Whether you have had or have an ovarian cyst, or maybe you are worried about a loved one who has been faced with the diagnosis of having an ovarian cyst this is an important question to answer. Having them be a very common occurrence between women in a fertile age it is crucial to know what an ovarian cyst is, what types of ovarian cysts are there, how they are diagnosed, how they affect you and can they cause infertility, and how they are treated.
What is an ovarian cyst?
What is an ovarian cyst?
An ovarian cyst is a sac filled with fluid within the ovary.But how does this cyst form? Well, it depends on the type of cyst. Usually ovarian cysts are divided into two categories:
- Functional
- Pathological
Functional cysts are formed during the menstrual cycle. What happens is the egg is formed in the ovary in a structure called a follicle. This follicle contains fluid that has the role of protecting the egg. Once the follicle bursts, the egg is released and the fluid gets discharged. But sometimes the follicle won’t release an egg or the fluid will stay trapped inside, and when this happens the follicle will swell and become a cyst.
Pathological cysts are more complex and are not part of the menstrual cycle. These cysts get formed from the cells that create the egg or the cells from the outside layer of the ovary. Some pathological cysts are: endometriomas, dermoid cysts, cystadenoma, and ovarian cancer.
What are the risk factors for developing an ovarian cyst?
Any woman can develop an ovarian cyst. But there are some risk factors that you can look out for:
- Medical history. If you have had an ovarian cyst before there is a bigger chance you might get one again.
- Some medical conditions like PCOS or endometriosis can increase your chances of getting a cyst.
- Your age. Ovarian cysts are more common in women of reproductive age.
- Pregnancy. If you are pregnant the likelihood of you developing an ovarian cyst increases.
- Medications for fertility. If you are taking medications to help you ovulate you are more likely to develop a cyst.
- Severe pelvic infection or severe pelvic inflammatory disease is also a risk factor.
How do you diagnose an ovarian cyst?
How do you diagnose an ovarian cyst?
Now that you know what ovarian cysts are and how they are formed we will talk about how you know whether you have one and how your doctor will diagnose it.
It is important to know that most ovarian cysts don’t give any symptoms, or even if they do they will give very subtle signs, a feeling that something is wrong, therefore you need to pay close attention to what your body is telling you. We can divide the symptoms into two categories:
The symptoms that are caused by a cyst that is not ruptured include: Pelvic pain that will come and go, and it can be dull or sharp. It is located in the area below your belly button leaning towards the left or the right side.[4] Bloating and having feelings of fullness. Pain during sex, painful periods, having an urgent need for peeing or pooping.
The symptoms that are caused by a cyst that has ruptured, include : sudden severe pain that is located in your abdomen or pelvis. This can be accompanied by nausea and vomiting and in severe cases signs of shock like lightheadedness, weakness, rapid breathing. These symptoms can also present if there is bleeding and or torsion of the cyst. If you experience any of these symptoms seek immediate medical help.
As most ovarian cysts don’t give many symptoms they are usually discovered in a routine pelvic ultrasound performed by your gynecologist. Sometimes, if needed, a CT scan or MRI will be done. However, it is important to know that the ultrasound is the most reliable method for diagnosing an ovarian cyst alongside a clinical presentation and endocrine tests if needed.
If a cyst is discovered on ultrasound and it is smaller than 2 inches( 5cm), follow-up imaging is not needed. And if the cyst is between 2 inches (5cm) to 2.7 inches (7cm) then follow-up imaging is required on a yearly basis. For cysts bigger than 2.7 inches (7cm) MRI will be done or a surgical assessment is needed.
Can you get pregnant with an ovarian cyst?
This widely depends on the type of ovarian cyst that you have. Some of the pathological forms of cysts that form outside of the menstrual cycle and are mentioned above are linked with infertility. Those cysts are:
Endometriomas
These cysts are part of a painful condition called endometriosis. Here the cysts are made up from part of the uterus lining and they may cause problems like infertility.
Polycystic ovary syndrome (PCOS) cysts
This condition is associated with many small cysts in the ovaries alongside irregular periods and a higher level of certain hormones.
Can you get pregnant with an ovarian cyst?
