Ovarian Cyst Treatment

What Is an Ovarian Cyst? Why Does It Form and What Are Its Types?

Ovarian cysts are fluid-filled sacs of varying sizes that develop in the ovaries. Based on their causes and structure, they are basically divided into two main groups:

1. Functional Ovarian Cysts:

These are the most common type of cyst and occur as a normal part of the menstrual cycle. They are related to hormonal changes, are usually benign, and often disappear on their own within a few menstrual cycles (1-3 months) without requiring any treatment.

• Follicular Cysts: Normally, every month, sacs called follicles form and grow in the ovaries, containing an egg cell. When ovulation time arrives, this follicle ruptures and the egg is released. If the follicle does not rupture and continues to grow, a follicular cyst forms. It is usually 2-3 cm in size, causes no symptoms, and resolves on its own.
• Corpus Luteum Cysts: The structure that forms in place of the ruptured follicle after ovulation and secretes the hormone progesterone is called the corpus luteum. Normally, if pregnancy does not occur, this structure shrinks and disappears. Sometimes it does not disappear and fills with fluid or blood, forming a corpus luteum cyst. It can cause a delayed period and groin pain. When pregnancy occurs, it is important for the continuation of the pregnancy and usually disappears on its own within the first 3 months. Types prone to bleeding (hemorrhagic corpus luteum cyst) can cause sudden pain.

2. Non-Functional Ovarian Cysts (Pathological / Neoplastic Cysts):

These are cysts that develop independently of the normal menstrual cycle, as a result of abnormal proliferation of ovarian cells. They do not disappear on their own and may require follow-up or treatment. The vast majority of cysts in this group are also benign, but rarely they carry the potential to be malignant (cancerous). The main types are as follows:

• Dermoid Cysts (Mature Cystic Teratoma): These are usually benign cysts arising from embryonic germ cells in the ovary, which may contain different tissue types such as hair, teeth, bone, and fat. They can occur at any age. They carry a risk of torsion (twisting).
• Cystadenomas: These are cysts that develop from the epithelial cells on the outer surface of the ovary, filled with either clear fluid (serous cystadenoma) or a sticky, mucus-like fluid (mucinous cystadenoma). They are usually benign, but some can reach very large sizes or, rarely, may be borderline (of uncertain malignant potential) or malignant.
• Endometriomas (Chocolate Cysts): These are cysts filled with old blood that form in the ovaries due to endometriosis. They are closely associated with pain and infertility. (Details are discussed in the previous topic).
• Other Benign Tumors: Solid tumors such as fibromas.
• Malignant (Cancerous) Ovarian Cysts (Ovarian Cancer): More common especially in advanced age and after menopause. May cause no symptoms in the early stage. A suspicious appearance on ultrasound (thick wall, solid areas within the internal structure, septa, dense vascularity) and elevated tumor markers such as CA-125 in the blood increase suspicion of cancer. There are different types of ovarian cancer (epithelial, germ cell, stromal).

What Are the Symptoms of Ovarian Cysts? Which Situations Are Important?

Most ovarian cysts, especially small and functional ones, cause no symptoms and are discovered incidentally during a routine gynecological examination or ultrasound. When symptoms do occur, the following are generally seen:

• Lower Abdominal or Groin Pain: The most common symptom. It is usually on the side where the cyst is located, and may be dull, aching, or sometimes sharp and stabbing. The pain may be constant or intermittent. It may increase during sexual intercourse (dyspareunia) or with certain movements.
• Abdominal Bloating, Fullness, or a Sensation of Pressure: Especially seen with large cysts.
• Menstrual Irregularities: Delayed periods, frequent periods, or spotting between periods (especially with hormonally active cysts or functional cysts).
• Pressure Symptoms: Large cysts can put pressure on the bladder, causing frequent urination or difficulty urinating; pressure on the intestines can cause constipation.
• Nausea, Vomiting: May be seen especially in complications such as cyst torsion or rupture, or sometimes with large cysts.
• Sudden and Severe Abdominal Pain: This is usually a sign of a complication (rupture of the cyst or torsion/twisting) and requires urgent medical attention. Severe pain may be accompanied by nausea, vomiting, sweating, or a feeling of faintness. If there is bleeding into the abdomen due to cyst rupture, shoulder pain may also occur.

How Is an Ovarian Cyst Diagnosed? Diagnostic Methods Used in Ankara

Various methods are used by Prof. Dr. Nuray Bozkurt in Ankara to diagnose ovarian cysts and determine their type:

• Detailed Medical History and Gynecological Examination: Information such as the patient’s complaints, menstrual pattern, pregnancy status, and family history is obtained. The uterus and ovaries are assessed with a gynecological examination, and any palpable mass or tenderness is checked.
• Ultrasonography (USG): This is the gold standard method for diagnosing ovarian cysts.
  
