A cyst on the ovary (ovarian cyst) is a partially fluid or tissue-filled cavity on the ovaries. An ovarian cyst is either congenital or develops under certain conditions. Most ovarian cysts do not cause any symptoms and go away on their own. Read all about the causes and treatment of a cyst on the ovary here.
ICD codes for cyst on the ovary: D27 | N83 | E28
Description of cyst on the ovary
A cyst on the ovary is a type of sac that can be filled with tissue or fluid. It is usually only a few millimeters to centimeters in size and does not cause any symptoms. It is often only discovered by chance during an ultrasound check-up. Such cysts occur most frequently during puberty or during the menopause, since strong hormonal fluctuations can occur here that promote the growth of a cyst.
Non-congenital ovarian cysts
Most ovarian cysts do not develop until puberty. They are also called “functional” cysts. Since they are mainly formed under the influence of hormones, they usually occur as part of the female cycle. However, women in puberty and during the menopause are particularly often affected, as the hormonal balance undergoes changes during this time. In some cases, the cysts can also occur as a side effect of hormone therapy or in the case of disease-related hormonal imbalances. A distinction is made between different functional ovarian cysts : follicular cysts, yellow body cysts, chocolate cysts and polycystic ovaries.
The gonad cells of the ovaries produce sex and sex hormones (estrogens and progesterone). A cyst develops when a gland duct is blocked or obstructed and the gland fluid builds up. This process takes place during embryonic development. The cyst is then called “congenital”. Congenital cysts include dermoid cysts and parovarian cysts. They are much rarer than functional cysts.
Symptoms of cyst on the ovary
Above a certain size, or if there are complications, an ovarian cyst causes symptoms. For example, if it presses on the surrounding tissue, this can lead to pain in the back, when urinating or during sexual intercourse. If the so-called pedicle of certain ovarian cysts tears or twists, severe pain can suddenly occur. Read all about the symptoms of a cyst on the ovary here.
Some women experience symptoms of an ovarian cyst, such as menstrual cycle disorders, such as irregular, unusually heavy, or prolonged bleeding. Sometimes there is no bleeding at all. In other cases, those affected suffer from persistent spotting. Very rarely, a cyst can also lead to fertility problems.
In polycystic ovary syndrome, the ovaries are interspersed with numerous small cysts. The concentration of male sex hormones (androgens) in the blood of affected women is increased. Androgens lead to typical changes in women’s bodies, such as a deeper voice or increased body hair. The menstrual cycle is also influenced by androgens. The monthly bleeding may decrease or stop altogether. Women who want to have children often have problems getting pregnant.
A small ovarian cyst rarely causes pain. However, when the cyst grows to a certain size, it can press on surrounding tissue or organs. This often causes complaints. Patients complain of cramps or pulling in the abdomen, back pain, or pain during intercourse.
Twist of style
A cyst on the ovary often sits on a pedicle that connects it to other tissue through blood vessels. For example, if this style twists with a jerky movement, the blood vessels are pinched off. The blood flow is interrupted and the tissue dies. An inflammatory reaction develops that can spread to other tissues and organs. If, for example, the peritoneum becomes inflamed, the patients usually have a fever, feel sick and their stomach becomes tense.
Sudden onset of severe pain, sometimes accompanied by nausea and vomiting, can indicate a twisted style of a cyst on the ovary. If you experience such symptoms, you should always see a doctor.
Rupture of a cyst
When a cyst on the ovary bursts (ruptures), patients usually only feel a slight pulling sensation in the lower abdomen, which is similar to the feeling of ovulation. Very rarely, however, blood vessels can also rupture, causing free bleeding into the abdominal cavity. The patients then have pain and, in the event of major blood loss, also suffer from dizziness and weakness. In severe cases, the circulatory system can break down and the patient goes into shock. The pulse is flat and rapid, the blood pressure extremely low.
Endometriotic cysts are surrounded by scattered lining of the uterus. Therefore, severe cramping pain often occurs around the monthly bleeding. Some of the patients also suffer from persistent abdominal or back pain. Since the lining of the uterus also bleeds, blood-filled cysts can form, which press on the surrounding tissue and cause pain.
