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 definition and facts
- What are the ovaries and how big are they?
- What are ovarian cysts?
- What causes ovarian cysts? What are the types of ovarian cysts?
- What are the signs and symptoms of ovarian cysts?
- What are the symptoms of a ruptured ovarian cyst?
- Can ovarian cysts cause cancer?
- What about ovarian cysts during pregnancy?
- Can a woman get ovarian cysts during menopase or postmenopause?
- How are ovarian cysts diagnosed?
- What is the treatment for ovarian cysts?
- What about surgery for ovarian cysts?
- Which specialties of doctors treat ovarian cysts?
- What is the prognosis for a woman with ovarian cysts?
- Can ovarian cysts be prevented?
- Find a local Obstetrician-Gynecologist in your town
How are ovarian cysts diagnosed?
Sometimes ovarian cysts may be noticed by a 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. Transvaginal ultrasound is a diagnostic tool to better visualize the ovaries using a thin ultrasound probe inside the vagina.
Functional ovarian cysts: 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 "functional 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.
Cancer risks: 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 still 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 many 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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