  • Transvaginal Ultrasonography (TVUS): The most commonly used method. It provides a much clearer and more detailed view of the ovaries and cysts. Features such as the cyst’s size, wall thickness, internal structure (whether it contains only fluid — a simple cyst; or whether it has septations, solid areas, dense content — a complex cyst), and vascularity (via Doppler) are evaluated. These findings provide important clues as to whether the cyst is benign or potentially malignant.
  • Abdominal Ultrasonography: Performed through the abdomen; it can be used especially in virgin patients or for a general assessment of very large cysts.
• Blood Tests (Tumor Markers):
  
  • CA-125: May be ordered to assess suspicion of ovarian cancer, especially in postmenopausal women or in patients with suspicious ultrasound findings. However, it is not diagnostic on its own, as it can also be elevated in many benign conditions.
  • Other Markers (HE4, ROMA score, AFP, Beta-hCG, LDH, etc.): May be needed to distinguish the type of cyst or to rule out rare conditions such as germ cell tumors in young patients.
• Advanced Imaging Methods:
  
  • Magnetic Resonance Imaging (MRI): Can be used in complex cysts where ultrasound is insufficient, to evaluate the cyst’s content and its relationship with surrounding tissues in more detail, or to investigate suspicion of cancer.
  • Computed Tomography (CT): Generally used to investigate the spread of cancer; MRI is superior for the initial assessment of pelvic cysts.
• Laparoscopy: A surgical method that can be used for both diagnosis and treatment. It allows direct visualization and removal of the cyst, especially in cases where cancer is suspected or treatment is required.

Ovarian Cyst Treatment: When and What Methods Are Applied?

Ovarian cyst treatment is not based on the rule that “every cyst must be operated on.” The treatment plan is entirely individual and is shaped according to the following factors:

• Type of Cyst: While functional cysts generally do not require treatment, cysts such as dermoid cysts, cystadenomas, or endometriomas may require follow-up or treatment.
• Size of the Cyst: Small (<5-7 cm) and simple-appearing cysts are generally followed, while larger cysts may require surgery.
• Ultrasonographic Appearance of the Cyst: Simple cysts (containing only fluid, thin-walled) are usually benign. Complex cysts (showing septations, solid areas, thick walls, dense vascularity) are more suspicious and may need to be surgically removed and examined.
• Patient’s Age: While functional cysts are common in women of reproductive age, newly appearing cysts after menopause are evaluated more carefully.
• Presence and Severity of Symptoms: Cysts causing complaints such as pain or a sensation of pressure may require treatment.
• Suspicion of Cancer: Cysts carrying a risk of malignancy must be surgically removed.

The main treatment approaches applied under the guidance of Prof. Dr. Nuray Bozkurt in Ankara are as follows:

1. Follow-up and Observation (Watch-and-Wait Approach):

• This is the most commonly used method.
• It is preferred especially for small (generally < 5-7 cm), simple-appearing (containing only fluid), asymptomatic functional cysts detected in women of reproductive age.
• The vast majority of these cysts disappear on their own within 1 to 3 menstrual cycles.
• Follow-up is generally done with repeat ultrasonography after 1-3 months. If the cyst has disappeared, follow-up is discontinued. If the cyst persists, grows, or its appearance changes, further evaluation or treatment is planned.
• Small (<5 cm), simple-appearing, asymptomatic cysts detected after menopause with a normal CA-125 level can also be monitored with close ultrasound and CA-125 follow-up.

2. Medical (Drug) Treatment:

• Preventing Recurrence of Functional Cysts: Birth control pills can prevent the formation of new functional cysts (follicular cyst, corpus luteum cyst) by suppressing ovulation. However, they do not dissolve or shrink an existing functional cyst.
• Other Cyst Types: There is no effective drug treatment for organic cysts such as dermoid cysts, cystadenomas, or suspicious cysts. For endometriomas (chocolate cysts), drug therapy is used only to suppress pain and does not eliminate the cyst.

3. Surgical Treatment:

• Situations Requiring Surgery:
  
  • Cysts that do not disappear or grow during follow-up.
  • Cysts generally larger than 7-10 cm (size alone is not the criterion).
  • Cysts causing complaints such as severe pain or pressure symptoms.
  • Emergencies such as torsion (twisting) or rupture of the cyst.
  • Findings on ultrasound or tumor markers raising suspicion of cancer (complex structure, solid areas, excessive vascularity, elevated CA-125, etc.).
  • Cysts such as dermoid cysts or cystadenomas that will not disappear on their own and are symptomatic or large.
• Surgical Methods: Today, the vast majority of ovarian cyst surgeries are performed via laparoscopy (minimally invasive/closed surgery). Laparoscopy is performed by entering through small incisions in the abdomen with a camera and thin instruments; it offers important advantages such as less pain, a shorter hospital stay, faster recovery, and better cosmetic results. In very large cysts, cases with a high suspicion of cancer, or when there are severe adhesions in the abdomen, laparotomy (open surgery) may be required.
• Procedures Performed:
  
