Am Fam Physician. 1998;57(10):2479-2480
See related article on adnexal masses.
What is an ovarian cyst? Is it something I should worry about?
An ovarian cyst is a collection of fluid that comes from an ovary. Many cysts are completely normal. These are called functional cysts. In women who are having periods, functional cysts are normal. They occur as a result of ovulation (the release of an egg). Functional cysts will normally shrink over time, usually in about one to three months. If you have a functional cyst, your doctor may decide to do nothing except see you again in one to three months to make sure the cyst has gotten smaller. Or your doctor may want you to take birth control pills, so you won't ovulate. If you don't ovulate, you won't form cysts.
If you are menopausal and are not having periods, you shouldn't form functional cysts. If you do have a cyst, your doctor will probably want you to have a sonogram, so he or she can look at the cyst. What your doctor decides to do after that depends on your age, the way the cyst looks on the sonogram and if you're having symptoms related to the cyst. Possible symptoms include pain and abdominal bloating, feeling full quickly after eating just a little and constipation.
What is a sonogram like?
A sonogram uses sound waves to make “pictures” of different organs in the body. It's an excellent way to “look” at ovaries. This kind of sonogram can be done two ways, either through your abdomen or through your vagina. When you have an abdominal sonogram, you have to have a full bladder so everything in your abdomen shows up on the picture.
If your ovarian cyst is small, you'll probably have a sonogram through your vagina. A long, narrow transducer, or probe, is put into a sterile covering and then put into your vagina. Neither type of sonogram is painful. The sonogram usually lasts about 30 minutes. It will give the doctor valuable information about the size and the appearance of your cyst.
Are there any other tests I might have?
Your doctor might test your CA-125 level. This is a blood test that is often done in women with ovarian cancer, to see how their treatment is working. Sometimes this test is done in women with an ovarian cyst, to see if their cyst could be cancerous. A normal CA-125 level is less than 35. However, this level can sometimes be high in women who have benign, or noncancerous, conditions. This is particularly true in women who are still in their childbearing years.
Do I need surgery for an ovarian cyst?
This depends on several things—your age, whether or not you are still having periods, the size of the cyst, its appearance, any symptoms you may be having related to the cyst, and your CA-125 level. If you're still having periods and the cyst is functional, you probably won't need to have surgery. If the cyst doesn't go away after several menstrual periods, or if it gets larger, your doctor may want you to have an operation. Your doctor may want you to have surgery if your cyst doesn't look like a functional cyst on the sonogram.
Many ovarian cysts in women of childbearing age require surgery. These cysts are almost always benign, or noncancerous. If you're past menopause and have an ovarian cyst, your doctor will probably want you to have surgery. Ovarian cancer is rare, but it's more common in women 50 to 70 years of age. Women who are diagnosed at an early stage do much better than women who are diagnosed later on.
What type of surgery would I need?
The type of surgery you need depends on the size of your cyst, how your cyst looks on the sonogram, your CA-125 level, and if your doctor thinks this might be cancer. If the cyst is small, about the size of a plum, if it looks benign on the sonogram and your CA-125 level is normal, your doctor may decide to do a laparoscopy. This type of surgery is done with a lighted instrument like a slender telescope. This is put into your abdomen through a small cut either just above or just below your navel. With the laparoscope, your doctor can see your organs. Often the cyst can be removed with only small incisions in the pubic hair line. If the cyst looks too big to remove with the laparoscope or if it looks suspicious in any way, your doctor will probably do a laparotomy.
A laparotomy needs a bigger cut to remove either the cyst or the entire ovary. The cyst can be tested while you are asleep (under an anesthetic) to find out if it is cancer. If it is cancerous, you would need to have a “staging” procedure. Depending on your age, this may mean removal of both ovaries, removal of your uterus (a hysterectomy), removal of a fatty apron called the omentum and removal of lymph nodes. It's very important that you talk to your doctor about all of this before the surgery, so you know what your doctor has in mind. Other important things to talk about are the risks with each kind of surgery, how long you are likely to be hospitalized and how long it will be before you can go back to doing the things you normally do.