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Ovarian cysts

Last Updated on May 19, 2021 by MyFormulary

Related Terms

  • Blood cyst, chocolate cyst, corpus luteum cyst, cyst, dentigerous cyst, dermoid cyst, endometrial cyst, endometrioid cyst, endometrioma, follicular cyst, functional ovarian cysts, hematocele, hematocyst, hemorrhagic cyst, physiologic ovarian cysts.

Background

  • A women’s reproductive system has two ovaries, one on either side of the uterus. The ovaries, each about the size of an almond, produce eggs (called ova) as well as the female sex hormones estrogen and progesterone. Eggs are fertilized by sperm from the male to produce offspring.
  • An ovarian cyst is a sac filled with fluid that forms on or inside an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea or larger than a cantaloupe.
  • Ovarian cysts affect women of all ages. They occur most often, however, during a woman’s childbearing years. Some ovarian cysts cause problems, such as bleeding and pain. Functional ovarian cysts usually don’t need treatment and typically disappear on their own within 8-12 weeks. Surgery may be required to remove cysts larger than five centimeters in diameter.

Causes

  • Ovarian cysts may occur during the process in which an egg is released from the ovary (ovulation). During the days before ovulation, a follicle grows. Usually for most months during ovulation, an egg is released from this follicle. However, if the follicle fails to break open and release an egg, the fluid stays in the follicle and forms a follicular cyst.
  • An endometrioid cyst is caused by endometriosis. Pathological cysts include those found in polycystic ovary syndrome (PCOS) or those associated with tumors.
  • Ovarian cysts are somewhat common, and they are more common during a woman’s childbearing years (from puberty to menopause). Ovarian cysts are rare after menopause.

Signs and Symptoms

  • Often there are no symptoms of an ovarian cyst. However, it may cause pain if it bleeds, ruptures (breaks open), is twisted or causes twisting (torsion) of the Fallopian tube, or pushes on nearby structures in the body.
  • Other symptoms of ovarian cysts may include abnormal uterine bleeding (a change from the normal menstrual pattern), which could occur in an absent menstruation, an irregular menstruation, a longer-than-usual menstrual cycle, or a shorter-than-usual menstrual cycle; bloating or swelling in the abdomen; pain during bowel movements; pain in the pelvis shortly after beginning or ending a menstrual period; pain with intercourse or pelvic pain during movement; or pelvic pain characterized by a constant, dull aching in the pelvic area.

Diagnosis

  • Pelvic examination: Examination of the vagina, uterus, rectum, and pelvis, including the ovaries, for masses or growths is performed during a pelvic examination.
  • Ultrasound: Pelvic ultrasound provides a safe, noninvasive way to evaluate the size, shape, and configuration of the ovaries. Ultrasound uses high-frequency sound waves to produce images of the inside of the body. However, an ultrasound cannot reliably distinguish between a cancerous growth and one that is not cancerous. Ultrasound can also find ascites (fluid in the abdominal cavity), a possible sign of ovarian cancer.
  • Blood tests: Blood tests may include those that measure hormone levels (such as LH, FSH, estradiol, and testosterone) or serum HCG (e.g., a pregnancy test).
  • Other tests: Other diagnostic tests may include computerized tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI).

Complications

  • Possible complication that can occur with ovarian cysts include bleeding, rupture of the cyst, and twisting or torsion of the Fallopian tube.

