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.
Here to to ease the worried minds of women and to discuss the risks of ovarian cysts is Peter Frederick, MD, FACOG. He is the Director of Minimally Invasive Surgery in the Department of Gynecologic Oncology at Roswell Park Comprehensive Cancer Center.
Selected Podcast
Ovarian Cysts: What Are the Risks?
Featured Speaker:
Learn more about Peter Frederick, MD
Peter Frederick, MD
Peter Frederick, MD, FACOG is the Director of Minimally Invasive Surgery in the Department of Gynecologic Oncology with Roswell Park Comprehensive Cancer Center.Learn more about Peter Frederick, MD
Transcription:
Ovarian Cysts: What Are the Risks?
Bill Klaproth (Host): Here to talk with us about the risks of ovarian cysts is Dr. Peter Frederick, Director of Minimally Invasive Surgery and the Department of Gynecologic Oncology at Roswell Park Comprehensive Cancer Center. Dr. Frederick, thank you for your time. So, what are the different types of ovarian cysts?
Dr. Peter Frederick (Guest): Well, there are a lot of different kinds of ovarian cysts, and I think the most common kind of ovarian cyst is what we term a functional cyst, which often occurs in women who are premenopausal – women who are still having their menstrual periods. Other kinds of cysts that we see can include dermoid cysts, which are sometimes made up of different cell lines – they could have bones, and teeth, and hair in them. There are cysts that are associated with certain hormonal conditions like polycystic ovarian syndrome. Other cysts that are associated with conditions like endometriosis – these are called endometriomas.
Bill: How do these cysts develop?
Dr. Frederick: Well, it really depends on the kind of cyst that we’re talking about. Certain cysts are mediated by hormones, so as hormones fluctuate during the menstrual cycle, some cysts can form as a result of that during ovulation. If there’s not a reabsorption of the cyst, that can occur. When we talk about polycystic ovarian syndrome, there are multiple small cysts that will usually occur in combination with other hormonal conditions, such as higher androgen levels and metabolic resistance.
With endometriosis, sometimes there’s some tissue from the uterus inside the ovary. Every time a menstrual period occurs, there’s a little bit of bleeding that occurs inside the ovary where these glands are located, and then that can cause the cyst to form over time. It’s a complicated answer depending on what cysts you’re talking about.
Bill: Right, and do ovarian cysts pose any fertility or pregnancy risks?
Dr. Frederick: No, not usually. Most women that have cysts don’t even know that they have them. When we’re talking about pregnancy, a lot of women are getting ultrasounds now to look at the pregnancy, and so sometimes cysts are identified incidentally. Whereas in the old days, when we weren’t getting routine ultrasounds, they were probably there, we just didn’t know about it. Some of those conditions that I did talk about like endometriosis and polycystic ovarian disease can increase the risk of having fertility, but just because a woman has endometriosis or PCOS doesn’t mean she’d necessarily be infertile.
Bill: So there are no symptoms of these?
Dr. Frederick: In some cases, there can be symptoms. If a cyst becomes a certain size, it can result in pain. Sometimes that’s pelvic discomfort; sometimes it can be abdominal pain if the cyst gets really large and grows outside of the pelvis and if the cyst is putting pressure on other structures in the pelvis, there can be GI symptoms or urinary symptoms as well.
Bill: So is pain the main reason they get discovered, or is it through routine ultrasounds?
Dr. Frederick: Yeah, I would think pain would be the main presenting symptom for the majority of women. Sometimes, if a woman is going to the physician for a regular gynecologic exam, they can be discovered on exam by the healthcare provider, and then sometimes they’ll get picked up on ultrasound as well.
Bill: Um-hum. So, do ovarian cysts pose any cancer risks?
Dr. Frederick: Not in themselves. They haven’t been shown to turn into cancer or anything of that nature. I think the challenge is that sometimes, cancer can present as a mass on the ovary. For the healthcare provider, it’s a challenge to differentiate between a benign cyst and a potentially cancerous cyst – or a potentially cancerous growth, in other words. Cysts themselves don’t cause cancer, but sometimes, it takes some experience and some expertise to differentiate between what is a benign cyst and what is potentially cancerous.
Bill: And Dr. Frederick, how are ovarian cysts generally treated?
Dr. Frederick: In the majority of cases, no treatment is required, especially if this cyst is asymptomatic. If it’s a functional cyst that causes some discomfort during the menstrual cycle, NSAIDs like Motrin or ibuprofen can help with the discomfort. If it’s appropriate, sometimes oral contraceptive pills can be used to suppress ovulation and prevent other cysts from forming. In extreme circumstances, if the cyst becomes really large, or if it’s uncertain if there might be a cancer involved, surgery may be required to remove the cyst, but certainly, if there’s a low suspicion for cancer, we would see surgery as more of a last resort.