Digestion and urinary tract
Sometimes a cyst on the ovary can grow so large that it presses on the bladder. The patients then suffer from a constant urge to urinate or an uncomfortable feeling when urinating. If the ovarian cyst presses on parts of the bowel, constipation and irregular stools can occur.
The waist circumference increases
In rare cases, an ovarian cyst can grow up to 30 centimeters in size. Such large ovarian cysts bulge the abdomen visibly forward. The waist circumference and body weight increase as a result. Patients occasionally have the sensation of a foreign body in their abdomen. The very large cysts press on the surrounding tissue and can lead to a wide variety of symptoms.
Severe pain – a warning sign
Depending on the type and size, the ovarian cyst can cause symptoms, including pain. New, particularly severe or persistent pain, especially accompanied by discomfort, nausea or dizziness, should always be clarified by a doctor. Painful sexual intercourse or urination, irregular bowel movements or rapid weight gain can be indications of an ovarian cyst, especially if cysts on the ovaries occur frequently in the family.
Causes and risk factors of cyst on the ovary
While congenital ovarian cysts are caused by a misplaced gonad outlet, acquired cysts develop under hormonal influence. There are different types of cysts.
After ovulation, the tissue of the ovary in which the egg cell has grown – the follicle – changes into what is known as the corpus luteum. This produces the sex hormones estrogen and progesterone. If the egg cell is fertilized, the corpus luteum initially remains intact during pregnancy. If the egg cell is not fertilized, the corpus luteum is broken down and menstrual bleeding occurs when the hormone concentrations in the blood drop.
However, if the corpus luteum has not broken down properly or even continues to grow, one or more cysts will form. They can also be caused by bleeding into the corpus luteum. Corpus luteum cysts can grow up to eight centimeters in size. In most cases, they regress on their own after some time.
Follicular cyst on the ovary
During the first half of the menstrual cycle, an egg cell matures in a follicle of the ovary. The follicle contains fluid to protect the egg. During ovulation, the follicle bursts, and the egg enters the fallopian tube, where it can be fertilized. If there is no ovulation, the follicle continues to produce fluid. A follicular cyst forms. These cysts particularly affect women of childbearing age. The follicular cyst lasts about four to eight weeks and continues to produce hormones. In most cases, it eventually resolves on its own.
In endometriosis, the lining of the uterus (endometrium) occurs outside the uterus. The endometriosis tissue reacts to the cyclic fluctuations in hormones like the normal lining of the uterus. It builds up, bleeds off and builds up again. However, if the blood cannot drain properly due to a localization on the ovary, blood-filled cysts can form. These cysts are then also called “chocolate cysts” because of their thickened, dark bloody content.
In polycystic ovaries, there are many small cysts in the ovaries. The numerous cysts arise due to a hormonal imbalance. An excess of male sex hormones and insulin is suspected to be the cause, which prevents the normal maturation of the follicles. The body produces too much insulin, for example, if you are overweight or have (latent) type 2 diabetes to compensate for the cells’ reduced sensitivity to the metabolic hormone. This favors the formation of numerous cysts in the ovaries. The so-called polycystic ovarian syndrome can not only lead to infertility and miscarriages, but also to cardiovascular diseases, diabetes mellitus and mental illnesses.
So-called dermoid cysts are congenital cysts. They have formed from the embryonic gonad tissue and may contain hair, sebum, teeth, cartilage and/or bone tissue. The dermoid cysts grow very slowly and can reach a size of up to 25 centimeters. A malignant degeneration of the cyst in the form of a tumor is only found in about one to two percent of cases.
The ovarian cysts (parovarian cysts) arise from embryonic tissue and are located next to the actual ovaries. They represent residual tissue from the embryonic development period. The parovarian cysts can be of variable size and may grow on a stalk.
Diagnosis of cyst on the ovary
If an ovarian cyst is suspected, the doctor will first ask about the symptoms and previous illnesses. The following questions can be asked, among others:
- How old are you and at what age did you have your first menstrual period?
