know about them unless they're getting an ultrasound for some reason. We watch these cysts grow with great interest and hope in infertility therapy and in vitro fertilization. Sometimes a woman can learn she has one because it becomes bigger and causes pain. Follicular cysts can look a certain way on ultrasound, clear fluid, with a very thin cyst wall. So we know for pretty sure that these are good cysts, and we try to wait and let them go away. Healthy Cysts and FertilityAfter ovulation, the follicular cyst becomes a corpus luteum cyst. This is a progesterone factory whose job it is to make the hormones to prepare the uterus for pregnancy. If no pregnancy occurs with the ovulation, then these cysts go away in about two weeks. These cysts are very active making hormones, and they have a rich blood supply. If they get bumped, and you can figure out ways that they could get bumped, they can bleed and grow rapidly with blood and can hurt. Women who have a corpus luteum cyst that bleeds a lot can come to the doctor or the emergency room and an ultrasound can usually make the diagnosis because they look like a cyst with new blood in it. We try not to operate and let the cyst go away on its own, which may take a month or so. Sometimes there's so much bleeding into the abdomen that it requires surgery, but we try not to operate and leave scars on the ovary if possible. So when a woman can tell me that she had a functional cyst or a corpus luteum cyst that required surgery or a follow-up, I know I don't have to worry because these are the good cysts. Big Bad CystsNow, the bad cysts. There are nonfunctional cysts or neoplastic new tissue cysts new tissue cysts. Any of the tissues in the ovary can grow to make a cyst and some of these cysts can get big, really, really, really big. The biggest neoplastic cyst in recorded history was 328 pounds. That is really big. These cysts come in different types, depending on the kind of cells that made these cysts. Serous cysts, mucinous cysts, dermoid cysts, I could go on. We usually operate to remove these cysts when they get bigger than two inches because they can grow and it's much easier to remove a cyst when it's two inches than when it's 20 inches or bigger, bigger, bigger. We cannot tell exactly what kind of cyst it is some of the time just by looking at an ultrasound, but we do know what it is when the pathologist looks at it. Some cysts are made out of egg tissue make hair and teeth and other kinds of tissues, and they look a certain way on ultrasound. But usually, we give them to the pathologist and let them figure it out. Why should you know what kind of cyst you had removed? Because some cysts tend to predict that you'll get another one. Screening for Cancerous Nonfunctional CystsNow, for the ugly. Some nonfunctional cysts are ovarian cancer. This is another reason that we remove nonfunctional cysts when they grow and look different on ultrasound than functional cysts. Ovarian cancer is not terribly common. About 10 per 100,000 women per year or a little more than 1% risk in a woman's lifetime. Ovarian cancer has no symptoms when it's very small so it can be hard to catch early. When a cancerous ovarian cyst gets bigger, it can cause pain, and pressure and a feeling of abdominal fullness because we cannot always tell which cysts or cancerous on ultrasound. Although cancer cysts do tend to look quite different from functional cysts, we tend to want to remove cysts when they grow, and especially if we find them in women who are post-menopausal and shouldn't be making cysts. So if you've had surgery or medical care for an ovarian cyst, you should keep a record of what kind of cyst it was. Get a copy of the report from your doctor and keep it in your medical records. Ovarian cysts come in different types, and we have different concerns, and different follow-up, for women with some cysts. In fact, any woman who has had surgery on her reproductive organs should have a copy of her operative report and pathology in her permanent medical records. Maybe someday, we'll have a universal electronic medical record and all of it will be there for your doctor to help you. But until then, keep your own copies on file and thanks for joining us on The Scope. updated: July 9, 2020 originally published: August 11, 2016 Ovarian cysts are fluid-filled sacs that can form in or on your ovaries. Most ovarian cysts are benign (noncancerous), and are typically caused by hormonal changes, pregnancy, or conditions like endometriosis. The most common type of ovarian cyst, known as a functional or ovulatory cyst, is completely normal. It develops every month when you ovulate. They aren’t usually harmful, have no symptoms, and typically go away on their own within a few weeks. But this isn’t the only type of cyst that can develop in or on your ovaries. Some other types are a lot less common than the cysts that develop each month due to ovulation. This article will look at the different types