Ovarian Cysts: What Are the Risks?
According to the Office on Women’s Health, U.S. Department of Health and Human Services, ovarian cysts are very common in women with regular periods. Most women will make at least one cyst—fluid-filled sacs that can range widely in size, from as small as a pea to larger than an orange—during their lifetime, but in most cases, cysts will be painless and cause no symptoms. In fact, most women won’t even be aware that they have a cyst unless there is a problem that causes the cyst to grow or if multiple cysts form. And more good news—for the most part, these cysts do not cause cancer, nor do they affect fertility or healthy pregnancies.
The most common ovarian cysts are called functional cysts, which include corpus luteum cysts and follicular cysts. Functional cysts occur in women who are still having menstrual periods, and most of these cysts will disappear on their own. Other types of cysts include cystadenomas, (which are benign growths that can sometimes grow quite large), and dermoid cysts (which contain different types of tissue including hair and skin and teeth).
"Fortunately these types of cysts are not typically related to infertility or cancer and most women can complete a healthy pregnancy to term if she has an ovarian cyst," says Dr. Peter Frederick, Director of Minimally Invasive Surgery in the Department of Gynecologic Oncology. “Ovarian cysts are commonly seen during pregnancy, and the vast majority of them cause no problems at all,” says Dr. Frederick. “If an ovarian cyst gets to be quite large, there may be a risk of the cyst rupturing. On rare occasions, the stem of an ovary can become twisted, blocking the blood supply to the cyst and causing abdominal or pelvic pain. Whether or not the cyst is removed or observed during pregnancy at this point depends on different factors, such as the size and appearance of the cyst and how far along the pregnancy is.”
Dr. Frederick notes that most ovarian cysts have no negative impact on fertility whatsoever. However, if cysts are associated with conditions such as endometriosis or polycystic ovarian syndrome (PCOS), there may be an increased risk of infertility. In endometriosis, the tissue that lines the inside of the uterus (endometrium) grows outside the uterus. If this tissue is located in the ovaries, this can result in cysts called endometriomas. In PCOS, there can be multiple small cysts on the ovaries, as well as an increase in certain hormones that can affect ovulation.
Most ovarian cysts appear without symptoms and may be discovered during a routine exam or seen during imaging done for a different reason. When symptoms do occur, they may include pelvic pain, pain during intercourse, abdominal bloating or fullness, painful bowel movements or problems with urination. “If these symptoms are severe or persist for 12 or more days in a 30-day period, it’s important to notify your healthcare provider,” says Dr. Frederick.
Do ovarian cysts increase cancer risk? “Ovarian cysts are not known to cause cancer themselves, but there are two caveats here,” says Dr. Frederick. “First, some conditions that are associated with ovarian cysts are also associated with an increased risk of developing cancer. For example, endometriosis has been associated with a small increase in the risk of ovarian cancer, and PCOS is associated with an increased risk of endometrial cancer. Second, sometimes it is difficult to distinguish a benign ovarian cyst from a cancerous growth on the ovary. Depending on the appearance of the mass on imaging, and other risk factors, your healthcare provider may opt to order additional tests to further clarify the likelihood of cancer, perform diagnostic surgery, or refer you to another specialist such as an oncologist for management.”
To reduce the incidence of ovarian cysts, women may be recommended oral contraceptive pills to prevent ovulation, which can reduce the frequency of new functional cysts from forming in the future. Surgical removal of the ovaries will also reduce the risk of cysts, but this is only done in certain circumstances.
Roswell Park’s team of board-certified gynecologic oncologists who specialize in cancers of the female reproductive system are committed to evaluating and treating women with pelvic masses that may be at risk for ovarian cancer. “Roswell Park also has a team of certified genetics counselors who can evaluate and advise women who have a personal or family history that may increase their risk of developing ovarian cancer in the future. Fortunately, the majority of ovarian cysts are benign and do not require surgery, but sometimes the decision to undergo surgery, or not, can be a complicated one that requires experience and expertise,” says Dr. Frederick.