Definition
Ovarian cysts are fluid-filled sacs that form inside or on the surface of the ovaries, which are the female reproductive organs that lie in the lower abdomen. Ovarian cysts appear and disappear regularly as part of the normal menstrual cycle. The cysts can, however, become a medical problem if they remain in the ovaries, enlarge, and cause pain or other symptoms.
Description
Ovarian cysts develop as a normal part of a healthy menstrual cycle; mature ovaries very often have cysts in them. The cysts that appear during the regular activity of the ovaries are called functional cysts. There are two types of functional cysts, known as follicular cysts and luteal cysts respectively.
In the ovaries, immature eggs are stored in the follicles, which are tiny tube-like membranes. When menstruation begins in the early teens, women have nearly 400,000 follicles that store and produce eggs in the ovaries. During each menstrual cycle, an egg matures inside one of the follicles, and the follicle sac fills up with a liquid (liquor folliculi) that nourishes the growing egg. This swollen follicle is a follicular cyst. When the egg is released into the fallopian tube during ovulation, the follicle opens or ruptures and the fluid drains away. Sometimes there is pain associated with ovulation, known as Mittelschmerz, which is a German word that means middle pain. Mittelschmerz may last from a few minutes to several days. A small amount of bleeding may also accompany the normal release of an egg from the follicle.
After ovulation, another functional cyst forms on the ovary where the egg was released. This cyst is called the corpus luteum, or luteal cyst. The luteal cyst has the function of secreting progesterone, an important female hormone that regulates the reproductive cycle. If no pregnancy occurs, the luteal cyst should disappear with the continuation of the menstrual cycle.
Abnormalities in the menstrual cycle may cause cysts to remain and grow irregularly. Sometimes the follicles stay filled with liquid after the egg is released, or the egg does not get released in the proper way and the follicle continues to grow. These follicular cysts can reach 2 in (5 cm) or more in diameter, and may cause pain and pressure. They may rupture completely. Luteal cysts can also become abnormal. These cysts can grow quite large, to 3 in (8 cm) or more in diameter, and can cause sharp pain in the abdomen. Luteal cysts are often misdiagnosed as ectopic (tubal) pregnancies, particularly when they break open and cause bleeding and severe pain. Sometimes a cyst can bleed; it is then known as a corpus hemorrhagicum, meaning a body that bleeds. Bleeding often occurs when the cyst naturally breaks and begins to go away. When bleeding lasts for longer than several days and a large cyst remains, surgical intervention is sometimes called for. Surgery on the ovaries is usually performed through an instrument called a laparoscope. A laparoscope is a small device with a tiny camera.
Other types of cysts and growths may occur on the ovaries as well. Neoplastic (new growth) cysts may appear, which are benign (noncancerous) growths. These cysts occur when cells of the ovaries not related to ovulation begin to grow abnormally. Dermoid tumors are a type of benign growth that may occur on the ovaries and resemble cysts. Abnormal cysts may contain fluid or blood, and may be inside the ovary or next to it under the surface. Other cysts can be solid or contain cellular debris. All abnormal cysts require close watch by a doctor.
There is also a condition known as polycystic ovary syndrome (PCOS), in which the eggs and follicles are not released from the ovaries and instead form multiple cysts. Obesity is linked to this condition, as 50% of women with PCOS are also obese. Hormonal imbalances play a major role in this condition, including high levels of the hormone androgen and low levels of progesterone, the female hormone necessary for egg release. High levels of insulin, the hormone that regulates blood sugar, are often found in women with PCOS. PCOS is also characterized by irregular menstrual periods, infertility, and hirsutism (excessive hair growth on the body and face). Although PCOS was formerly thought to be an adult-onset condition, more recent research indicates that it begins in childhood, possibly even during fetal development.
In adolescent girls, ovarian cysts may be associated with a genetic disorder known as McCune-Albright syndrome, which is characterized by abnormal bone growth, discoloration of the skin, and early onset of puberty. The ovarian cysts are responsible for the early sexual maturation.
Causes & Symptoms
The causes of nonfunctional ovarian cysts are not yet fully understood. Many factors are believed to play a role in the development of cysts, including a woman's general state of health, weight, diet, personal history, and lifestyle. The mind/body connection may also be a factor with cysts, as stress and anxiety may be prominent factors. Some alternative practitioners and psychotherapists believe that unexpressed creativity and repressed emotions like guilt and anger may be linked to problems in the ovaries. For PCOS, obesity, hormonal imbalances and high blood insulin levels are closely linked to the condition. For example, women with PCOS are five to ten times more likely to develop type 2 (adult-onset) diabetes than women in the general population.
