When it comes to taking care of your health, asking questions never hurts. But is it always worth a visit to your doctor? We’re asking experts to weigh in on your burning questions—from feminine to general health and everything in between—so you can get advice from a pro before you go. The doctor will see you now.
September is Ovarian Cancer Awareness Month. If your town is as teal as mine is right now, with ribbons on every lamppost, you hear “ovarian” and expect the word “cancer” to follow. While cancer is a possibility, a condition that is far more common is ovarian cysts. The Mayo Clinic reports that the incidence of cysts in women age 14 and over is very common; there are more than three million known cases each year. So what do we need to know about ovarian cysts and how to proceed when we do have them?
For one, says our resident expert Dr. A. Nicky Hjort, M.D., OB-GYN, you should know that there are many kinds of cysts. “Cyst” itself is a catchall term for a variety of fluid collections, masses, and hematomas (aka bruises). Some are hormonally active; others are not. Some can be dangerous; others are harmless. Most cysts in the ovaries are benign, and while they may cause uncomfortable symptoms, the good news is they tend to resolve on their own.
Types of Cysts
Dr. Hjort says the least worrisome category is the simple cyst, which consists of one outer membrane filled with fluid. One type of simple cyst, the graafian follicular cyst, forms when the ovary does not properly release an egg during ovulation. The second type, the corpus luteum cyst, forms in the same situation, but its wall may rupture, releasing fluid into the ovary and possibly causing pain. Both types of simple cysts tend to disappear on their own in a matter of a few months.
Complex cysts are—you guessed it—more complicated. They may be composed of various tissue densities, may have solid or fluid components, and may contain various types of tissues (a dermoid cyst). Because these can grow larger, they are more likely to cause pain. The pressure they put on other organs may also cause bloating or nausea.
Symptoms of Ovarian Cysts
Symptoms may include:
- Abdominal bloating/swelling
- Pelvic pain before or during your period
- Painful bowel movements
- Painful intercourse
- Lower back pain, pelvic pain, or pain on the side of your body
- Breast tenderness
- Nausea and vomiting
It may be a twisted or ruptured cyst that will require immediate attention if you have these symptoms:
- Severe pelvic pain
- Feel faint or dizzy
- Rapid breathing
What Your Doctor Will Look For
If you’re of reproductive age and experiencing pain, nausea, bloating, or an abnormal period—this could mean missed periods, irregular bleeding, or another change that’s unusual for you—a cyst could be to blame. The first thing your doctor will likely do is rule out pregnancy with a test, as these are also common first trimester symptoms.
If you are pregnant, she’ll want to be sure the fertilized egg has made its way into the uterus and isn't stuck in the ovaries, fallopian tubes, or elsewhere. With this condition, called an ectopic pregnancy, the baby cannot develop properly, and the mother’s life may be at risk. Your doctor may do a pelvic exam and take an ultrasound to look for a healthy implantation.
If you’re not pregnant, a pelvic exam and/or ultrasound is still the next order of business. Dr. Hjort says an ultrasound allows your doctor to see tissue density, via how sound moves through that tissue and the speed at which it bounces back. It can be performed externally on the abdomen or vaginally. It will enable your doctor to see, among other things, the size, shape, character, and lining of the uterus, including any tumors, like fibroids, that may be present. An ultrasound can also shine a light on what’s going on in your ovaries.
What Sizes Mean
Dr. Hjort warns the bigger the cyst, the more cause for concern. Those that are five centimeters or larger often require medical or surgical intervention. Cysts smaller than five centimeters are usually not dangerous. If there’s concern that a cyst may be malignant (unlikely in women under 40), your doctor may order more comprehensive imaging or a blood test to make a diagnosis.
Ovarian cancer is often diagnosed in its latter stages, as it presents in a nonspecific way, Dr. Hjort says. Women with ovarian cancer are usually post-menopausal, so changes in the menstrual cycle aren't a common symptom. Rather, patients report gastrointestinal issues, bloating, and a general feeling that something is wrong. There are many types of ovarian cancer, and unfortunately, most are very difficult to treat, even with surgery and chemotherapy.
A cyst need not be cause for alarm. Ruptured cysts that require urgent care are rare, and simple cysts don’t usually interfere with your fertility. But if you’re worried about any symptoms, visit your gynecologist for an exam. Better safe than sorry!