Ovarian Cysts

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Ovarian cysts are fluid-filled sacs that form on or inside the ovaries. While the word “cyst” can sound alarming, the majority of ovarian cysts are benign (non-cancerous) and often go away on their own without causing symptoms. However, in some cases, they may cause discomfort, affect fertility, or signal an underlying medical condition that requires attention.

What Are Symptoms of Ovarian Cysts?

Many ovarian cysts are small and harmless, causing no noticeable symptoms. However, when symptoms do occur, they may include:

• Pelvic pain or a dull ache, often on one side
• A feeling of fullness or bloating in the abdomen
• Pain during intercourse
• Painful menstruation (dysmenorrhoea)
• Irregular menstrual cycles
• Frequent or urgent need to urinate
• Difficulty emptying the bladder completely
• Unexplained weight gain or abdominal swelling
• Nausea or vomiting (in the case of cyst rupture or torsion)

If you experience sudden, severe pelvic pain, especially with fever, vomiting, or fainting, you should seek immediate medical attention. These could be signs of a ruptured cyst or ovarian torsion, both of which are medical emergencies.

What Are the Types of Ovarian Cysts?

Ovarian cysts come in various types, each with different characteristics and implications:

1. Functional Cysts

These are the most common type and form as part of the normal menstrual cycle. They are usually harmless and resolve on their own within a few weeks or months.

• Follicular cysts form when the ovary doesn’t release an egg.
• Corpus luteum cysts occur when the follicle sac doesn’t dissolve after releasing an egg.

2. Dermoid Cysts

These cysts can contain tissue such as hair, fat, or bone. They are typically benign but may grow large and require removal.

3. Endometriomas

These develop due to endometriosis and are filled with old blood, often referred to as “chocolate cysts.” They can cause pain and may affect fertility.

4. Cystadenomas

These cysts form from cells on the outer surface of the ovary and may contain watery or mucous material. Some can grow quite large.

5. Polycystic Ovaries

In women with Polycystic Ovary Syndrome (PCOS), multiple small cysts may form due to disrupted ovulation. PCOS is a hormonal disorder that requires specific management.

6. Malignant (Cancerous) Cysts

Although rare, some cysts can be cancerous, especially in postmenopausal women. Regular screening and prompt investigation of suspicious cysts are essential.

What Are Some Risk Factors of Ovarian Cysts?

Ovarian cysts can occur for many reasons, and certain factors may increase your risk:

• Hormonal imbalances
• Pregnancy (some cysts form during early pregnancy and resolve naturally)
• Endometriosis
• History of ovarian cysts
• Polycystic Ovary Syndrome (PCOS)
• Pelvic infections that spread to the ovaries
• Family history of ovarian or breast cancer

Understanding the cause is key to appropriate treatment and prevention of recurrence.

How Are Ovarian Cysts Diagnosed?

To diagnose an ovarian cyst, the doctor will take a comprehensive medical history and perform a physical examination. Diagnostic tools may include:

• Pelvic Ultrasound: This is the most common and effective way to visualise cysts, determine their size, and evaluate their features (solid vs. fluid-filled).

• Blood Tests: This includes tumour markers that can help assess the risk of ovarian cancer, especially in postmenopausal women or those with suspicious cysts.

• Hormone Level Testing: To rule out hormonal imbalances or PCOS.

• MRI or CT Scans: In rare cases, advanced imaging may be used for further evaluation.

When to Seek Help

You should consult a gynaecologist if you experience:

• Ongoing or severe pelvic pain
• Menstrual irregularities
• Bloating or a feeling of heaviness in the abdomen
• Pain during intercourse
• Trouble conceiving
• A known cyst that is growing or causing discomfort

Prompt evaluation and treatment can prevent complications and provide peace of mind.

How Are Ovarian Cysts Treated?

Treatment depends on the type, size, and appearance of the cyst, as well as your age, symptoms, and whether you're planning to have children. Options may include:

1. Watchful Waiting

In many cases, especially for small, functional cysts, no immediate treatment is necessary. Regular follow-up scans may be recommended to monitor the cyst over time.

2. Medications

• Hormonal birth control pills may prevent new cysts from forming by regulating ovulation.
• Pain relief medications (e.g., NSAIDs) can be used for symptom control.

3. Surgical Removal

If the cyst is large, persistent, painful, or suspicious for malignancy, surgical removal may be recommended. Minimally invasive laparoscopic surgery is often used for:

• Dermoid cysts
• Endometriomas
• Complex or symptomatic cysts
• Cysts that are growing or do not resolve with time

In some cases, only the cyst is removed ( cystectomy ), while in others, the affected ovary may need to be removed ( oophorectomy ) — especially if cancer is suspected or confirmed.

Dr. Wei-Wei is highly experienced in laparoscopic (keyhole) surgery , which offers a faster recovery, less post-operative pain, and smaller scars compared to traditional open surgery.