Ovarian cysts are fluid filled sacs that develop on the female ovary. They are not uncommon; the majority of cysts develop as a natural consequence of the female menstrual cycle.
They are usually benign and of little consequence however in the minority of women they can have sinister consequences. For this reason it is important that women recognize the symptoms before it is too late.
Ovarian cyst accidents are the fourth most common reason for emergency gynaecological admissions, by the age of 65 years, 4% of women in the UK would be admitted for this reason.
Things that can go wrong with cysts acutely are:
- R = Rupture (release of the cysts contents into the abdominal cavity)
- I = Infection
- T = Torsion (ovary twisting on itself)
- H = Haemorrhage (bleeding)
The most common symptom of all these complications is pain. Sometimes it may be a "niggling" sort of pain where it comes and goes over a few days to weeks then all of a sudden becomes acute sometimes causing the sufferer to take a deep breath and stop what they are doing occasionally it can cause the sufferer to double over.
When this happens it is important to seek medical help even if it only to exclude a complication of ovarian cyst.
Women should insist on a pelvic ultrasound scan to at least exclude an ovarian cyst. If the ultrasonographer is experienced they may be able to tell if the cyst, if present is twisted or ruptured.
There have been reports of women who have presented these symptoms and have not had an ultrasound scan and present a few months later with persistent pain only to find that the ovary has killed itself and has become detached from its pedicle (Auto-amputation of the ovary). This may have a consequence on future fertility.
Sometimes these symptoms may be managed conservatively depending on the severity of symptoms and the scan findings.
If the ovary is twisted surgery is always required. Most often in modern times this should always be done laparoscopically. An important question patients should always ask their surgeon is whether the ovary would need to be removed. Traditionally this was the case by now it is possible to often save the ovary even if it looks "dead".
There is a recent report where a woman needed to have surgery for ovarian torsion. The ovary looked dead but the surgeons preserved it. A week or so later she needed to have another operation for appendicitis. The ovary was inspected and it was "plum normal"
The Ideal treatment should be to untwist the ovary and remove the cyst.
In some instances if the attachment (pedicle) of the ovary is long it may be necessary to perform an ovariopexy (this is where the ovary is repositioned to prevent it from twisting in the future). In the unfortunate circumstance that the ovary cannot be saved and needs to be removed some authors suggest that the other ovary is repositioned.
Ask your doctor whether they are able to do this and whether they are able to do this by means of laparoscopy.
Find out more from a UK Consultant Gynaecologist or read UK Gynaecologist blog
