Ovarian cysts are structures that are quite common in women and occur as fluid-filled sacs in the ovaries. These cysts are usually benign, but in some cases they can cause serious health problems. Ovarian cysts are more common in women of childbearing age and often disappear on their own without causing any symptoms. Cysts are divided into two main categories, functional and pathological (neoplastic), according to their causes and contents.
Functional cysts are cysts that form during the normal menstrual cycle and usually disappear spontaneously. These include follicle cysts, which occur when the follicle in which the egg cell grows does not burst, corpus luteum cysts, which occur when the remaining follicle fills with fluid after the egg is released, and theca lutein cysts, which can be seen during pregnancy or mole hydatidiform. Pathological (neoplastic) cysts are not related to the normal menstrual cycle and can be more serious. This group includes dermoid cysts (teratomas), which are complex structures that can contain tissues such as hair, teeth, and bone, endometriomas (chocolate cysts) that occur as a result of endometriosis, serous cystadenomas containing clear fluid, mucinous cystadenomas containing thick, sticky fluid, and cystadenocarcinomas, which are very rare cancerous cyst etc.
Ovarian cysts are often asymptomatic and are detected incidentally. However, large cysts or complicated conditions may cause symptoms such as pelvic pain, menstrual irregularities, a feeling of bloating in the abdomen, discomfort during sexual activity, frequent urination, constipation, and, especially in the case of cyst torsion, nausea and vomiting. These symptoms vary depending on the size, location, and complications of the cyst.
The most important method for diagnosing ovarian cysts is regular gynecological examination. Large cysts can be detected during manual examination and palpable masses and tenderness in the ovaries are evaluated. Ultrasonography, especially transvaginal ultrasonography, is the most commonly used diagnostic method. With this method, the size, content, wall thickness and blood supply of the cysts are evaluated and this information helps to understand whether the cyst is benign or malignant. Magnetic resonance (MR) imaging can be used in complex cysts or in cases where a clear diagnosis or origin cannot be made with ultrasonography. MRI is especially valuable in the diagnosis of dermoid cysts and endometrioma. Tumor markers such as CA-125, AFP, hCG are evaluated especially in cases where cancer is suspected, but these tests alone are not diagnostic.
Treatment of ovarian cysts is planned according to the type of cyst, its size, the patient's age and desire to have children. Small, functional cysts usually disappear spontaneously within 2-3 months and in this case only regular follow-up is sufficient. This "wait and watch" approach is preferred especially in reproductive ages. Hormonal therapy can be used in some cysts. Birth control pills can prevent new cyst formation, progestin therapy is used in the treatment of endometrioma and short term GnRH analogues may be preferred in cases of severe endometriosis.
Surgical treatment may be necessary if the cyst is larger and does not shrink after follow, if there is cyst torsion (turning over), cyst ruptures and internal bleeding, suspicion of cancer, severe pain and other symptoms, or if newly formed cysts occur in the postmenopausal period. Today, most ovarian cyst surgeries are performed laparoscopically. In this method, small incisions are made into the abdomen, images are taken with the help of a camera, and the cyst is removed while preserving the ovary. Laparoscopic surgery provides rapid recovery and less pain. Open surgery (laparotomy) may be preferred for large cysts or in complicated cases.
Ovarian cysts can rarely lead to serious complications. Cyst torsion is when a cyst twists around itself, disrupting the blood supply to the ovary. It causes severe abdominal pain, nausea, and vomiting, and requires immediate surgical intervention. Cyst rupture is when a cyst bursts, usually with severe pain and internal bleeding. In this case, emergency intervention may be required. Although very rare, some cysts can be cancerous, and this risk is higher in newly formed cysts, especially in the postmenopausal period.
Although it is not possible to completely prevent ovarian cysts, regular gynecological examinations, maintaining hormonal balance for a regular menstrual cycle are important to reduce the risk. Ovarian cysts usually do not affect pregnancy and even cysts that occur during pregnancy often disappear spontaneously. However, large cysts or complicated conditions can cause problems during pregnancy and in this case, treatment is planned according to the weeks of pregnancy.