  • Cystectomy (Removal of the Cyst Only): This is the preferred method for cysts thought to be benign, especially in women of reproductive age who wish to have children. The goal is to remove only the cyst wall while maximally preserving healthy ovarian tissue.
  • Oophorectomy (Complete Removal of the Ovary Together with the Cyst): If the risk of the cyst being malignant is high, if the ovarian tissue has been completely destroyed due to the cyst, in cases of severe torsion or infection, or sometimes in postmenopausal women, complete removal of the ovary may be necessary.
  • Salpingo-oophorectomy (Removal of the Ovary Together with the Fallopian Tube on the Same Side): Sometimes, along with oophorectomy, removal of the fallopian tube on the same side may also be necessary.
• Frozen Section During Surgery: If there is suspicion of cancer during surgery, the removed cyst tissue is sent for rapid pathological examination (frozen section), and the result is awaited. If the result is benign, the procedure is completed; if it is malignant, the scope of the surgery is extended and cancer surgery (removal of the uterus and the other ovary, lymph node removal, etc.) may be performed (this is usually carried out by Gynecologic Oncology Surgery specialists).

Ovarian Cysts and Possible Complications

Although most ovarian cysts are uncomplicated, some complications can develop:

• Ovarian Torsion (Twisting of the Ovary): This occurs when the ovary twists on itself, cutting off blood flow. It is generally more common with medium-sized cysts (5-10 cm). It presents with sudden onset, very severe groin pain, nausea, and vomiting. It requires urgent surgical intervention. If not treated early, the ovarian tissue may lose its viability (necrosis) and may need to be removed.
• Cyst Rupture (Tearing/Bursting): This is when the cyst wall tears, spilling its contents into the abdominal cavity. It can cause sudden-onset abdominal pain. Rupture of simple cysts is generally not dangerous and can be managed with pain relievers. However, if the cyst content is blood or pus, or if significant internal bleeding occurs as a result of the rupture, emergency surgery may be required.
• Bleeding Into the Cyst or Abdomen (Hemorrhage): Corpus luteum cysts in particular are prone to bleeding. Surgery may be required in cases of severe bleeding.
• Infection: Rarely, cysts can become infected and form an abscess. This causes fever and severe pain, requiring antibiotic treatment and sometimes surgical drainage.
• Malignancy (Cancer Development): The risk of ovarian cysts turning into cancer is generally low but not impossible. This risk should be kept in mind, especially for cysts that occur after menopause or that have suspicious features on ultrasound.

Prof. Dr. Nuray Bozkurt for Ovarian Cyst Follow-up and Treatment in Ankara

Prof. Dr. Nuray Bozkurt helps her patients diagnosed with ovarian cysts at her clinic in Ankara with the following approaches:

• Accurate Diagnosis and Risk Assessment: She evaluates the type, size, and characteristics of the cyst in detail using high-resolution transvaginal ultrasonography and Doppler examination. When necessary, she orders blood tests (CA-125, etc.) or advanced imaging methods (MRI). She performs a risk assessment by determining whether the cyst is benign or suspicious.
• Personalized Management Plan: Together with the patient, she decides on the most appropriate management strategy (follow-up, medication, or surgery) based on the patient’s age, complaints, cyst characteristics, and future plans (such as wishing to have children). She avoids unnecessary treatments and surgeries.
• Safe Follow-up: For patients for whom follow-up is chosen, she monitors changes in the cyst through regular check-ups and updates the treatment plan when necessary.
• Priority for Minimally Invasive Surgery: When surgery is needed and appropriate for the patient, she prefers laparoscopic (minimally invasive) surgery methods, aiming for a faster and more comfortable recovery process. She takes the utmost care to preserve ovarian tissue (cystectomy).
• Emergency Management: She has the capacity for rapid diagnosis and effective surgical intervention in emergencies such as ovarian torsion or rupture.
• Referral for Suspicious Cysts: For cysts carrying a suspicion of cancer, she refers the patient to centers experienced in Gynecologic Oncology Surgery for further evaluation and treatment.
• Comprehensive Information and Support: She informs her patients in detail about their condition, treatment options, risks, and the recovery process, answers their questions, and works to ease their concerns. Being reachable (0538 983 18 78)(0312 284 00 12) is essential.

If a cyst has been detected in your ovaries, if you have complaints related to this condition, or if you would like a second opinion, it is important to consult a specialist physician without worry. By making an appointment with Prof. Dr. Nuray Bozkurt at our clinic in Ankara, you can have your condition accurately evaluated and a personalized follow-up or treatment plan created for you. You can reach us for an appointment at 0538 983 18 78.