Health Square: What You Need To Know About Ovarian Cysts, page 2 Common Types

Once a month, your body produces what is, in effect, an ovarian cyst. It is part of ovulation, the process during which an egg ripens and is released from the ovary. The ovary contains follicles, sacs containing immature eggs and fluid. Each month during your childbearing years, the ovary produces hormones that cause a follicle to grow, and the egg within it to mature.

Once the egg is ready, the follicle ruptures and the egg is released. Thus the follicle is a fluid­filled cyst that ruptures when you ovulate. Many women experience pain or cramping when this occurs. This pain is known as mittleschmerz, the German word for “middle (mid­cycle) pain.”

Once the egg is released, the follicle changes into a smaller sac called the corpus luteum, or “yellow body,” named for the yellowish fatty material it contains. If the egg is not fertilized, the corpus luteum gradually disintegrates and a new follicle begins growing during the next menstrual cycle. If the egg is fertilized, the corpus luteum will remain for a few months, secreting estrogen and progesterone to support the developing embryo.

Functional Cysts

Cysts that develop as part of the natural function of the ovary are dubbed “functional cysts.” There are two types, the follicle cyst and the corpus luteum cyst.

Follicle Cysts can develop in two ways: during ovulation when the follicle ruptures to release the egg, or when a developing follicle fails to rupture, leaving the follicle, or sometimes several follicles, to continue to enlarge. Follicle cysts rarely grow larger than one­and­a­half to two inches in diameter, and usually rupture or shrink after one or two menstrual cycles.

Because these cysts are usually painless, most women are unaware of them. However, when one ruptures, perhaps during sexual intercourse, you may experience intense abdominal pain that is often worsened by physical activity. The pain usually subsides after a day or two but quite often is severe enough to bring you to the emergency room. You may also experience abdominal discomfort if, in response to fertility drugs, several follicle cysts begin to grow.

TWO LEADING OFFENDERS

In this cutaway view of the ovary, a follicle cyst has developed alongside an endometrial cyst. Usually painless, follicle cysts often develop when a follicle fails to release a mature egg and continues to grow instead. This type of cyst generally subsides on it own. Endometrial cysts, however, continue to grow, frequently requiring surgical removal. They form when, in pace with the regular menstrual cycle, a misplaced patch of tissue from the uterine lining bleeds and sloughs off inside the ovary. As the blood builds up over months and years, it turns brown, giving rise to the nickname “chocolate cyst.”

Corpus Luteum Cyst. The corpus luteum that forms after ovulation is also a cyst­like structure, and it is very prone to the development of fluid or blood­filled cysts that can grow from the size of an egg to the size of a softball.

Unlike follicle cysts, corpus luteum cysts usually cause pain on only one side of the lower abdomen. If you have a corpus luteum cyst, you may be experiencing menstrual changes such as late periods or bleeding between periods. Because this set of symptoms is also associated with the dangerous condition known as tubal or ectopic pregnancy, you should be sure to go to a doctor.

Polycystic Ovaries

In some women, the ovaries tend to develop numerous follicle cysts. You may hear this condition referred to as polycystic ovarian syndrome or “disease” (PCO), Stein­Leventhal Syndrome, or sclerocystic ovarian disease.

Actually polycystic ovaries are not a “disease” at all, but the result of a hormone imbalance that causes the persistent growth of follicular cysts accompanied, usually, by failure of one follicle to mature and succeed in ovulating. The condition is fairly common and usually occurs in adolescents and young women. Many women with polycystic ovaries have no symptoms, but the condition can cause fertility problems, due to infrequent ovulation, and can result in excess body hair and weight problems, due to hormone imbalances.

Because women with polycystic ovaries rarely or never ovulate, their menstrual periods are generally irregular, often with many months between periods. When they do have a period, it may be quite heavy, since the lining of the uterus has continued to grow during the months since their last period. While polycystic ovaries do not themselves become cancerous, excessive growth of the uterine lining, or endometrium, is thought to increase risk of cancer of the uterus (endometrial cancer).

