The female ovary is a very active organ, producing a mature follicle (egg) every month from the teenage years until just before the menopause. Because of this activity, it is prone to produce growths that may cause pain, infertility or in rare cases, cancer. Ovarian cysts come in many different forms but in general, they can be classified as;
Physiological cysts – each cycle when the ovary forms an egg and a pregnancy does not occur, that follicle should rupture and the next cycle begins. Sometimes these follicles persist and they can grow quite large. They may have bleeding into them, twist or burst irritating the lining of the abdomen and causing pain.
- Tumours – these may be benign or malignant (cancerous). Benign tumours arise within the ovary in a host of different forms. In younger women, the main types are;
- Endometriotic cysts – ovarian cysts caused by and associated with endometriosis
- Dermoid cysts – made up of various materials such as hair, sebaceous fluid, cartilage and other material
- Adenomas – glandular tumours containing thick fluid
- Fibromas – solid tumours like the fibroids found in the uterus
As a woman gets older and especially after the menopause, the risk of an ovarian cyst being malignant increases and a pathological diagnosis must be made, and many of the benign cysts above have malignant variants.
Ovarian cysts can present in a number of ways;
- Silent – they are palpated at a routine examination and do not give any symptoms
- Symptoms – women may feel abdominal bloating, an increase in weight or tightening of clothing, changes in bowel or bladder function such as urinary frequency or pain with defaecation.
- Pain – a cyst may twist on its blood supply causing pain or bleeding, it may rupture with similar results.
They can be diagnosed by your GP or gynaecologist at a pelvic examination and will almost always be confirmed by an ultrasound to detail the nature of the cyst.
Laparoscopy has a special place in the diagnosis and management of ovarian cysts. Unless obvious cancer is suspected, an ovarian cyst can be removed via the keyhole approach with minimal scarring and rapid return to normal activity. It is troubling to note even today that many women will be subjected to a laparotomy incision (large horizontal or vertical abdominal scar) because their gynaecologist is unable or unwilling to perform the surgery laparoscopically. If that is you please see us for a second opinion before committing to an unnecessary scar.
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