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While your ovaries are mostly awesome organs of reproduction, sometimes they can be a real pain.
Let’s talk about the awesome part first. Each month for 40ish years of your life, your ovaries do their best to help you procreate. Every month they nurture an egg in a fluid filled sack (follicle) until it is ready to venture out on its own. After the egg breaks free of the follicle (ovulation) and heads out in search of its sperm prince charming, the optimistic ovary then gets busy preparing for pregnancy by transforming the former follicle into a small cyst that secretes the hormone progesterone. Of course, the majority of the time pregnancy does not occur, so the cyst dissolves, you experience a period, and the whole process begins again the next month. At least this is what is supposed to happen. Sometimes the cysts do not get the memo that they are supposed to dissolve, and the cyst remains on the ovary. Most times these cysts go unnoticed and do no harm – but other times, they can cause quite a ruckus (that’s where the pain part comes in).
How Do I Know if I Have One?
The most common symptoms of an ovarian cyst are bloating, abdominal pain, pelvic pressure and deep pain with intercourse. Some women are very sensitive and experience these symptoms with ovulation each month, but most women only experience these sensations when a cyst becomes larger than usual. If these symptoms are persistent and severe then your doctor will likely order an ultra sound which is the best way to diagnose ovarian cysts.
Types of Ovarian Cysts
Simple cysts that are filled only with fluid will likely resolve on their own over a couple months. If the cyst continues to grow or if it causes severe pain then it may need to be surgically removed. This is most often a minor outpatient surgery called laparoscopy. Occasionally a cyst can rupture resulting in intense pain that often brings women to the hospital in fear of appendicitis or something more serious. Luckily the pain from a ruptured cyst usually lasts less than a day and can be treated with pain medications.
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Sometimes when the egg is exiting the follicle at ovulation it hits a blood vessel during its escape attempt. When this happens the cyst fills with blood, which causes a different type of cyst, called a “hemorrhagic corpus luteum.” As you might imagine from the name, these cysts are much less fun. They usually resolve on their own over time, but occasionally they rupture and can lead to serious internal bleeding. In addition to bloating and pelvic pain, a bleeding cyst can also cause shoulder pain and dizziness.
Ovarian masses that are solid or filled with debris are classified as tumors and managed differently. They are usually benign in women of childbearing age, but are more likely to need surgical removal since they don’t resolve on their own like simple follicular cysts. Sometimes the ovaries get really bored with normal cysts and decide to fill the cysts with all sorts of craziness like hair, teeth, skin or even brains. Before you get too weirded out, let me explain: your ovaries contain the precursor cells for every organ in the body, and occasionally, instead of turning these cells into eggs, they use the cells to instead create these weird cysts, called “dermoids” or “teratomas.” These cysts do need surgical removal but are rarely cancerous. Also women who are postmenopausal should not be forming cysts anymore, since their ovaries are retired and no longer ovulating. Cysts in this age group are treated more aggressively to confirm that there is no malignancy.
Do Cysts Damage My Ovaries?
Luckily, cysts are usually more of a pain to you than to the ovary itself. Simple fluid cysts rarely affect fertility. Sometimes, though, removing multiple cysts from the same ovary can affect the blood supply to the ovary and cause it not to function as well. And occasionally, cysts are so large that in order to remove them the entire ovary must also be removed.
Extremely large cysts can also increase the risk of a condition called “ovarian torsion.” This is a situation where the ovary gets twisted on its stem, which also happens to be its blood vessels. If the ovary stays twisted for too long, it can cut off its own blood supply and begin to die. Pain of ovarian torsion is usually very sudden in onset, intermittent and often so severe it will cause nausea. Ovarian torsion is treated by surgery, where the ovary is untwisted and the offending cyst is removed. If the ovary stays twisted for too long then permanent damage can occur to the ovary and it will stop functioning.
If you are experiencing persistent bloating, abdominal pain, pelvic pressure and deep pain with intercourse, notify your provider. They can check to see if you might have an ovarian cyst, and if so, can talk with you about the best treatment options for your (mostly) awesome ovaries.
by Heather Rupe, DOBoard-certified OB/GYN
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