Ovarian Cysts (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Ovarian cysts facts
- What is the ovary and what are ovarian cysts?
- What causes ovarian cysts?
- What symptoms are caused by ovarian cysts?
- How are ovarian cysts diagnosed?
- How can the physician decide if an ovarian cyst is dangerous?
- How are ovarian cysts treated?
- What are the risks of ovarian cysts during pregnancy?
- Find a local Obstetrician-Gynecologist in your town
What symptoms are caused by ovarian cysts?
Most ovarian cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the abdomen or pelvis is the most common one. The pain can be caused from:
- rupture of the cyst,
- rapid growth and stretching,
- bleeding into the cyst, or
- twisting of the cyst around its blood supply (known as torsion).
If the cyst has reached a large size, other symptoms may arise as a result of pressure or distortion of adjacent anatomical structures. These symptoms can include abdominal fullness or bloating, indigestion, feeling full after eating only a small amount (early satiety), urinary urgency, feeling an urge to defecate or having difficult bowel movements, or pain with sexual intercourse.
How are ovarian cysts diagnosed?
Sometimes ovarian cysts may be noticed by a your doctor during a bimanual examination of the pelvis. If a cyst is suspected based upon symptoms or physical examination, imaging techniques are used. Most cysts are diagnosed by ultrasound, which is the best imaging technique for detecting them. Ultrasound uses sound waves to produce an image of structures within the body. Ultrasound imaging is painless and harmless.
Cysts can also be detected with other imaging methods, such as CT scan or MRI scan (magnetic resonance imaging).
How can the physician decide if an ovarian cyst is dangerous?
If a woman is in her 40's, or younger, and has regular menstrual periods, most ovarian masses are "functional ovarian cysts," which are not really abnormal. Examples include follicular cysts and corpus luteum cysts. These are related to the process of ovulation that happens with the menstrual cycle. They usually disappear on their own during a future menstrual cycle. Therefore, especially in women in their 20's and 30's, these cysts are watched for a few menstrual cycles to verify that they disappear.
Because oral contraceptives work by preventing ovulation, physicians will not generally expect women who are taking oral contraceptives to have common "functioning ovarian cysts." These women do not have functional ovarian cysts. They may receive further evaluation with pelvic ultrasound or possibly surgical intervention. Functional ovarian cysts do not occur in women after they have reached menopause. Small cystic arrested follicles may persist in the ovary after menopause.
Other factors are helpful in evaluating ovarian cysts (besides the woman's age, or whether she is taking oral contraceptives). A cyst that contains a simple sac of fluid on ultrasound is more likely to be a benign neoplasm than a cyst with solid tissue in it. So the ultrasound appearance also plays a role in determining the level of suspicion regarding an ovarian tumor.
Ovarian cancer is rare in women younger than age 40. After age 40, an ovarian cyst has a higher chance of being cancerous than before age 40, although most ovarian cysts are benign even after age 40. CA-125 blood testing can be used as a marker of ovarian cancer, but it does not always represent cancer, even when it is abnormal, and it may be normal in the presence of malignancy. CA-125 is a protein that is elevated in the bloodstream of approximately 80% of women with advanced ovarian cancer.
- First, many benign conditions in women of childbearing age can cause the CA-125 level to be elevated, so CA-125 is not a specific test, especially in younger women. Pelvic infections, uterine fibroids, pregnancy,, benign (hemorrhagic) ovarian cysts, endometriosis, and liver disease are some of the conditions that may elevate blood CA-125 levels in the absence of ovarian cancer.
- Second, even if the woman has an ovarian cancer, not all ovarian cancers will cause the CA-125 level to be elevated. Furthermore, CA-125 levels can be abnormally high in women with breast, lung, and pancreatic cancer.
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