Bill: In most cases, simple management is what’s effective?
Dr. Frederick: Yeah, that’s right. Especially for simple, functional cysts, the majority of them – about 80% -- will resolve on their own without any kind of surgical intervention, so sometimes, we’ll just follow them up with a repeat ultrasound in six to eight weeks just to confirm that they’re not getting any bigger, and then 80% of the time they’ll go away on their own.
Bill: So are there any other risks involved with ovarian cysts?
Dr. Frederick: Well, in some cases, if there’s a cyst present it can result in a torsion, which means the ovary will turn on its stalk. That can be uncomfortable – the blood supply is cut off to the ovary, and so if that’s the case, a timely diagnosis and surgical intervention are important to do. If the cyst gets large in some cases, it can rupture, and that can also cause some discomfort. I think it’s important to educate our patients to be mindful of those symptoms like pelvic pain and GI or genitourinary issues, and if they have those symptoms for a prolonged period of time to bring that to the attention of their healthcare provider. And obviously, if it's a pain that’s really severe, you don’t want to wait twelve days. Let your doctor know right away.
Bill: Okay, that’s good advice. And Dr. Frederick, can ovarian cysts be prevented?
Dr. Frederick: I think the oral contraceptive pills can prevent functional ovarian cysts from forming in the future. Endometriosis can also be treated with hormonal treatment. Some cysts like dermoid cysts, there’s really no known prevention that we know of. Obviously, if a woman has surgery and her ovaries are removed, that would prevent cysts from forming in the future, but we would only do that if she’s got a high risk of developing cancer or if she’s very symptomatic from the cyst that can’t be managed in a non-surgical fashion.
Bill: So generally, lifestyle doesn’t cause these or promote these?
Dr. Frederick: No, it doesn’t appear to. Obviously, we encourage healthy diet and exercise for all of our patients, but lifestyle practices seem unrelated to cyst formation.
Bill: And Dr. Frederick, is there anything that I haven’t asked you that we should know about ovarian cysts?
Dr. Frederick: There are a lot of different kinds of ovarian cysts, and there are a lot of other kinds of masses in the pelvic area that may not be cysts. If there’s any uncertainty, it’s always good to communicate with your healthcare provider, and don’t be afraid to get a second opinion.
Bill: Always good advice and Dr. Frederick, thank you so much, for your time today. For more information, visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
Ovarian Cysts: What Are the Risks?
Bill Klaproth (Host): Here to talk with us about the risks of ovarian cysts is Dr. Peter Frederick, Director of Minimally Invasive Surgery and the Department of Gynecologic Oncology at Roswell Park Comprehensive Cancer Center. Dr. Frederick, thank you for your time. So, what are the different types of ovarian cysts?
Dr. Peter Frederick (Guest): Well, there are a lot of different kinds of ovarian cysts, and I think the most common kind of ovarian cyst is what we term a functional cyst, which often occurs in women who are premenopausal – women who are still having their menstrual periods. Other kinds of cysts that we see can include dermoid cysts, which are sometimes made up of different cell lines – they could have bones, and teeth, and hair in them. There are cysts that are associated with certain hormonal conditions like polycystic ovarian syndrome. Other cysts that are associated with conditions like endometriosis – these are called endometriomas.
Bill: How do these cysts develop?
Dr. Frederick: Well, it really depends on the kind of cyst that we’re talking about. Certain cysts are mediated by hormones, so as hormones fluctuate during the menstrual cycle, some cysts can form as a result of that during ovulation. If there’s not a reabsorption of the cyst, that can occur. When we talk about polycystic ovarian syndrome, there are multiple small cysts that will usually occur in combination with other hormonal conditions, such as higher androgen levels and metabolic resistance.
With endometriosis, sometimes there’s some tissue from the uterus inside the ovary. Every time a menstrual period occurs, there’s a little bit of bleeding that occurs inside the ovary where these glands are located, and then that can cause the cyst to form over time. It’s a complicated answer depending on what cysts you’re talking about.
Bill: Right, and do ovarian cysts pose any fertility or pregnancy risks?
