Ovarian cystectomy

Ovarian cysts are fluid-filled sacs which develop around the ovaries. They are relatively common, rarely malignant (cancerous) and frequently disappear on their own without treatment. However, large or persistent ovarian cysts, or those that cause unwanted symptoms, may need to be surgically removed.

I have a question about removal of ovarian cysts and ovarian cyst symptoms

What are ovarian cysts?

Ovarian cysts are fluid filled sacs which can develop either inside or on the surface of the ovaries. Most ovarian cysts are non-cancerous but some, more commonly in women who have been through the menopause, can be cancerous.

There are two principal types of ovarian cyst. The most common type is functional ovarian cysts which develop as part of the menstrual cycle; they are usually harmless and short-lived.

Much less common are pathological ovarian cysts which are the result of abnormal cell growth. These include:

Dermoid cysts

These form from embryonic cells and can contain hair follicles, skin and sometimes even teeth.

Endometriomas

These develop as a result of endometriosis, where uterine endometrial cells grow outside your uterus. These cysts are sometimes referred to as chocolate cysts as the fluid inside resembles chocolate.

What causes ovarian cysts?

Functional ovarian cysts

These are very common and are linked to the menstrual cycle and the formation of follicles within the ovaries. Each egg is formed inside a follicle which contains a fluid to protect the egg as it grows.  Sometimes when a follicle doesn’t release a fully-grown egg, or it retains the fluid after the egg is released, the follicle can swell and become a cyst. These cysts are usually benign (non-cancerous) but can sometimes cause pelvic pain.

Pathological ovarian cysts

These are less common and aren’t related to the menstrual cycle so can occur in women before and after the menopause. The cysts are caused by the abnormal growth of the cells used to create eggs or the cells of the outer part of the ovary. These cysts can sometimes grow large, or burst, and potentially block the supply of blood to the ovaries. Pathological cysts are usually benign (non-cancerous), but a small number are cancerous.

Ovarian cysts can also sometimes be the result of an underlying condition, such as endometriosis, where small pieces of the womb lining (the endometrium) are found outside the womb (in fallopian tubes, ovaries, bladder, bowel, vagina or rectum). This tissue can sometimes form blood-filled cysts.

Another condition, polycystic ovary syndrome (PCOS), can cause numerous harmless cysts to develop on your ovaries. These small PCOS cysts are caused by egg follicles that don’t reach ovulation, as a result of abnormal hormone levels.

What are the signs and symptoms of ovarian cysts?

Ovarian cysts normally only cause symptoms if they’re very large, if they rupture, or if they block the blood supply to your ovaries.

The signs of a cyst forming, and the ruptured ovarian cyst symptoms could include:

  • Pelvic pain, ranging from dull heaviness to a sudden sharp and severe pain
  • Although the ovary pain location is near the pelvis, you may experience pain during sexual intercourse
  • A need to urinate frequently
  • Difficulty emptying your bowels
  • Abnormally heavy or light periods, or irregular periods
  • Bloated abdomen and/or feeling full after eating very little
  • Sometimes, difficulty getting pregnant
  • Ovarian cyst rupture discharge may occur

If you experience any of these signs of ovarian cysts, contact your GP.

How are ovarian cysts diagnosed?

If your GP suspects ovarian cysts, you may be referred to have an ultrasound scan. If an ovarian cyst is diagnosed, it may need to be monitored over a few weeks or months by successive ultrasound scans to determine if treatment is required.

Can an ovarian cyst cause infertility?

Most ovarian cysts don’t cause infertility. However, in rare cases, cysts that become infected may cause scarring in the Fallopian tubes, which could result in infertility.

If you have any concerns, contact your GP.

What is the treatment for ovarian cysts?

Whether treatment is needed will depend on:

  • The size and appearance of the cyst
  • Whether you have any symptoms
  • Whether you've had the menopause – if you are postmenopausal there’s a slightly higher risk of ovarian cancer, so your GP may recommend regular ultrasounds and blood tests

In most cases, ovarian cysts disappear after a couple of months without any need for treatment and your GP may recommend another ultrasound to check whether the cyst has gone.

If your scan is clear, and the cyst has disappeared, you won’t need further treatment. If it’s still there and is causing you pain, or if it’s very large (in which case it may press on the bladder or other organs), or if there’s a possibility that it could be cancerous, your GP may refer you to our Consultant Gynaecological Surgeons for an ovarian cystectomy.

What is an ovarian cystectomy?

An ovarian cystectomy is a procedure to removes cysts from the ovary. 

An ovarian cystectomy is usually carried out as ‘keyhole’ surgery (laparoscopy). A cyst may be removed during a biopsy carried out to test whether or not the cyst is cancerous - the removed tissue will be examined in a laboratory after the operation.

What happens during an ovarian cystectomy?

A cystectomy is usually carried out as day surgery, which means you’ll be able to return home on the same day, but you won’t be able to drive yourself.

The procedure will be carried out under a general anaesthetic so you’ll be asleep during the operation. An ovarian cystectomy can be carried out in two different ways; laparoscopically or by open surgery (laparotomy).

What should I expect after an ovarian cystectomy?

After the removal of your ovarian cyst, you’ll feel some pain or discomfort which we’ll help manage with painkillers.

Following a laparoscopy (keyhole surgery) you'll need to rest and avoid strenuous activities for a couple weeks. Laparotomy recovery takes a bit longer, usually between six and eight weeks.

If any tissue is sent for analysis, we’ll let you have the results as soon as they’re available - usually after a couple of weeks. We’ll also discuss the need for any further treatment, if required.

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