The way your ovarian cysts will be treated depends on several factors including the size, type and location, whether you are exhibiting any symptoms and whether you have been through the menopause.
There are several different treatments for ovarian cysts, including ‘watchful waiting’, contraceptive pills and surgery.
Where a cyst is small and does not cause any problems or discomfort, your GP may suggest taking a ‘watchful waiting’ approach, which involves monitoring the cyst, but withholding treatment. In such cases, an ultrasound scan may be recommended every three months to determine any changes to the cyst.
In many cases, the ovarian cysts will remain the same size decrease, or even disappear, in which instance no action is usually required.
Most functional cysts tend to disappear on their own without causing any problems to the woman, so this option prevents a woman undergoing treatment where it is not necessary.
In the case of women who are suffering from recurrent ovarian cysts, your GP may prescribe oral contraceptive pills, which are designed to stop ovulation and prevent any new cysts from developing.
Surgery for ovarian cysts
Where a cyst is large, persistent, causing uncomfortable or painful problems, or appears cancerous, your GP may recommend undergoing surgery to remove the cyst or in some cases, the whole ovary. There are two types of surgery which are used to remove ovarian cysts; laparoscopy and laparotomy. In the vast majority of cases, the operation is done via laparoscopic keyhole surgery.
Most ovarian cysts can be removed using a keyhole procedure in which three or four small (5-10mm) incisions are made on the tummy wall. Gas is then blown into the pelvis in order to give the surgeon access to the ovaries. A camera and special surgical instruments (laparoscope) are then inserted to remove the cyst, whilst healthy ovarian tissue is preserved. The cyst is then put in a plastic bag, decompressed and removed, with no spillage inside the tummy. Once the cyst has been removed, the incisions will be closed up using dissolvable stiches.
Minimally invasive keyhole surgery avoids the need for a large incision and has the advantage of reduced hospital stays, quick recovery times and an easy return to normal life.
Where a cyst is exceptionally large or there is a high chance that it could be cancerous, a laparotomy might be the best medical option.
During a laparotomy, a single, large incision is made in the abdomen to allow the surgeon to have easy access to the cyst. From here, the entire cyst or, in some case, the ovary, is removed and sent off to a laboratory for testing for cancer. Once complete, stiches or staples are used to close the cut.
This is the less preferred option, since it is more invasive and usually requires a hospital stay following the procedure.
Do ovarian cysts always need removal?
Not all ovarian cysts need removal. Functional (follicular) cysts will often resolve spontaneously on their own accord. Surgery may be needed if the cysts are persistent or if there are symptoms (see above). If there is a suspicion of cancer, urgent surgery is necessary to make a diagnosis and also to provide treatment.
Will I lose my ovary?
Whether the surgery involves removing only the cyst or the entire ovary depends upon your age and what is found during the procedure. If malignancy is suspected, then the ovary should be removed in order to avoid rupture and spillage of the cyst content. In every other case though, only the cyst will be removed.
How can I prevent recurrent ovarian cysts?
It may not always be possible to prevent ovarian cysts, but going on the contraceptive pill may prevent cyst-formation to a certain degree.
What are the follow-up procedures after removal?
After an ovarian cyst is removed, you will not need further tests if you do not develop any symptoms.
However, some types of ovarian cysts, such as endometriomas (chocolate cysts) and functional ovarian cysts, are more likely to recur than others. If you are concerned about recurrent cysts you should undergo yearly pelvic ultrasound scans.