Ovarian Cysts: Normal or a Problem?

Pathophysiology
Most Ovarian Cysts are small fluid-filled sacs that develop in a woman's ovaries as a normal part of a women’s menstrual cycle. During childbearing years a women produces a single egg once a month in a small sac called a follicle. The release of estrogen signals the sac to rupture and release the egg into the fallopian tube where it travels to the uterus. If the egg is fertilized, it implants on the uterine wall; unfertilized eggs are expelled with the uterine lining during menstruation. If the follicle fails to rupture and release the egg, fluid remains in the sac and a follicular cyst may form. Another type of cyst (corpus luteum cyst) can form even if the egg is released; this type of cyst contains a small amount of blood. Small cysts of either type—less than one half an inch—are common, produce no symptoms, and disappear on their own in a few weeks. A large cyst may cause pressure, bloating, pelvic pain, pain during intercourse if bumped, a increased desire to urinate, or a late period. Sudden and severe pelvic pain, often accompanied by nausea and vomiting, may be a sign of twisting of the ovary and reducing its blood supply or the rupture of a cyst and internal bleeding. If benign, the pain will improve dramatically within 45 minutes.

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Risk Factors

• History of previous ovarian cysts
• Irregular menstrual cycles
• Increased upper body fat distribution.
• Cigarette smoking.

    
NOTE: the use of oral contraception decreases risk because it prevents the ovaries from producing an egg during ovulation.

Signs & Symptoms

• Lower abdominal pain accompanied by abdominal fullness, pressure or bloating. May radiate to lower back. Severity is variable. Onset tends to be at the beginning, during, or after the menstrual period. Abrupt, sharp, severe pain indicates rupture and, if benign, will improve within 45 minutes.
• Pelvic pain during intercourse.
• Irregular periods or spotting, nausea, ± vomiting, fatigue.
• Increased frequency in urination or difficult urination with bowel movements due to intra-abdominal pressure from the cyst.

Treatment

• 95% of ovarian cysts are benign and require no treatment other than rest and NSAIDs for mild-moderate pain. NSAIDs are more effective when given early.
• Maintain hydration to avoid constipation.
• Avoid caffeine, alcohol, sugar, & foods that cause gas.
• Limiting activity may reduce the risk of torsion or rupture.
• Consider a non-urgen Level 3 Evacuation if mild-moderate pain/pressure persists with treatment.
• Begin an urgent Level 1 Evacuation if no improvement in severe pain or pain after 45 min.

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