- When was the last menstrual period?
- Do you have a regular cycle?
- How many days does the bleeding last?
- Do you or do you take hormone preparations?
- How many pregnancies and births have you had so far?
- Are you known to have endometriosis?
- Is there a family history of ovarian disease?
- Do you have a desire to have children?
The doctor will then examine the patient to feel for any (painful) enlargement of the ovaries. Depending on the cause of the cyst, it can be assessed by means of a laparoscopy and removed at the same time.
In women over the age of 40 in particular, a cyst on the ovary should always be precisely examined in order to rule out a malignant event.
The ultrasound examination (sonography) enables the visual representation of the ovaries. The doctor can evaluate the ovaries and surrounding structures with a transducer through the abdominal wall or vagina. In many cases, it is already possible to determine the type of cyst by means of an ultrasound examination.
For many types of cysts, it is sufficient for the doctor to monitor the course using ultrasound examinations. If, however, the suspicion of a dermoid cyst or an endometriosis cyst has to be taken into account by means of a sonography, a laparoscopy is usually carried out under general anesthesia. The camera and surgical instruments are inserted into the abdominal cavity through three small incisions in the abdominal wall. The surgeon can examine the ovaries up close, take tissue samples from the cyst or remove them completely.
Treatment of cyst on the ovary
The treatment of the ovarian cyst depends on its type and size. As long as it does not cause any problems and is not too big, its growth can be observed for the time being. In over 90 percent of cases, the cyst regresses on its own. For this purpose, cysts should be observed by the doctor at regular intervals by means of ultrasound and palpation examinations. Drug therapy with hormones can sometimes lead to a regression of the cysts. In rare cases, however, surgical removal is necessary.
Ovarian function is suppressed by hormone preparations such as birth control pills. In some cases, the hormones can also inhibit cyst growth or even cause it to regress. A substance similar to the male sex hormone is used to treat endometrial cysts.
Surgical removal of ovarian cysts
Most ovarian cysts are acquired cysts that resolve spontaneously and do not require surgery. Surgery to evaluate or remove the cyst is usually not done until symptoms or complications arise. In the case of new cysts after menopause or cysts that have existed for months, an operational clarification must also be carried out.
Various methods are available for the surgical intervention. The choice of procedure depends on the size of the cyst and its cause. A laparoscopy is usually performed to examine the cyst and possibly remove it. Only in the case of large cysts does the abdomen have to be opened through an incision.
Therapy of polycystic ovaries
The treatment of polycystic ovarian syndrome depends on whether or not you want to have children. The top priority is to reduce body weight through increased physical activity and a balanced diet. If necessary, the insulin level must be lowered with medication. Furthermore, hormones can be given that regulate the ovarian function and counteract the increased production of male sex hormones.
Cyst on the ovary: course of the disease and prognosis
In over 90 percent of cases, an ovarian cyst will heal on its own and cause no discomfort or complications. In very rare cases, however, it can tear or twist (stalk rotation). This can lead to complications.
Rupture of an ovarian cyst
Only in rare cases does an ovarian cyst rupture. Sometimes this can happen during a palpation, but more often than not the cyst ruptures without any particular trigger. Although the process is often painful, for example in the form of a sudden, stabbing pain, it is usually harmless. However, if adjacent vessels also rupture, bleeding can occur in the abdominal cavity, which usually has to be treated surgically.
Stalk rotation of a cyst on the ovary
Large ovarian cysts, such as endometriotic cysts, are sometimes connected to the ovary by a movable vascular pedicle. Sudden body movements can cause the pedicle to rotate, cutting off the blood supply to the cyst or surrounding tissue. Depending on where the cyst is located, a lack of blood supply leads to severe pain, nausea, vomiting and sweating. The tissue around the cyst can die and lead to further complications such as peritonitis or blood poisoning.
In most cases, ovarian cysts do not pose a health risk. However, they can very rarely lead to malignant diseases such as ovarian cancer and should therefore be checked regularly. However, stem rotation is a dangerous and painful complication. It is possible for new cysts to form on the ovary after a cyst has been removed.