Endometrial Cysts

Endometrial cysts are also known as endometriomas or “chocolate cysts,” because they are filled with dark blood that resembles chocolate syrup. These cysts form as the result of endometriosis, the disease in which patches of tissue from the uterine lining are found outside the uterus. In about half the cases of endometriosis, these patches appear in or on the ovaries.

With successive menstrual cycles, these misplaced pieces of endometrial tissue bleed, gradually forming endometrial cysts. Over time, the cysts grow, and some can eventually become as large as a grapefruit. Endometrial cysts can cover a large part of the ovary and prevent ovulation, resulting in infertility. Some women have no symptoms with an endometrial cyst; others have severe menstrual cramps, pain with intercourse, or pain during a bowel movement.

Although complications are infrequent, if a sizeable endometrial cyst ruptures, its contents can spill into the pelvic cavity, causing some internal bleeding. The material in the cyst may also spill onto the surface of other organs in the pelvis, such as the uterus, fallopian tubes, bladder, and intestines. This can cause the formation of scar tissue (adhesions), which in turn can cause pain and fertility problems.

IF CYSTS KEEP COMING

When, cycle after cycle, the hormonal system fails to trigger release of an egg, the resulting follicle cysts can build up inside the ovary, producing a condition called polycystic ovarian syndrome. While polycystic ovaries are not dangerous in themselves, the hormonal imbalance that causes them can produce infertility and, because menstrual periods are delayed, lead to excessive growth of the uterine lining.

Cystadenomas

Unlike functional ovarian cysts, which develop from variations in the normal function of the ovaries, or endometrial cysts, which are a consequence of endometriosis, or even polycystic ovaries, which result from hormone imbalance, cystadenomas are known as neoplasms, meaning “new growths.” Ovarian neoplasms are new and abnormal formations that develop from the ovarian tissue. Cystadenomas are the most common type.

Cystadenomas are classified according to the type of fluid they contain. A serous cystadenoma is filled with a thin watery fluid and is relatively large, between 2 and 6 inches in diameter. This type most frequently appears in women in their 30s and 40s, but may occur in women between the ages of 20 and 50.

A serous cystadenoma usually causes no specific symptoms, unless it grows to be so large that it results in weight gain and a large abdomen. Generally, these cysts are discovered during a routine gynecological exam. Although considered a benign growth, they do have the potential to become malignant.

A mucinous cystadenoma is filled with a sticky, thick gelatinous material and can become enormous. While most are between 6 and 12 inches in diameter, there have been rare cases of gigantic tumors measuring up to 40 inches and weighing over 100 pounds. Mucinous cystadenomas develop most often in women between the ages of 30 and 50.

Although cystadenomas are almost always benign, complications may develop. If they grow very large, they can interfere with other abdominal organs, disturbing the normal functioning of the stomach, intestines, and bowel. They may also twist, rupture, or bleed. Keep in mind, though, that if you have regular gynecological exams, your doctor would probably discover a cystadenoma long before it could grow to its potentially enormous size.

Dermoid Cysts

Dermoid cysts are also ovarian neoplasms. They are so named because they contain skin or related tissue such as hair, teeth, or bone. They are also known as benign cystic teratomas, teratoma meaning a tumor consisting of skin and hair tissue. Dermoid cysts contain this unusual type of tissue because they develop from the ovary's germ cells, the cells that normally produce the egg and contain the forerunner of all human tissues. Dermoid cysts may be present from birth, but rarely grow large enough to be noticed until adulthood.

Dermoid cysts are quite common, and although they can occur in women of any age, they most frequently affect women between the ages of 20 and 40. They generally measure between 2 and 4 inches in diameter, and usually cause no symptoms unless they become so large that they press on the intestines, bladder, or rectum. While these growths are almost always benign, there is about a 1 percent chance that a malignancy could develop. As is true of most types of cysts, the dermoid may be prone to bleeding, rupture, or twisting on its stem.

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