February 26th 2020
Sex & Gynae
Why you’ve probably had an ovarian cyst without even knowing about it
February 6th 2019 / 0 comment
Many ovarian cysts come and go with no symptoms, but as Kate Beckinsale’s recent experience proves, they can also be very painful and result in serious health problems. It’s high time to demystify the cyst…
“Turns out a ruptured ovarian cyst really hurts and morphine makes me cry. So thankful to everyone who looked after me.”
Kate Beckinsale’s Instagram post from her hospital bed last week was met with over 337,000 likes and much sympathy from a group of women that she now dubs her “cysters”:
“So moved and touched by all the kind wishes I have received over the last few days and staggered by the similar and worse stories my #cysters have been sending me. I am feeling much better and I hope all the other girls going through it are too.”
For a medical issue that many of us might never realise we have (consultant gynaecologist Mr Narendra Pisal highlights that “most women have them at some stage of their life”), how can ovarian cysts become such a critical health problem and why do they form in the first place? We called on London Gynaecology’s Mr Pisal for ovarian cyst intel.
They’re very common
This is meant as a point of reassurance - Mr Pisal underlines that, while they’re common, the majority of cysts are “asymptomatic” and will clear up without the need for treatment or you even noticing that they’re there. Clearly you can’t see them with the naked eye, but “they’re fluid-filled lumps that are often seen within ovaries.” Not all cysts are made equal, however…
There are three types of ovarian cyst
Dr Pisal explains what distinguishes different types of ovarian cyst:
Functional ovarian cysts
“These cysts are also known as follicular cysts and are common in young women. The function of the ovaries is to produce eggs every month and it is not unusual for these eggs to be retained and then grow larger in size, resulting in a cyst. These types of cyst are often self-limiting, which means that it should have no long-term effects on your health, and they can be monitored. More often than not these cysts will resolve spontaneously without you needing any treatment.”
Benign ovarian cysts
“If your ovarian cysts do not resolve spontaneously, they could be benign, These cysts are not cancerous and tumour marker (CA125) levels are often normal. If the cysts are persistent or you’re experiencing unpleasant symptoms (more on those to come), surgery can be performed as a keyhole (laparoscopic) procedure to remove them.”
Malignant ovarian cysts
“These cysts are most often seen in older, post-menopausal women and the tumour marker (CA125) level may be raised in tests. Even though ovarian cancer may be suspected on tests, it is only confirmed after cyst removal and histological analysis. Treatment is often (but not always) by open surgery. In some cases of advanced ovarian cancer, further treatment may be required after surgery in the form of chemotherapy.”
Just to stress the point, the vast majority of cysts form during your menstrual cycle and are both harmless and symptom-free. Malignant cysts are rare, but if you’ve been through the menopause or have a family history of ovarian cancer (or have tested positive for the BRCA 1 and 2 genes) you’ll be closely monitored by way of regular blood tests and ultrasound scans as your risk of developing a malignant cyst will be greater.
Ovarian cyst symptoms to look out for
Cysts can become highly problematic if they rupture, as in Kate Beckinsale’s case, block the blood supply to the ovaries or become very large. It’s important to go to your GP as soon you notice any symptoms as complications of ovarian cysts can be serious, not to mention the fact that they can grow quite alarmingly (Mr Pisal reports that the largest that he has removed was 55cm in diameter and weighed a whopping 19kg). Here’s when to see a doc:
“Some kinds of ovarian cyst produce hormones that can cause irregular bleeding, especially heavy or light periods or even excessive hair growth, so if you’ve noticed a disruption to your usual cycle, get it checked.
“Some ovarian cysts may also result in symptoms such as abdominal pain, abdominal swelling, lumps and occasionally sharp pain, which should never be ignored. Sharp pain that comes on acutely can be a sign of complications such as bleeding, rupture or torsion. Ovarian torsion occurs when the cyst twists around its axis and cuts of its blood supply. Urgent surgery is needed in this situation to save the ovary from becoming necrotic, whereby cells die due to a lack of blood and oxygen. In extreme circumstances the ovary affected may need to be removed.
“Other symptoms of ovarian cysts can include pain during sex, bloating, indigestion, acid reflux, feeling unusually full or altered bowel habits. See your GP urgently if you’re over 50 in particular, especially if you’ve noticed the onset of pelvic pain. These symptoms can seem very similar to those of IBS, but can be signs of ovarian cancer, so see a doctor even if your symptoms seem vague or unrelated to be on the safe side.”
How ovarian cysts are diagnosed
As above, the symptoms of ovarian cysts can mimic other conditions, so a vaginal or abdominal ultrasound scan will be carried out to make an accurate diagnosis. If there are any concerns from here, Mr Pisal explains that an MRI scan may be advised to find out more information and determine the nature of your ovarian cysts. Blood tests (known as tumour marker tests) may be performed, but don’t panic if your tumour markers are raised, as Mr Pisal advises that “while this is often raised in cancerous cysts it may also be raised in other benign conditions such as endometriosis, fibroids, infection, during monthly periods and after surgery.”
Why your cysts might not need to be removed
Mr Pisal affirms that the greater majority of functional ovarian cysts won’t require removal and will clear up by themselves. If you’re experiencing symptoms or ovarian cysts grow too large, surgery may be on the cards, but usually only to remove the offending cysts on the ovaries - removing the ovaries themselves is a rare measure only required if the cyst is suspected to be cancerous or extremely large. And if your cysts do need to be removed:
“Most ovarian cysts can be removed by keyhole surgery. To do this, three or four small (5-10mm) incisions are made in the tummy wall. A camera and special surgical instruments are then inserted to remove the cyst and healthy ovarian tissue is conserved. The cyst is then put in a plastic bag, decompressed and removed without spilling anything inside the tummy. Keyhole surgery avoids the need for a big incision and has the advantage of reduced hospital stay and quick recovery - you’ll feel well enough to return to your normal life pretty soon afterwards.”
How ovarian cysts can affect fertility
One to be aware of if you notice symptoms or suffer from endometriosis especially:
“A large ovarian cyst can stop that ovary from functioning properly. Some ovarian cysts are caused by endometriosis which can be associated with a reduced chance of getting pregnant. Most of the time, however, an ovarian cyst will not interfere with chances of ovulation and fertility.”
Which is a relief given that most women get them.
They can be be more likely to crop up if you’re pregnant
But they’re usually a good thing according to Mr Pisal:
“The ovarian cysts that occur during pregnancy are called ‘corpus luteal cysts’ and produce the progesterone hormone to support the pregnancy.”
Ovarian cysts can have teeth
I kid you not:
“A type of ovarian cyst called a dermoid cyst can contain different tissues such as hair, fat, teeth, cartilage, bone or even thyroid tissue.”
You’ll likely never know about it, but you’ll probably have that image in your head for the whole day. You’re welcome.
Can I prevent ovarian cysts?
Given that last nugget of information you’ll be even more keen to give ovarian cysts the heave-ho, and while Mr Pisal admits that “we don’t know exactly why some women appear to have a tendency to develop recurrent functional cysts especially”, he notes that “going on the contraceptive pill can help in some cases by preventing the development of an ovarian follicle and therefore cysts.”
Otherwise, don’t stress unless you’ve noticed symptoms.