Ovarian Cyst Management

What happens after an ovarian cyst is found?

A diagnosis of ovarian cyst is not a definite indication for treatment. Once a cyst is detected, doctors typically try to collect additional information to establish if it will pass on its own or if additional evaluation is necessary.

These can involve,

• Examining symptoms and medical history.
• Performing a pelvic examination.
• Understanding abnormalities seen on the ultrasound exam.
• Understanding risk factors and reproductive intentions.
• Planning for follow-up imaging as needed.

How do doctors evaluate an Ovarian Cyst?

There are a few factors that are taken as a consideration while analysing an ovarian cyst.

Symptoms

• Pelvic pain or discomfort.
• Abdominal bloating.
• Pain during intercourse.
• Changes in menstrual patterns.
• Pressure symptoms affecting neighbouring organs.
  

Imaging findings

Ultrasound imaging is the first imaging to assess the ovarian cyst.

• Size of the cyst.
• Shape and appearance.
• Presence of solid components.
• Internal septations or complex features.
• Blood flow patterns when Doppler ultrasound is used.

Age and Menopausal status

The recommendations for management might vary among,

• Adolescents
• Women of reproductive age.
• Postmenopausal women.

Additional Investigations

In selected cases, doctors may recommend,

• MRI for further evaluation of complex cysts.
• Blood tests for specific tumour markers.

Can Ovarian Cysts go away on their own?

Many ovarian cysts go away on their own.  When a doctor says watchful waiting it means that the cyst looks good on an ultrasound and does not have any concerning features.

• The symptoms are mild or non-existent.
• The cyst is relatively small.
• Repeat ultrasound scans can be performed to track changes over time.

When is Treatment needed?

Treatment may be recommended if,

• The cyst causes significant symptoms.
• It keeps on growing.
• It does not solve itself.
• It interferes with fertility.
• Some potential risk of complications.
• Imaging shows that there is a higher-risk cyst.

What treatment options are available?

Observation and monitoring

Many ovarian cysts can be safely monitored.

• Regular follow up appointment.
• Repeat USG examination.
• Monitor for new or worse symptoms.

Symptom Management

• Pain relieving medication advice by healthcare practitioners.
• Lifestyle adjustment.
• Regular follow up.

Hormonal Management

They will not remove existing cysts, but can help to minimize the formation of some functional cysts in some patients.

• Hormonal therapy may be appropriate for some people and not for others.

Surgery

Surgery may be considered if the,

• Cyst is large or persistent.
• If symptoms are affecting the quality of life.
• If there is concern for ovarian torsion or rupture.
• If the cyst presents with suspicious features.
• If there are fertility-related concerns that require intervention.

 Numerous procedures are now available that can be done with a minimally invasive laparoscopic approach.

How can Ovarian Cyst affect fertility?

There is a big misunderstanding that many women have, that a cyst on their ovary is a problem for them to conceive and become pregnant. In fact, the effect on fertility will depend on the type of cyst.

There are some cysts that have little or no effect on fertility, and there are other cysts that can influence the outcome of the reproductive process, such as,

• Endometriomas related to endometriosis.
• Large cysts that impact the ovarian function.
• Cysts requiring surgical removal that may involve the removal of ovarian tissue.

Preservation of fertility is a key element of modern treatments. Women intending to become pregnant should consult a gynaecologist about fertility issues.

What recent advances improved Ovarian Cyst management?

• High-definition and 3D laparoscopy imaging, which gives more precision to the surgical procedure.
• The use of advanced energy devices to reduce bleeding during surgery.
• The increasing focus on fertility preserving surgical techniques.
• Implementation of Enhanced Recovery After Surgery (ERAS) protocols, which help patients to heal faster and be discharged from hospital earlier.
• Good laparoscopic surgical techniques to minimize the damage to healthy ovarian tissue.
• Improved risk prediction model that helps to find difference between benign and potentially malignant cyst.

The treatment of ovarian cysts is very individualized and relies on the nature of the cyst, symptoms, imaging, age, and desired fertility.

Treatment of the ovarian cyst may be medical or surgical if it does not go away on its own, or it may not be necessary to treat the ovarian cyst and it can be observed.

Imaging, risk classification and minimally invasive surgery have helped to diagnose and manage ovarian cysts and to protect reproductive health.

Cysts in the ovary or symptoms associated with ovarian cysts should be evaluated by a gynaecologist in the area and treatment options should be recommended on a case-by-case basis.