Ovarian Cysts

Torted (twisted) paraovarian cyst

Ovarian cysts are very common and are broadly divided into physiological and pathological.
Physiological cysts are the normal cysts that develop each month containing the ‘egg’ to be released in pre-menopausal ladies. They are usually completely painless but occasionally cause pain with ovulation. These cysts, if discovered incidentally on an ultrasound scan need no intervention at all.
Pathological cysts are abnormal cysts of the ovaries although the majority are benign. If they cause symptoms, which they frequently do not, they may cause intermittent pain on one or other side of the pelvis or sudden severe pain which usually requires admission to hospital. This severe pain is as a result of the cyst causing the ovary to ‘roll’ in the pelvis, thereby pinching off the blood supply to the ovary and usually causing it to die (ovarian torsion). The less severe intermittent pain is probably the ovary partially rolling, but not fully cutting off it’s blood supply.
The management of ovarian cysts depends on the chances of the cyst being malignant. The varst majority of ovarian cysts identified before the menopause are benign (over 99%). Virtually all benign cysts can and should be managed by keyhole surgery as a day case. The assessment of the likelihood of a cyst being malignant depends on the features of the cyst on ultrasound scan and, postmenopausally, a blood test called a Ca 125.

Torted cyst (close up)

If a cyst is considered likely to be benign it can be removed by keyhole surgery by either simply removing the cyst (ovarian cystectomy) or removing the ovary and usually the fallopian tube (salpingooophorectomy). The decision as to which operation would be recommended is dependent on several factors including your age, fertility desires, condition of the other ovary and type of ovarian cyst amongst other things.More information regarding ovarian cysts before the menopause can be found on the Royal College of Obstetricians & Gynaecologists website.