Treatment

  • General: Functional ovarian cysts usually don’t need treatment and typically disappear on their own within 8-12 weeks. Birth control pills (oral contraceptives) may help make the menstrual cycle more regular and may decrease the development of functional ovarian cysts.
  • Analgesics: Pain caused by ovarian cysts may be treated with pain relievers, including acetaminophen (Tylenol®), nonsteroidal anti-Inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®, Advil®), or narcotic pain medicine (by prescription). NSAIDs usually work best when taken at the first signs of the pain.
  • Birth control pills (oral contraceptives):
    Oral contraceptives (OCs) prevent follicles from forming, because they prevent ovulation. Anything that makes ovulation less frequent reduces the chance of developing an ovarian cyst.
  • OCs do not protect against human immunodeficiency virus (HIV) infection or other sexually transmitted diseases. Conversely, patients with known HIV infection or acquired immunodeficiency syndrome (AIDS) should be aware that the use of this oral hormonal contraceptive will not prevent the transmission of HIV or other sexually transmitted diseases to their partner(s).
  • Common adverse effects include abdominal pain, breast tenderness, fluid retention, weight gain, and headache. Oral contraceptives are contraindicated during pregnancy and are categorized as FDA pregnancy risk category X. Females receiving combined hormonal contraceptives should be advised not to smoke tobacco. The concurrent use of potassium-containing products (e.g., potassium iodide, potassium salts, dietary salt substitutes) and other potassium-containing medications (e.g., antibiotics) may increase the risk of hyperkalemia, especially in the presence of kidney impairment. Additionally, chronic heparin therapy may predispose a patient to develop hyperkalemia. Other drug-drug interactions include anticonvulsants and antibiotics.
  • Nonpharmacological treatments:
    Compresses may be used to stimulate circulation and healing in the ovaries. A hot water bottle covered with a towel soaked in castor and essential oils can be applied to the lower abdomen near the ovaries, which may relax tense muscles and relieve cramping and lessen discomfort. Lavender, rosemary, and chamomile are essential oils that are sometimes used with compresses. A hot compress can also be made by heating a cloth soaked in castor and essential oils in a warm oven, which is then applied to the lower abdomen. Bags of ice covered with towels can be used alternately as cold treatments to increase local circulation. Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion.
  • Surgery:
    Simple ovarian cysts that are larger than 5-10 centimeters and complex ovarian cysts that do not resolve on their own should be removed with surgery (laparoscopy or exploratory laparotomy).
  • Laparoscopic surgery, also called minimally invasive surgery (MIS), Band-Aid surgery, keyhole surgery, or pinhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5 centimeters), compared to larger incisions needed in traditional surgical procedures.
  • A laparotomy is a surgical procedure involving an incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. In a diagnostic laparotomy (most often referred to as an exploratory laparotomy and abbreviated ex-lap), the nature of the disease is unknown, and laparotomy is deemed the best way to identify the cause.

Integrative Therapies

  • Currently, there is a lack of evidence available on the safety or effectiveness of integrative therapies for the prevention or treatment of ovarian cysts.

Prevention

  • In patients not trying to get pregnant and who often get functional cysts, hormone medications (such as birth control pills), which prevent follicles from forming, are sometimes recommended by a healthcare provider. Anything that makes ovulation less frequent reduces the chance of developing an ovarian cyst. Birth control pills, pregnancy, and breastfeeding in the first six months following birth prevent ovulation. Ovulation ceases when menopause is complete.
  • It has been suggested that some foods may contribute to the development of ovarian cysts, such as foods high in estrogen or carbohydrates. Eliminating caffeine and alcohol, reducing sugars, and increasing foods rich in vitamin A and carotenoids (such as carrots and salad greens) and B vitamins (such as from whole grains) may help reduce pain associated with ovarian cysts.
  • Essential fatty acids found in fatty fish, such as salmon and trout, may help promote hormonal balance. Omega-3 essential fatty acids, such as flaxseed oil or evening primrose oil, may be of benefit. Including a dietary source of iodine, such as seaweed, for thyroid support may be beneficial in some patients. A high-quality multivitamin and mineral supplement is also recommended for overall health.

Author Information

  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Barron ML. Proactive management of menstrual cycle abnormalities in young women. Journal of Perinatal and Neonatal Nursing. 2004 Apr-Jun;18(2):81-92.
    View Abstract
  2. Grimes DA, Jones LB, Lopez LM, et al. Oral contraceptives for functional ovarian cysts. Cochrane Database Systems Review. 2006 Oct 18;(4):CD006134.
    View Abstract
  3. Huber JC, Bentz EK, Ott J, et al. Non-contraceptive Benefits of Oral Contraceptives. Expert Opinion on Pharmacotherapy. 2008 Sep;9(13):2317-25.
    View Abstract
  4. Knight JA, John EM, Milne RL, et al. An inverse association between ovarian cysts and breast cancer in the breast cancer family registry. International Journal of Cancer. 2006 Jan 1;118(1):197-202.
    View Abstract
  5. National Institutes of Health. .
  6. Natural Standard: The Authority on Integrative Medicine. .
  7. Schneider JG, Tompkins C, Blumenthal RS, et al. The metabolic syndrome in women. Cardiology in Review. 2006 Nov-Dec;14(6):286-91.
    View Abstract
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