PCOS is also known to run in families, which suggests that genetic factors contribute to its development. As of 2002, the specific gene or genes responsible for PCOS have not yet been identified; however, several groups of researchers in different countries have been investigating genetic variations associated with increased risk of type 2 diabetes in order to determine whether the same genetic variations may be involved in PCOS.
As of early 2003, McCune-Albright syndrome is known to be associated with mutations in the GNAS1 gene. The mutation is sporadic, which means that it occurs during the child's development in the womb and that the syndrome is not inherited.
Some cysts can be asymptomatic (without symptoms), while others can cause swelling, aching, sharp pain, and bleeding. Pain from cysts may last from a few minutes to a few days. Other symptoms of cysts include late or missed periods, feelings of pressure or weight in the lower abdomen, and constipation and problems urinating due to internal pressure from cysts. Ruptured cysts can cause intense pain, and produce symptoms resembling those of appendicitis, infection or ectopic pregnancy. Medical attention should be sought at once for the following symptoms:
- sudden sharp pain in the lower abdomen
- persistent pain on the right side of the abdomen accompanied by sickness, fever, or vomiting
- abdominal pain along with vaginal discharge, fever, or swelling
- Intermittant bursts of pain in the lower abdomen during intercourse, bowel movements, or exercise.
Diagnosis
The majority of ovarian cysts in adults are found during routine pelvic examinations performed by doctors or gynecologists (specialists in women's sexual organs and health issues). An ultrasound test can be given to identify the location, size and probable type of cyst. Cysts less than 1.6 in (4 cm) in diameter are considered normal in premenopausal women. Doctors examine cysts closely to make certain they are not fibroid tumors or cancer. The cysts may be watched for a few months to allow them to go away or shrink on their own. For abnormal, painful or bleeding cysts, a biopsy may be performed. A biopsy is a procedure in which a small amount of tissue is surgically removed and examined to determine the exact type of growth. In alternative treatment, practitioners will closely consider lifestyle, diet, and emotional and psychological profiles in order to identify all the factors that may be playing a role in the development of cysts.
Ovarian cysts can be diagnosed in female fetuses by transabdominal ultrasound during the mother's pregnancy.
Treatment
Alternative treatment strives to reduce the possible causes and symptoms of cysts. Consumers should search for practitioners who have experience treating women's problems in general and ovarian cysts in particular. Because cysts may have many possible causes, ranging from hormone imbalances to emotional stress, a holistic approach to healing should include measures to balance and improve physical, emotional, and mental health. Preventive and supportive measures include dietary and nutritional changes, herbal supplementation, hot/cold compresses, daily exercise, and stress management through mind/body techniques. Treatments for existing cysts include such traditional healing systems as traditional Chinese medicine, Ayurveda, homeopathy, and naturopathic medicine.
Diet and Nutrition
Dietary guidelines for treatment and prevention of cysts include:
- Eliminating caffeine and alcohol.
- Reducing intake of sugars, including honey and maple syrup, and refined starches such as white flour products.
- Increasing use of foods rich in vitamin A and carotenoids; good choices include carrots, tomatoes, and salad greens.
- Eating foods high in B vitamins such as whole grains.
- Including a dietary source of iodine such as seaweed for thyroid support.
Nutritional supplements include:
Herbal Therapies
Herbs that promote hormonal balance, steady blood sugar levels, and immune system strengthening are generally recommended. Herbs used to treat cysts include burdock, mullein, yarrow, vitex, dandelion, black cohosh, St. John's wort, red raspberry, nettles and Siberian ginseng. Chinese herbs include astragalus, ginger, dong quai, cinnamon, rehmannia root, and scrophularia root, although the specific formula that is given is tailored to the symptoms of the specific patient. A competent herbalist or naturopathic doctor should be consulted for herbal treatment of ovarian cysts.
Compresses
Compresses can be used to stimulate circulation and healing in the ovaries. A hot water bottle covered with a towel soaked in castor and essential oils can be applied to the lower abdomen near the ovaries. Lavender, rosemary, and chamomile are recommended essential oils. A hot compress can also be made by heating in a warm oven a cloth soaked in castor and essential oils, which is then applied to the lower abdomen. Bags of ice covered with towels can be used alternately as cold treatments to increase local circulation.
