Ovarian Cysts (Polycystic Ovaries; Stein-Leventhal Syndrome)
Ovarian cysts are benign growths that form on the ovaries, the two small, almond-shaped organs located on either side of the uterus. There are many different types, but the most common are functional cysts, which develop in the following way:
During the first half of a woman's menstrual cycle, the ovaries increase estrogen secretion, which in turn signals the pituitary gland to release FSH and LH hormones that stimulate the ovaries to ripen one or more eggs. The eggs mature in tiny sacs called follicles, which grow to a size of 1/2 to 1 inch in diameter. During ovulation, the mature egg bursts from its follicle, which is then replaced by the corpus luleum, a structure that secretes the hormone progesterone. Sometimes the egg is not released from the follicle, which then thickens to form a cyst that continues to pump out estrogen.
A cyst may grow as large as an orange, possibly rupture, and cause severe hemorrhaging and pain. More often, the woman experiences abdominal pain and irregular or abnormally heavy menstruation for a few cycles, but the cyst disappears in time, and normal periods resume.
In the case of polycystic ovaries, multiple cysts have developed, causing the ovaries to enlarge. This condition is associated with failure to ovulate and women who have polycystic ovaries typically experience menstrual abnormalities and infertility.
Women with endometriosis may develop ovarian chocolate cysts, or endometnomas, which form when tissue similar to the lining of the uterus attaches to the ovaries.
Diagnostic Studies and Procedures
Most ovarian cysts are found when a doctor palpates the ovaries during a pelvic examination. Blood tests may be ordered to measure hormone levels. Ultrasound can determine whether the growth is solid or filled with fluid. For some cases, laparoscopy may be ordered, especially if the cyst appears to be solid. In this procedure, a viewing tube is inserted into the pelvic cavity through a small incision near the navel. The examination is usually done under general anesthesia in a hospital setting.
Medical Treatments
Treatment depends on symptoms, the size and type of cyst, and the woman's age and overall health. A young women with a small functional cyst and no symptoms will probably be told to wait for two or three menstrual cycles to see whether the cyst disappears on its own.
Hormones may be prescribed to stimulate ovulation, especially if the woman wants to conceive. If these do not work, surgery may be performed to remove the cystic portion of the ovary. Surgery may also be advised if the cyst is large or has ruptured, if there is severe pain or bleeding, or if the cyst becomes twisted, cutting off circulation.
It is possible sometimes to remove the cyst while leaving the ovary intact, but in other cases, one or both ovaries may have to be removed completely.
Alternative Therapies
Alternative therapies are not effective in treating ovarian cysts, although acupuncture may alleviate pain.
Self-Treatment
Self-care cannot eliminate an ovarian cyst. If you develop menstrual irregularity or are having trouble conceiving, a home ovulation test can determine if you are ovulating normally. Should symptoms persist for more than three menstrual cycles, see your doctor.
Other Causes of Pelvic Pain
Endometriosis, menstrual cramps, tubal pregnancy, and pelvic inflammatory disease can cause symptoms similar to those of ovarian cysts. Ovarian cancer should be ruled out, especially if the cyst is solid. An adrenal tumor or hormonal disorder should also be investigated as a possible cause of menstrual abnormalities or other symptoms linked to ovarian cysts, particularly if masculinization develops.