Been told you have an ovarian cyst? Don't panic

Dr. Judith Reichman 'Today' show contributor • Profile • E-mail

Ovarian cysts are found in nearly all pre-menopausal women, and up to 15 percent of those who are postmenopausal. What makes them occur, what is the chance that a cyst is or will become cancerous and how aggressively should it be treated? "Today" health contributor and gynecologist Dr. Judith Reichman was invited to appear on "Today" to share some insight on  understanding the cystic nature of a woman’s pelvic area. She shares more on the subject here.

First, what is the difference between a cyst and a fibroid?
A cyst is a fluid-filled sac. Cysts found in the pelvis usually originate in the ovary, but may also develop within the fallopian tube. A fibroid is a solid smooth muscle growth that develops in the walls of the uterus.

Fibroids tend to grow in the later reproductive years and indeed are found in at least one-third of women over the age of 35. They are more common in women whose mothers or sisters have a history of fibroids, and in African American women. They can either grow into the wall of the uterus (intramural), project from the outer surface of the uterus (subserosal), or grow into the endometrial cavity (submusosal). Most women with fibroids have no symptoms. These benign tumors are often found during routine pelvic exam or ultrasound. They constitute a problem only if they become large (causing pressure on the bladder and rectum, and-or protruding abdominally) or cause excessive bleeding or pelvic pain. It may be difficult to differentiate a fibroid from an ovarian cyst or mass by pelvic exam alone, but pelvic ultrasound will definitively differentiate between the two.

Although we are dealing chiefly with ovarian cysts, I want to address a common misconception.  Non-symptom causing fibroids do not become cancerous and do not have to be removed “just in case.” Procedures for treatment of fibroids should only be contemplated if these benign uterine tumors cause significant problems. 

Now, let’s consider ovarian cysts. 

Most cysts that develop in women in the reproductive age are a function of their “working” ovaries. We start puberty with about 400,000 egg-producing follicles in our ovaries. Each month hundreds of these follicles attempt to develop, fail to do so and (sadly) die. Only one (rarely several) succeeds in it’s developmental effort and continues the process that allows it to produce a mature egg. It enlarges, produces estrogen and secretes fluid that surrounds the egg, then breaks open and releases the egg into the fallopian tube during ovulation. Once its egg is extruded, the follicle continues to function for the next two weeks as a corpus luteum secreting both estrogen and progesterone; hormones that prepare the uterine lining to receive and nourish a possible pregnancy. In the absence of a pregnancy, the corpus luteum collapses and disappears. Hence, each month that a woman ovulates, a small ovarian cyst is formed; this usually measures 1.5 to 2 centimeters. Subsequent to the release of the egg, this cyst or corpus luteum may collect a small amount of blood prior to its degeneration.

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Now on to larger functional cysts…  Prior to ovulation, the follicle may accumulate too much fluid and form a cyst that is greater than three centimeters. This can cause mid-cycle pain.  After ovulation, a corpus luteum can bleed into itself and also enlarge, forming a hemorrhagic cyst. A woman may present to her physician with pain, or she may go in for a routine exam at which time an enlarged ovary or mass in the pelvis is detected. At this point, an ultrasound is usually done. Then comes the announcement: “you have an ovarian cyst.” And that’s where the concern (and unfortunately for many women, the panic) begins. (By the way, women who smoke have a two-fold increased risk of developing functional ovarian cysts compared to non-smoking women.)

So here is my reassuring gynecologic statement: Functional cysts rarely become larger than six centimeters and should resolve and dissolve after two to three cycles. 

There are, of course, cysts that are not functional. They remain and continue to grow. Age is a factor for both symptoms and diagnosis. Blood-filled cysts in women of reproductive age may be due to endometriosis. This disease affects at least 10 percent of women. Endometrial-like cells that are normally part of the lining of the uterus attach themselves or develop on the wrong surfaces in the pelvis (the ovaries, pelvic wall, bladder, or intestines) and respond to hormonal cycling by expanding, bleeding, causing irritation and the formation of scar tissue.  They can also collect to form a blood-filled cyst on the ovary (an endometrioma). Although this type of cyst can become quite large, the pain caused by endometriosis is not directly related to size of the lesions. Small implants of endometrial cells scattered in the pelvis (and not felt during exam or seen on ultrasound) may actually cause the worst pain. 

Aren’t some ovarian cysts tumors?
Yes. But not all ovarian tumors are cancer. A tumor means a growth. There are several types of benign growths that can develop on the ovaries. Once more, the age at which the tumor occurs usually impacts the type of tumor or cyst that is most commonly found. Dermoid cysts (also called benign cystic teratoma) are the most common form of benign ovarian tumors in young women. These develop from germ cells which are primitive cells that are capable of producing eggs and all human tissues. A dermoid cyst is formed if the germ cells multiply bizarrely without fertilization, forming an encapsulated tumor that contains hair, sebaceous or oil materials, cartilage, bone, neural tissue and teeth. Dermoid cysts are most commonly diagnosed in women between the ages of 20 and 40. They range in size from one to 45 centimeters. Up to 15 percent of dermoid cysts occur on both ovaries. The good news is that 98 percent of these tumors are benign. Only on rare occasions do the overactive germ cells form malignant tumors (malignant teratomas).

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