Exercise and Bodywork
Daily exercise for twenty minutes or more is recommended. Exercising outdoors in plenty of sunlight may help regulate hormones. Yoga includes exercises specifically designed to increase circulation and healing in the lower abdomen, and is an excellent stress-reduction technique as well.
Mind/Body Therapies
Mind/body therapies seek to heal the emotional and psychological components that may be contributing to cyst formation. Stress reduction can be achieved through yoga, meditation, t'ai chi, breathing techniques, progressive relaxation, and others. Visualization techniques, yoga, and qigong may help stimulate healing in the internal organs. Some practitioners have theorized that problems in the ovaries may be linked to certain emotional states. For instance, the ovaries are the organs that create life, and blocked creativity in women may contribute to their dysfunction. Furthermore, the ovaries are the specific female organs, and some healers have proposed that women who suffer abuse, low self-esteem, guilt and anger may be susceptible to ovarian problems. Psychotherapy, support groups, and other mind/body therapies seek to help women uncover and confront emotional issues.
Other Systems
Traditional Chinese medicine utilizes acupuncture, acupressure, dietary and herbal remedies for ovarian cysts. Ayurvedic medicine uses herbal remedies, diet, exercise, yoga, massage, and detoxification. Homeopathic practitioners prescribe the remedies Apis for cysts on the right ovary and Colocynthis for cysts on the left ovary, as well as other remedies for hormone and immune system balance. Naturopathy tends to view ovarian cysts as associated with blood sugar problems, and uses herbal, dietary and other natural remedies to balance hormone and insulin levels.
Allopathic Treatment
The treatment of ovarian cysts may vary according to the type of cyst and the patient's symptoms. Some cysts can be drained of fluid with the use of a fine needle, although this treatment has been shown to be no more effective in eliminating cysts than leaving them alone. Many cysts, particularly small ones, can be watched closely for several months to determine if they will go away on their own. Ultrasound is used to view cysts. A laparoscopy is a surgical procedure that may be used to correct bleeding cysts and other cyst conditions without removing the ovary, and allows doctors to view the ovaries. Doctors advise surgical removal for cysts that are larger than 4 in (10 cm) and for complex cysts. Complex cysts are solid or have additional growths inside them.
Most uncomplicated ovarian cysts in female infants resolve on their own shortly after delivery. Complicated cysts are treated by laparoscopy or laparotomy after the baby is born.
McCune-Albright syndrome is treated with testolac-tone (Teslac), an anti-estrogen drug that corrects the hormonal imbalance caused by the ovarian cysts.
Long-term management of PCOS has been complicated in the past by lack of a clear understanding of the causes of the disorder. Most commonly, hormonal therapy has been recommended, including estrogen and progesterone and such other hormone-regulating drugs as ganirelix (Antagon). Birth control pills have also been prescribed by doctors to regulate the menstrual cycle and to shrink functional cysts. In severe and painful cases, the ovaries have been removed by surgery.
More recent studies have shown that increasing sensitivity to insulin in women with PCOS leads to improvement in both the hormonal and metabolic symptoms of the disorder. As of 2002, this sensitivity is increased by either weight loss and exercise programs or by medications. Metformin (Glucophage), a drug originally developed to treat type 2 diabetes, has been shown to be effective in reducing the symptoms of hyperandrogenism as well as insulin resistance in women with PCOS.
Another strategy that is being tried with PCOS is administration of flutamide (Eulexin), a drug normally used to treat prostate cancer in men. Preliminary results indicate that the antiandrogenic effects of flutamide benefit patients with PCOS by increasing blood flow to the uterus and ovaries.
A surgical procedure known as ovarian wedge resection appears to improve fertility in women with PCOS who have not responded to drug treatments. In an ovarian wedge resection, the surgeon removes a portion of the polycystic ovary in order to induce ovulation.
Expected Results
Neither type of functional ovarian cyst, follicular or luteal, has been shown to progress to cancer. When cysts do not go away on their own, they often can be removed without harming the ovaries. Some women have opted to live with large cysts instead of surgery without negative consequences. The chances for cysts recurring can vary. Some women never have cysts, others get them once or occasionally, while others see them appear and disappear almost constantly. Likewise, ovarian cysts can be painful and bothersome for some women, while other women experience no symptoms.
