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Benign Ovarian Cysts
An ovarian cyst is a fluid-filled sac that forms in the ovary. Ovarian cysts are common and, in the vast majority of cases, they are benign (noncancerous). They vary in size and may occur at different sites in the ovary; the most common type develops when an egg-producing follicle does not rupture and release the egg but instead swells with fluid and forms a follicular cyst. Benign ovarian cysts often cause no symptoms and are discovered incidentally during a routine pelvic examination. In some cases, however, they may alter hormone production in the ovaries or grow large enough to produce noticeable symptoms. Cysts often disappear on their own without treatment, but in some cases they may require surgical removal. In rare cases a cyst that twists or ruptures may cause serious complications warranting emergency surgery. There are no known causes and no way to prevent benign ovarian cysts.
Symptoms can include:
- In many cases, ovarian cysts produce no symptoms.
- Mild abdominal ache.
- Abdominal swelling or a feeling of fullness or pressure.
- Pain during sexual intercourse.
- Menstrual irregularities including absence of menstrual bleeding (amenorrhea), heavy bleeding (menorrhagia), and painful periods (dysmenorrhea).
- Unusual hair growth on the face and body caused by an increased production of masculinizing hormones (hirsutism).
- Sudden, sharp abdominal pain, fever, and nausea if a cyst becomes twisted or ruptures.
- Rarely, painful, frequent urination-or urinary retention-if a cyst presses against the bladder.
If you experience any of the symptoms of ovarian cysts, call a gynecologist. If you have been diagnosed with an ovarian cyst and you experience sudden, sharp abdominal pain, fever, or vomiting, see a doctor immediately.
To diagnose this condition a gynecological examination is necessary. If a lump or mass in the ovary is detected, further tests are necessary to rule out the possibility of ovarian cancer. Abdominal or pelvic ultrasonography may be performed. A minor procedure called laparoscopy (insertion of a scope through a small incision in the abdomen to view the ovaries) may be used to confirm the diagnosis and determine the size and position of the cyst.
Ovarian cysts often disappear without treatment. Surgery to remove the cyst may be needed if cancer is suspected, if the cyst does not go away, or if it causes symptoms. In many cases it can be taken out without damaging the ovary, but sometimes the ovary has to be removed. In some cases ovarian cyst may be drained during laparoscopy.
Your doctor may perform one or more tests to diagnose a benign ovarian cyst -- a collection of fluid within a normally solid ovary:
- Pelvic Exam
Oftentimes, ovarian cysts are detected during a routine pelvic exam. But because the pelvic exam cannot produce a definitive diagnosis, the next step is to perform a vaginal sonogram.
- Vaginal sonogram
This imaging test allows a physician to get the most accurate picture of the ovary and cyst. The test is performed by inserting a small instrument into the vagina, which then bounces sound waves off your uterus, fallopian tubes and ovaries, forming a picture on a monitor. This image enables the doctor to determine with accuracy the size of the cyst and, just as importantly, to see inside it and detect whether it is solid or fluid-filled. While the vaginal sonogram detects the presence of a cyst, it cannot verify whether it is benign or malignant. Therefore, if the sonogram detects a cyst, the next step is the surgical removal of the cyst to find out if it is malignant or benign.
- Laparoscopy
This minimally invasive surgical procedure allows your doctor to see and remove the cyst by making a small incision in the abdomen rather than a long cut, as was the common practice just years ago. The laparoscope, a thin lighted telescope, is inserted through a small incision into your abdomen. Small instruments placed near the pubic bone allow the doctor to then remove the cyst. Patients welcome the benefits of laparoscopy, which is performed on an outpatient basis and allows for a quick recovery time.
Most benign ovarian cysts are harmless and may even disappear on their own. This is why, in most situations, the first line of treatment is simply observation. There are instances, however, in which more immediate, aggressive treatment is recommended. For example, if you have a family history of cancer, a cyst that is causing a lot of pain, a solid enlargement of the ovary, and/or are over 40, your doctor may suggest that doing more than "watch and wait." The following may be used to treat this condition:
- Birth control pills
If your doctor suspects that your cyst is related to hormone fluctuation, he or she may prescribe birth control pills to treat it. Hormone therapy shrinks the cyst by altering your hormone levels; it also prevents the growth of new cysts.
- Aspiration or removal
If your cyst is unusually large, your doctor may choose to aspirate (suction out the fluid) it or remove it entirely. If your doctor removes the cyst, he or she will then biopsy it via fine needle aspiration (FNA) to check for cancerous cells. Either procedure is likely preformed using laparoscopy.
- Transvaginal Ultrasound-Guided Ovarian Cyst Aspiration
This procedure, because it requires specialized equipment and significant expertise, is not widely practiced to treat benign ovarian cysts. Johns Hopkins physicians, however, have been using it for quite some time. Quick and painless, transvaginal ultrasound-guided ovarian cyst aspiration involves placing an ultrasound probe that’s attached to an automated and retractable needle puncture device into the patient's vagina (ultrasound enables the sonographer to detect density differences between tissue and fluid inside the pelvic area). Using sonographic images as a guide, the physician advances the needle into the ovary to drain fluid from a cyst. Both the physician and patient can watch the cyst collapse on a TV-video monitor. The procedure requires no painkiller or sedation, and takes only a few minutes.
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