About Your Diagnosis

Ovarian cysts are fluid filled structures that develop in the ovary. Ovarian cysts develop with every menstrual cycle. Fluid collects around developing eggs; one egg becomes “dominant” and that egg ovulates (leaves the ovary and goes into the fallopian tube). The ovulated egg leaves a cyst behind in the ovary. This cyst is usually 2–3 centimeters (1–2 inches) in diameter. This type of cyst is called a “physiologic cyst,” “follicular cyst,” or “simple cyst.” If the cyst remains a normal size, it does not cause any symptoms. If the cyst grows larger, 4 centimeters or larger, it can cause pain. Symptomatic cysts are very common; in most cases, the cyst and symptoms will resolve without any treatment. Occasionally, cysts can bleed into themselves. A very small blood vessel in the wall of the cyst breaks, and the blood goes into the cyst. These are called “hemorrhagic cysts” and sometimes are more painful. Hemorrhagic cysts are common as well. Occasionally, hemorrhagic cysts can rupture, and the blood goes into the abdominal cavity. No blood is seen out of the vagina. If a cyst ruptures, it is usually very painful. Hemorrhagic cysts that rupture are less common. Most hemorrhagic cysts are selflimiting; some need surgical intervention (see below). Even if the hemorrhagic cyst ruptures, in many cases it will resolve without surgery. Sometimes surgery is necessary. Another condition that can occur with ovarian cysts is “torsion” or twisting of the ovary and fallopian tube. If the ovary and tube twist a little, this can cause pain, but it is not dangerous. If the ovary and tube twist completely around, this is very painful and immediate surgical treatment is necessary. Cysts are usually diagnosed by pelvic ultrasound. This is a painless test in which the ovaries, fallopian tubes, and uterus can be seen so the cyst can be confirmed. If the cyst appears to be “clear” inside, the diagnosis of a physiologic cyst is made. If the cyst is not clear inside, then it is possible a hemorrhagic cyst is present.

Living With Your Diagnosis
Ovarian cysts can cause pelvic pain. The pain can be sharp, dull, or feel like pressure. It may be localized to one side of the abdomen, or it may be more diffuse across the lower abdomen. Activity such as walking, exercise, or intercourse will often make the pain worse. Usually bladder or bowel habits are not affected, although sometimes pelvic pain can cause urinary frequency (make you feel like you need to empty your bladder more often). Usually, the appetite is not affected unless the pain is severe. If the pain is from a physiologic cyst or from a hemorrhagic cyst, it will usually resolve in a few days up to 10–14 days (by the next period). If the pain is from a ruptured hemorrhagic cyst or an ovarian cyst that is twisting, the pain usually worsens until it is extremely severe, necessitating medical attention.

Treatment
If you have a physiologic cyst that grew larger than it should have, usually no treatment is necessary except to decrease the pain. Ibuprofen can be taken to decrease the pain: 400 milligrams every 4 hours or 600 milligrams every 6 hours or 800 milligrams every 8 hours. (Obviously, do not take ibuprofen if you have been told you should not take it because of a medical condition, an allergy to it, or because it is incompatible with another medication you are taking.) Sometimes a prescription pain medication will be prescribed if ibuprofen does not relieve the pain enough or cannot be taken. Sometimes a warm bath or heating pad can help lessen the discomfort. Often a follow-up pelvic ultrasound will be recommended to make sure the cyst has resolved. If you have a ruptured or twisting cyst, you may need laparoscopic surgery. This is a procedure in which a telescope-like instrument and other instruments are placed into the abdominal cavity through very small incisions. The cyst can be seen and the bleeding stopped by cauterizing it. If the ovary and fallopian tube are twisting, sometimes the ovary and tube can be untwisted, or sometimes the ovary and tube have to be removed. If you have recurrent ovarian cysts, birth control pills may be recommended. Birth control pills prevent most ovulation, so cysts do not develop.

The DOs
• Take ibuprofen 400 milligrams every 4 hours or 600 milligrams every 6 hours or 800 milligrams every 8 hours for pain. (Do not take ibuprofen if have been told you should not take it because of a medical condition, an allergy to it, or because it is incompatible with another medication you are taking.)
• Sometimes a hot tub or heating pad can help relieve the discomfort.

The DON’Ts
• Refrain from strenuous activity (e.g., exercise, sexual activity). Activity will make the discomfort worse.

When to Call Your Doctor
• If the pain gets worse instead of gradually decreasing.
• If a fever, or nausea and vomiting develop.