- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
The cysts discussed here are fluid-filled sacs that develop on a woman’s ovaries. During a normal menstrual cycle, small cysts may form and then disappear once the next period begins.
This occurs throughout the reproductive years for most women. These cysts are usually harmless and cause minimal discomfort. However, some cysts may enlarge, some may contain blood, and others may twist, leading to complications such as bleeding and/or pain, which may require surgical treatment.
Some cysts grow larger and must be treated either with medication or by surgical removal. A small percentage of cysts are serious because they may rupture or become cancerous.
Although young women are more prone to developing cysts, the majority are benign and go away without treatment. Some cysts can cause pain during intercourse or create a feeling of fullness/pressure in the abdomen.
Most ovarian cysts are benign (non-cancerous). Some types of benign ovarian cysts include:
The diagnostic approach includes a physical examination, blood tests for ovarian tumor markers (CA-125), ultrasound and laparoscopy.
The endometriosis lesions can lead to pathological cysts when endometrial tissue grows on the ovaries. These cysts are often called “chocolate cysts,” because they contain old dark blood.
Each month, this tissue bleeds, but the blood becomes trapped inside the cyst, causing it to grow. Some can grow to the size of a grapefruit! Eventually, these cysts may rupture, potentially damaging the ovary and causing severe pain.
Treatment includes monitoring and laparoscopic surgery.
For a personalized assessment of your case, book an appointment with Dr. Panagiotis Polyzos at his office in Athens or Volos.
Ovarian cystectomy is a surgical procedure used to remove one or more cysts from the ovary. Laparoscopic surgery is a minimally invasive technique that requires only a few small incisions in the abdominal area.
Many women will develop at least one ovarian cyst in their lifetime. Most cysts cause little to no symptoms. However, if a cyst causes painful or bothersome symptoms, surgical removal may be the best treatment option.
An ovarian cyst may need to be removed if it:
A small incision is made just below the navel, and a laparoscope — a thin tube with a camera — is inserted. Carbon dioxide gas is used to inflate the abdomen for better visualization. Once the cyst is located, one or two additional small incisions are made to insert surgical instruments. The cyst is removed and sent for a pathology examination. If cancer is detected, both ovaries may need to be removed. The instruments are withdrawn, and the incisions are closed with stitches or staples and covered with dressings. If laparoscopy is not feasible, the surgeon may convert to an open abdominal surgery (laparotomy) using a larger incision.
This procedure has low risks, but some potential complications include:
Before the procedure, the surgical team will discuss:
Pre-operative preparation includes:
Full recovery takes up to 2 weeks. Physical activity will be limited during this time. Intercourse should be avoided. Seek assistance with daily tasks and delay returning to work if possible.
Contact your gynecologist if you experience:
After surgery, abdominal and navel soreness and bruising are common.
Shoulder and back pain may occur due to the gas used during laparoscopy. Some light vaginal spotting may also occur. The abdominal incisions are closed with dissolvable stitches and may be covered with adhesive dressings.
Most ovarian cysts are found by chance on a routine ultrasound. They do not hurt and do not change your cycle. But when they grow or bleed, your body sends signals worth recognizing.
None of these symptoms is unique to cysts. Only a transvaginal ultrasound gives a definite answer.
Two complications need immediate medical care, because every hour of delay can cost the ovary.
A cyst makes the ovary heavier, and the ovary can twist around the blood vessels that supply it. The risk rises mainly when the cyst is larger than about 5 centimeters. The typical sign is sudden, very severe pain on one side, often with nausea and vomiting. It is treated surgically, usually laparoscopically, by “untwisting” the ovary and preserving it whenever possible.
It often happens after intercourse or intense exercise. Most ruptures cause pain that gradually eases within one to two days. However, if the cyst bleeds into the abdomen, surgery may be needed.
Go to a hospital right away if you have:
Transvaginal ultrasound is the main test. The doctor looks not only at the size but, above all, at the features of the cyst.
Specialist sonographers use international classification systems, such as IOTA and O-RADS, which reliably estimate the likelihood of cancer. When the picture is not clear, an MRI helps tell them apart.
The tumor marker CA-125 also rises in many benign conditions: endometriosis, fibroids, pelvic inflammation, even during your period. That’s why it is interpreted with caution in young women. It is more useful after menopause.
A simple functional cyst in a woman of reproductive age usually disappears within 6 to 12 weeks. The repeat scan is ideally done at the start of the next cycle, a few days after your period ends, when the ovary is “quieter.”
After menopause, the ovaries no longer ovulate, so functional cysts are much less common. Even so, small simple cysts are found in many postmenopausal women, and the vast majority are benign.
The assessment here is more careful. The doctor combines three elements: the ultrasound picture, CA-125 and menopausal status. These are often used to calculate a risk of malignancy index (RMI), which determines whether monitoring is enough or a referral to a gynecologic oncologist is needed.
Most cysts do not affect fertility. The question becomes critical when surgery is needed, because any operation on the ovary inevitably removes some healthy tissue with follicles as well.
A common confusion: polycystic ovaries are not cysts in the sense used on this page. They are many small follicles that did not mature, as part of a hormonal disorder, and they are not removed surgically.
In the first trimester, a corpus luteum cyst is a very common finding. It produces progesterone that supports the pregnancy until the placenta takes over, and it usually disappears by the second trimester.
Most are functional and benign, and they go away on their own within two to three cycles.
When the cyst is large, persists, causes symptoms or has ultrasound features that call for histological examination.
Usually yes. Functional cysts do not affect fertility. Endometriotic cysts and polycystic ovary syndrome (PCOS) can make it harder.
The bursting of a cyst, which causes sudden pain low in the abdomen. It is usually managed conservatively, but severe pain needs immediate assessment.
Birth control pills do not dissolve an existing cyst, but they reduce the chance of new functional cysts forming.
Yes. Some functional cysts, such as a persistent corpus luteum cyst, keep producing progesterone and can delay your period by a few days or weeks. Before the delay is blamed on the cyst, pregnancy should always be ruled out with a simple test.
Size alone is not enough. A simple 4-centimeter cyst in a young woman is usually harmless, while a smaller cyst with solid parts needs further investigation. Cysts over 5 centimeters are monitored more closely because of the risk of torsion, and cysts over 7 to 10 centimeters are often removed, because they are hard to assess fully by ultrasound.
Functional cysts can appear again in any cycle, because they are linked to ovulation. Endometriomas have a significant chance of recurring in the following years. Hormonal treatment after surgery, for women not trying to get pregnant right away, lowers this chance. Dermoid cysts rarely come back once they are removed completely.
For small simple cysts without symptoms, no restrictions are needed. For cysts larger than 5 centimeters, your doctor may advise you to avoid sports with sudden twisting, jumping or impact until the repeat scan or surgery. If intercourse is painful, stop and mention it at your next exam.