Ovarian cancer cysts
They are complex, pathological cysts that can be filled with multiple sacs of fluid and solid tissue. The treatment of ovarian cancer can unfortunately lead to fertility problems and sometimes even infertility.
These types of ovarian cysts are not linked with infertility:
Functional cysts
The cysts that form within the menstrual cycle and are part of the normal creation of a follicle. They can be a follicular cyst or a corpus luteum cyst. These are the most common cysts and both are not linked with infertility.
Cystadenomas
These cysts form from the outer layer of the ovary and may become big in which case they will need to be surgically removed. But even then they don’t cause infertility.
Dermoid cysts
This type of ovarian cyst can contain tissue that can be skin, teeth, or hair. They are also not linked with infertility. There is a misconception that dermoid cysts are failed pregnancies because of their composition, but that is not the case.
So how to get pregnant with an ovarian cyst that causes problems with fertility?
Here we will cover the treatment options for women with endometriosis and PCOS cysts.
Endometriosis cysts can be treated with the “wait and see” approach, with medication , and or with surgery. If the cyst is small in diameter your doctor will wait for 6-8 weeks to see if it will shrink in size. If this is unsuccessful or the cyst is bigger you will be prescribed GnRH agonists that will put your body in temporary menopause( this is in case you are not trying to get pregnant). And if the medicine is not working, or the cyst is much bigger (more than 1.5 inches or 3.8 cm.) your doctor will talk with you about the possibility of surgery. If you are trying to get pregnant, the second approach is excluded and your doctor will do a thorough examination of the cysts and their location and size and will develop a tailored plan for achieving pregnancy through possibly surgery and assisted reproductive technology like in vitro fertilization (IVF). This usually helps with infertility.
In the PCOS cysts case it is important for the underlying problem to be addressed and that is the PCOS syndrome. One of the first approaches is the change of the lifestyle of someone with PCOS syndrome. Eating healthy and maintaining a healthy weight with including 8 hours of sleep will go a long way in the treatment. Other than that medicine can also be given. The most commonly prescribed medicine for ovulation problems in women with PCOS syndrome is clomiphene. Clomiphene is a tablet taken orally. If clomiphene is ineffective in causing ovulation then other medicines called gonadotropins may be recommended. Gonadotropins are given as an injection, but it is important to note that they can cause multiple pregnancies. In addition to this IVF can also be recommended and a surgical procedure to treat your ovaries can also be done. This surgical procedure is called Laparoscopic ovarian drilling(LOD). During this procedure your surgeon will make a small cut to get in your abdomen with a laparoscopic device in order to treat your ovaries with a laser or heat which will help destroy the testosterone-producing cells. This can help restore the normal function of your ovaries and help with infertility. Women with PCOS syndrome have higher chances of miscarriage.
What to do if you are already pregnant and your OBGYN finds a cyst on your ultrasound in the first trimester?
If this happens your OBGYN will do a thorough examination to see whether anything more is needed than a “wait and see” approach. The probability of this happening is 0,2% to 2% depending on the stage of the pregnancy. The previously mentioned diagnostic tools like the ultrasound and the MRI are both safe for pregnant women and they can make a difference between benign and malignant neoplasms. An ovarian cyst while pregnant can cause abdominal pain and discomfort but in most cases it does not affect the baby. Depending on how the ovarian cyst will influence an ongoing pregnancy, if needed both laparoscopy and surgery can be done, depending on the size of the cyst, gestational age, and surgical expertise. If you have an ovarian cyst during pregnancy do not worry as most of them go away on their own in a few months.
Can an ovarian cyst cause miscarriage?
It depends on the type of ovarian cyst that has formed. Even though most cysts can cause discomfort or abdominal pain, due to their size, they are not directly linked to miscarriage.
Dr Gordana Miteva is a medical doctor with experience as a primary care physician. Throughout her career she witnessed her patients’ desire to have a clear understanding and accessible information about their health conditions. To bridge this gap, she developed a friendly, simple, yet informative approach to communicate conditions and treatment options. Dr Miteva’s experience as a teacher to medical nurses and physical therapists further refined her ability to make complex medical content educational, engaging, and easy to understand. Now, combining her medical expertise and teaching skills, she empowers women facing fertility challenges through her work as a medical writer.