Am Fam Physician. 2003;67(11):2375-2376
What is an ovarian cyst?
An ovarian cyst (say: sist) is a fluid-filled sac in the ovary. Many cysts are completely normal. These are called functional cysts. They occur as a result of ovulation (the release of an egg from the ovary). Functional cysts normally shrink over time, usually in about one to three months. If you have a functional cyst, your doctor may want to check 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 will not ovulate. If you do not ovulate, you will not form cysts.
If you are menopausal and are not having periods, you should not 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 are having symptoms such as pain, bloating, feeling full after eating just a little, or constipation.
What is a sonogram?
A sonogram uses sound waves to make pictures of organs in the body. It is a good way to look at the ovaries. This kind of sonogram can be done through your abdomen or your vagina. Neither type is painful. The sonogram usually lasts about 30 minutes. It will give your doctor good information about the size and appearance of your cyst.
Are there any other tests I might have?
Your doctor might test the level of a protein called CA-125 in your blood. This is a blood test that is often done in women with ovarian cancer. 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 test is not always an accurate way to tell if a woman has cancer. For example, some women with ovarian cancer have a normal CA-125 level. Also, this level sometimes can be high in women who do not have cancer, particularly if they are in their childbearing years. For these reasons, the CA-125 blood test is usually only done in women who are at high risk for ovarian cancer.
Do I need surgery for an ovarian cyst?
The answer depends on several things, such as your age, whether you are having periods, the size of the cyst, its appearance, and your symptoms.
If you are having periods and the cyst is functional, you probably will not need to have surgery. If the cyst does not go away after several menstrual periods, if it gets larger, or if it does not look like a functional cyst on the sonogram, your doctor may want you to have an operation to remove it. There are many different types of ovarian cysts in women of childbearing age that require surgery. Fortunately, cysts in women of this age are almost always benign (not cancer).
If you are past menopause and have an ovarian cyst, your doctor will probably want you to have surgery. Ovarian cancer is rare, but women 50 to 70 years of age are at greater risk. Women who are diagnosed at an early stage do much better than women who are diagnosed later.
What type of surgery would I need?
The type of surgery you need depends on several things, such as the size of the cyst, how the cyst looks on the sonogram, and if your doctor thinks it might be cancer. If the cyst is small (about the size of a plum) and if it looks benign on the sonogram, your doctor may decide to do a laparoscopy. This type of surgery is done with a lighted instrument called a laparoscope that is like a slender telescope. This is put into your abdomen through a small incision (cut) 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 uses a bigger incision to remove the cyst or possibly the entire ovary. The cyst can be tested while you are under general anesthesia (this puts you into a sleep-like state) to find out if it is cancer. If it is cancer, your doctor may need to remove both of the ovaries, the uterus, a fold of fatty tissue called the omentum and some lymph nodes. It is important that you talk to your doctor about all of this before the surgery. Your doctor also will talk to you about the risks of each kind of surgery, how long you are likely to be in the hospital, and how long it will be before you can go back to your normal activities.