of ovarian cysts, the typical size of each, as well as potential treatment options. There are different types of ovarian cysts, each with unique causes and characteristics. The size of an ovarian cyst can also vary depending on what type of cyst it is. Size is also one of several factors that can help determine whether a cyst needs to be surgically removed. Generally speaking, surgery isn’t recommended for ovarian cysts unless they’re larger than 50 to 60 millimeters (mm) (about 2 to 2.4 inches) in size. However, this guideline can vary. For instance, a simple cyst may be left alone until it’s 10 cm (4 inches) in size. And cancerous cysts may be removed when they’re much smaller. Let’s look at each type of ovarian cyst in more detail as well as the typical size of each. Functional cysts form when your menstrual cycle follows its normal pattern. In some cases, though, the cyst can continue growing. Two examples of functional cysts include the following:
Most functional cysts are 2 to 5 centimeters (cm) (about 3/4 of an inch to 2 inches) in size. Ovulation happens when these cysts are around 2 to 3 cm in size. However, some may reach sizes of 8 to 12 cm (around 3 to 5 inches). Dermoid cysts are also called teratomas. They can contain different types of tissue, such as skin, hair, and fat. Dermoid cysts are often asymptomatic, although they may cause symptoms and complications if they become large. These cysts are actually a type of ovarian tumor. They’re almost always benign and are often present from birth. Dermoid cysts can grow during a woman’s reproductive years These cysts often grow slowly, progressing at a rate of about 1.8 mm (about 0.07 inches) per year. Dermoid cysts do have the potential to become large, though. Case studies have reported that some dermoid cysts can grow more rapidly, between 8 and 25 mm (0.3 to about 1 inch) per year. In rare cases, giant dermoid cysts over 15 cm (about 6 inches) in diameter have been reported. Cystadenomas are benign tumors that develop on the surface of your ovaries. They can be filled with a watery or mucus-like liquid. When viewed using ultrasound, a cystadenoma often looks like a functional cyst. However, while functional cysts typically go away after several menstrual cycles, a cystadenoma will continue to get bigger. Cystadenomas can also become quite large. While some can be on the smaller side, around 1 to 3 cm (roughly half an inch to 1 inch), some can grow up to 30 cm (almost a foot)! Endometriomas form due to endometriosis. Endometriosis is a condition where the cells of the uterine lining grow outside of the uterus. This tissue can attach to the surface of your ovary and form a cyst. It’s estimated that between 17 and 44 percent of women with endometriosis will have an endometrioma. These cysts are sometimes called chocolate cysts because they can contain thick, dark blood that gives them a brownish color. Endometriomas are typically small, but like other cysts, they can come in a range of sizes. Many times, ovarian cysts don’t have any symptoms. When symptoms are present, they can include:
Other less common symptoms can include: Complications from ovarian cysts are rare. Sometimes a cyst can break open (rupture), leading to pain or bleeding. In other cases, the ovary can become twisted around surrounding tissues (torsion), potentially cutting off the blood supply to the ovary. Be sure to seek prompt medical attention if you experience any of the following symptoms: Not all ovarian cysts require treatment, and many go away on their own. Because of this, your doctor may recommend a period of watchful waiting to monitor your cyst to see if it goes away after one or two menstrual cycles. If you experience discomfort from an ovarian cyst, your doctor may suggest over-the-counter (OTC) pain medications to help with pain relief. Examples include:
Sometimes, an ovarian cyst may require surgical removal. This may be necessary when a cyst:
Surgical removal of ovarian cysts is often accomplished using minimally invasive methods like laparoscopy. However, more invasive open surgery may be necessary when a cyst is very large or cancer is suspected. If you often get functional cysts, your doctor may prescribe a hormonal contraceptive for you. While this medication can help prevent new functional cysts from forming, it won’t shrink an existing cyst. Most women have ovarian cysts at some point during their lifetime. In fact, functional ovarian cysts are a normal part of your menstrual cycle. These cysts typically don’t have any symptoms and usually go away within a few weeks. Some other types of cysts, like dermoid cysts, cystadenomas, and endometriomas, are a lot less common. These cysts can continue to grow and become large in size. Most cysts don’t need to be surgically removed. However, surgery may be recommended for cysts that are large, don’t go away on their own, or appear abnormal by ultrasound. |
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