Ovarian Cysts in Women are divided into two categories: benign and malignant. The types of ovarian cysts, cancer risks, and treatment options can vary depending on whether they occur during adolescence, reproductive age, or menopause.

Ovarian cysts generally appear without symptoms. When symptoms occur, they may cause discomfort such as bloating or indigestion. Ovarian cysts that naturally appear during ovulation or the menstrual cycle, which generally regress and are benign, are called ‘functional cysts’. Follicular cysts, which occur due to the failure of ovulation, leading to fluid accumulation inside, can range in size from 3 to 10 cm and may appear in multiples. These cysts fall under the same category. If the ultrasound images are clear, consisting of fluid contents, and without cauliflower-like protrusions, it indicates a benign functional cyst. In such cases, instead of opting for surgery, doctors may prefer monitoring in subsequent menstrual cycles, and medications may be prescribed.

The primary diagnostic tool is physical examination. During this examination, the abdomen is palpated by a specialist to detect any areas of pain. Following this, the most important imaging tool is ultrasound. In ultrasound, the size, appearance, and structure of the cysts are evaluated by the specialist. In necessary cases, blood tests called tumor markers may be performed or an MRI may be used for further assessment. However, an MRI is not requested for every cyst, and it is only ordered when the doctor deems it necessary or when further evaluation is needed.

What Are Ovarian Cysts?

The frequency of ovarian cysts can vary according to age groups. Different types of cysts can be encountered during adolescence, reproductive age, or menopause. Ovarian cysts seen in these age groups are as follows:

Follicular Cyst: This cyst occurs when the egg does not rupture as it should, and the egg continues to grow. Common in younger women, follicular cysts are typically 2-4 cm in size and usually disappear after the menstrual period.

Corpus Luteum Cyst: This cyst originates from the structure where the egg matures and is released. It forms from cells that can secrete progesterone. Normally, after the egg is released during the menstrual cycle, the corpus luteum breaks down. If it does not, fluid accumulates, forming corpus luteum cysts that can reach sizes of 3-5 cm. Since these cysts produce hormones, they may cause menstrual irregularities.

Chocolate Cysts (Endometriomas): Commonly referred to as "chocolate cysts" due to their appearance resembling melted chocolate, these cysts are the ovarian form of endometriosis. Chocolate cysts are common, affecting about 1 in 10 women of reproductive age. When it comes to surgery, a more selective approach is taken, as most patients may want to conceive. Therefore, immediate surgery is not always recommended for chocolate cysts. However, if the cyst is large (9-10 cm) or causes significant pain, surgery might be required. If the cyst is smaller (e.g., 5 cm), without irregularities on ultrasound and with a homogeneous appearance, it may just be monitored. These cysts can recur even after successful surgery, and sometimes surgery can impact ovarian reserve. Therefore, when possible, the cyst may be monitored through ultrasound, especially if the patient desires or plans for pregnancy, and surgery may be avoided.

Dermoid Cysts: These cysts typically form during embryonic development, due to the abnormal growth of tissue inside the ovary. Dermoid cysts contain tissues that should not normally be present, such as hair, teeth, bone, and cartilage.

Serous Cystadenomas: These are benign cysts that are filled with clear fluid and can grow to a size of 5-15 cm. While they are typically benign (non-cancerous), there is a 30% chance they can turn malignant over time.

Mucinous Cystadenomas: These are the largest cysts that can develop in the ovaries, and their size can grow up to 30 cm.

Ovarian cysts typically manifest with symptoms such as lower abdominal pain, pain radiating to the leg or hip, pressure and fullness in the lower abdomen, menstrual pain, menstrual delay, inability to menstruate, pain during intercourse, bloating, palpable mass in the abdomen, abdominal pain, frequent urination due to pressure on the bladder, constipation, painful bowel movements, loss of appetite, nausea, vomiting, breast tenderness, and pain, as well as torsion (the cyst twisting on itself).

However, having these symptoms does not necessarily mean you have an ovarian cyst. If you are experiencing any of these symptoms, it is essential to consult a specialist for early diagnosis and intervention. The treatment for ovarian cysts may vary depending on the type of cyst. Simple cysts are generally monitored by a specialist, and birth control pills may be prescribed to shrink or dissolve these cysts.

For inflammatory cysts, antibiotics may be recommended to alleviate pain and inflammation. Cysts that exceed 8 to 10 cm or those that continue to grow, or those with a high risk of malignancy as seen in ultrasound and blood tests, may require surgical removal based on the doctor's evaluation.

How Do Ovarian Cysts Form?

The most common cause of ovarian cysts is hormonal imbalance. Normally, during each menstrual cycle, cysts called follicles form within the ovaries. These follicles, which can grow up to 3 cm, contain the egg. When a follicle matures, it ruptures and releases the egg. If the egg is fertilized by sperm, pregnancy occurs. If the egg is not fertilized, it is expelled from the body as menstrual blood. However, if there is a hormonal imbalance, the follicle does not rupture and continues to grow, forming a follicular cyst.

Each month, the egg cell inside the follicle grows inside a fluid-filled sac called the follicle. The follicle typically grows to a diameter of 18-20 mm, and upon the increase of hormones, it ruptures at the weakest point and releases the egg around the 14th day of the menstrual cycle.

As mentioned earlier, in some cases, the follicle does not rupture and continues to grow, resulting in the formation of a cyst. This cyst is surrounded by a special cyst wall that separates it from the surrounding tissues and contains fluid inside.

Most of these cysts disappear with the regular menstrual cycle. Some do not disappear and remain in the body, causing menstrual and bleeding irregularities. Others do not cause any structural problems and may remain asymptomatic for a long time. Just like any other health issue, ovarian cysts can have noticeable or unnoticed effects. For proper diagnosis and intervention, it is important to consult a specialist.

For more detailed questions or support regarding ovarian cysts, please feel free to contact our clinic.