Dr. Frederick: No, not usually. Most women that have cysts don’t even know that they have them. When we’re talking about pregnancy, a lot of women are getting ultrasounds now to look at the pregnancy, and so sometimes cysts are identified incidentally. Whereas in the old days, when we weren’t getting routine ultrasounds, they were probably there, we just didn’t know about it. Some of those conditions that I did talk about like endometriosis and polycystic ovarian disease can increase the risk of having fertility, but just because a woman has endometriosis or PCOS doesn’t mean she’d necessarily be infertile.
Bill: So there are no symptoms of these?
Dr. Frederick: In some cases, there can be symptoms. If a cyst becomes a certain size, it can result in pain. Sometimes that’s pelvic discomfort; sometimes it can be abdominal pain if the cyst gets really large and grows outside of the pelvis and if the cyst is putting pressure on other structures in the pelvis, there can be GI symptoms or urinary symptoms as well.
Bill: So is pain the main reason they get discovered, or is it through routine ultrasounds?
Dr. Frederick: Yeah, I would think pain would be the main presenting symptom for the majority of women. Sometimes, if a woman is going to the physician for a regular gynecologic exam, they can be discovered on exam by the healthcare provider, and then sometimes they’ll get picked up on ultrasound as well.
Bill: Um-hum. So, do ovarian cysts pose any cancer risks?
Dr. Frederick: Not in themselves. They haven’t been shown to turn into cancer or anything of that nature. I think the challenge is that sometimes, cancer can present as a mass on the ovary. For the healthcare provider, it’s a challenge to differentiate between a benign cyst and a potentially cancerous cyst – or a potentially cancerous growth, in other words. Cysts themselves don’t cause cancer, but sometimes, it takes some experience and some expertise to differentiate between what is a benign cyst and what is potentially cancerous.
Bill: And Dr. Frederick, how are ovarian cysts generally treated?
Dr. Frederick: In the majority of cases, no treatment is required, especially if this cyst is asymptomatic. If it’s a functional cyst that causes some discomfort during the menstrual cycle, NSAIDs like Motrin or ibuprofen can help with the discomfort. If it’s appropriate, sometimes oral contraceptive pills can be used to suppress ovulation and prevent other cysts from forming. In extreme circumstances, if the cyst becomes really large, or if it’s uncertain if there might be a cancer involved, surgery may be required to remove the cyst, but certainly, if there’s a low suspicion for cancer, we would see surgery as more of a last resort.
Bill: In most cases, simple management is what’s effective?
Dr. Frederick: Yeah, that’s right. Especially for simple, functional cysts, the majority of them – about 80% -- will resolve on their own without any kind of surgical intervention, so sometimes, we’ll just follow them up with a repeat ultrasound in six to eight weeks just to confirm that they’re not getting any bigger, and then 80% of the time they’ll go away on their own.
Bill: So are there any other risks involved with ovarian cysts?
Dr. Frederick: Well, in some cases, if there’s a cyst present it can result in a torsion, which means the ovary will turn on its stalk. That can be uncomfortable – the blood supply is cut off to the ovary, and so if that’s the case, a timely diagnosis and surgical intervention are important to do. If the cyst gets large in some cases, it can rupture, and that can also cause some discomfort. I think it’s important to educate our patients to be mindful of those symptoms like pelvic pain and GI or genitourinary issues, and if they have those symptoms for a prolonged period of time to bring that to the attention of their healthcare provider. And obviously, if it's a pain that’s really severe, you don’t want to wait twelve days. Let your doctor know right away.
Bill: Okay, that’s good advice. And Dr. Frederick, can ovarian cysts be prevented?
Dr. Frederick: I think the oral contraceptive pills can prevent functional ovarian cysts from forming in the future. Endometriosis can also be treated with hormonal treatment. Some cysts like dermoid cysts, there’s really no known prevention that we know of. Obviously, if a woman has surgery and her ovaries are removed, that would prevent cysts from forming in the future, but we would only do that if she’s got a high risk of developing cancer or if she’s very symptomatic from the cyst that can’t be managed in a non-surgical fashion.
Bill: So generally, lifestyle doesn’t cause these or promote these?
Dr. Frederick: No, it doesn’t appear to. Obviously, we encourage healthy diet and exercise for all of our patients, but lifestyle practices seem unrelated to cyst formation.
Bill: And Dr. Frederick, is there anything that I haven’t asked you that we should know about ovarian cysts?
Dr. Frederick: There are a lot of different kinds of ovarian cysts, and there are a lot of other kinds of masses in the pelvic area that may not be cysts. If there’s any uncertainty, it’s always good to communicate with your healthcare provider, and don’t be afraid to get a second opinion.
Bill: Always good advice and Dr. Frederick, thank you so much, for your time today. For more information, visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.