MEDICINE: Ovarian Cysts

Dr. Martin

What are ovarian cysts?

Ovarian cysts are small, fluid-filled sacs in the ovaries and are very common in women of child-bearing age (about 7% of women will develop ovarian cysts). 


Normally, during the menstrual cycle, a follicle  (a cell-lined sac that encloses an egg) in each ovary grows in response to hormones produced in the pituitary gland. Only one follicle will ultimately burst, releasing its egg into a Fallopian tube towards the uterus where fertilization may occur. During ovulation, at mid-cycle, some women experience sudden sharp lower abdominal pain, known as “mittelschmerz”  (German for middle pain), on the side where ovulation occurs. This sharp pain, lasting usually a day or so, can be treated with warm compresses or even analgesics (ibuprofen, Tylenol) if bothersome enough.

Sometimes a follicle won’t burst and will continue to enlarge into a follicular cyst, a harmless, usually painless, cyst that will go away in a couple of cycles without treatment.

Another common cyst is the corpus luteum cyst. Normally, after ovulation, the follicle will shrink and produce progesterone; however, sometimes, this post-ovulation follicle, called the corpus luteum, continues to grow into a cyst up to 4 inches in diameter. It can bleed or even cause torsion of the ovary, all painful emergencies.

Smoking may increase the chance of developing cysts. There may be an association between hypothyroidism and development of ovarian cysts.

There are other, less common ovarian cysts. In older women, the chance of a cystic ovarian cancer increases.

The symptoms of ovarian cysts are:

•                Bloating or swelling in the abdomen

•                Pain during bowel movements

•                Pain in the pelvis shortly before or after beginning a menstrual period

•                Pain with intercourse or pelvic pain during movement

•                Pelvic pain -- constant, dull aching

•                Sudden and severe pelvic pain, often with nausea and vomiting, may be a sign of torsion or twisting of the ovary on its blood supply, or rupture of a cyst with internal bleeding

•                Change in menstrual cycles with longer intervals between cycles and heavier menstrual bleeding

If you have any of these symptoms, you should see your doctor. The diagnosis of an ovarian cyst is usually made by ultrasound. There’s usually no treatment necessary for follicular cysts, but if the cysts are recurrent or symptomatic, your doctor might prescribe birth control pills for a couple of cycles. These will suppress the development of the follicles and ensuing cysts. Rarely, a cyst (cystadenomas, dermoid cysts, cancerous cysts) will require more evaluation and treatment, even surgery.

The important thing is that you see your doctor if you have the symptoms listed earlier. Ovarian cysts are usually harmless and often resolve on their own. But, it's always good to be safe (not sorry).

The Doctor Behind the Medicine: 

Dr. Martin went to medical school at UCSF. He has now retired from his long and brilliant career as an anesthesiologist, now playing guitar and making bread on his spare time. Dr. Martin and three associates have started a delicious commercial wine, MC4. For those who are 21 and older, I advise you to check out MC4-- cheers!