Resources
Books
Blum, Jeanne. Woman Heal Thyself: An Ancient Healing System for Contemporary Women. New York: Tuttle, 1995.
Hobbs, Christopher, and Kathi Keville. Women's Herbs, Women's Health. Loveland, CO: Interweave Press, 1998.
Morgan, Peggy, and the Editors of Prevention Magazine. The Female Body: An Owner's Manual. Emmaus, PA: Rodale, 1996.
Northrup, Christiane, M.D. Women's Bodies, Women's Wisdom. New York: Bantam, 1994.
"Pelvic Pain." Section 18, Chapter 237 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
"Physical Conditions in Adolescence." Section 19, Chapter 275 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. White-house Station, NJ: Merck Research Laboratories, 1999.
"Pregnancy Complicated by Disease: Disorders Requiring Surgery." Section 18, Chapter 251 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
Periodicals
Ajossa, S., S. Guerriero, A. M. Paoletti, et al. "The Antiandrogenic Effect of Flutamide Improves Uterine Perfusion in Women with Polycystic Ovary Syndrome." Fertility and Sterility 77 (June 2002): 1136–1140.
de Sanctis, C., R. Lala, P. Matarazzo, et al. "Pubertal Development in Patients with McCune-Albright Syndrome or Pseudohypoparathyroidism." Journal of Pediatric Endocrinology and Metabolism 16 (March 2003) (Suppl. 2): 293–296.
Ehrmann, D. A., P. E. Schwarz, M. Hara, et al. "Relationship of Calpain-10 Genotype to Phenotypic Features of Polycystic Ovary Syndrome." Journal of Clinical Endocrinology and Metabolism 87 (April 2002): 1669–1673.
Elkind-Hirsch, K. E., B. W. Webster, C. P. Brown, and M. W. Vernon. "Concurrent Ganirelix and Follitropin Beta Therapy is an Effective and Safe Regimen for Ovulation Induction in Women with Polycystic Ovary Syndrome." Fertility and Sterility 79 (March 2003): 603–607.
Franks, S. "Adult Polycystic Ovary Syndrome Begins in Childhood." Best Practice and Research: Clinical Endocrinology and Metabolism 16 (June 2002): 263–272.
Kazerooni, T., and M. Dehghan-Kooshkghazi. "Effects of Metformin Therapy on Hyperandrogenism in Women with Polycystic Ovarian Syndrome." Gynecological Endocrinology 17 (February 2003): 51–56.
Legro, R. S. "Polycystic Ovary Syndrome. Long-Term Sequelae and Management." Minerva ginecologica 54 (April 2002): 97–114.
Marx, T. L., and A. E. Mehta. "Polycystic Ovary Syndrome: Pathogenesis and Treatment Over the Short and Long Term." Cleveland Clinic Journal of Medicine 70 (January 2003): 31–33, 36–41, 45.
Mittermayer, C., W. Blaicher, D. Grassauer, et al. "Fetal Ovarian Cysts: Development and Neonatal Outcome." Ultraschall in der Medizin 24 (February 2003): 21–26.
Ovalle, F., and R. Azziz. "Insulin Resistance, Polycystic Ovary Syndrome, and Type 2 Diabetes Mellitus." Fertility and Sterility 77 (June 2002): 1095–1105.
Vankova, M., J. Vrbikova, M. Hill, et al. "Association of Insulin Gene VNTR Polymorphism with Polycystic Ovary Syndrome." Annual of the New York Academy of Sciences 967 (June 2002): 558–565.
Yildirim, M., V. Noyan, M. Bulent Tiras, et al. "Ovarian Wedge Resection by Minilaparatomy in Infertile Patients with Polycystic Ovarian Syndrome: A New Technique." European Journal of Obstetrics, Gynecology, and Reproductive Biology 107 (March 26, 2003): 85–87.
Organizations
American College of Obstetricians and Gynecologists (ACOG). 409 12th Street, SW, P. O. Box 96920, Washington, DC 20090-6920. .
The Health Resource. 209 Katherine Drive. Conway, AR 72032. (501) 329-5272.
Herb Research Foundation. 1007 Pearl Street, Suite 200. Boulder, CO 80302.
Polycystic Ovarian Syndrome Association. P. O. Box 80517, Portland, OR 97280. (877) 775-PCOS. .
[Article by: Douglas Dupler; Rebecca J. Frey, PhD]
