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It is important to state from the outset that formation of cysts is a normal physiological function of ovaries. Ovaries repeatedly form cysts. They are supposed to do that. The presence of a cyst on an ovary is, therefore, in the majority of cases, completely normal.

What’s a cyst

A cyst is a fluid-filled sac. Ovaries are not the only part where cysts form. A typical ovarian cyst is usually fairly small, measuring less than 5 cm across and is filled with clear fluid. An ultrasound scan will show it is a uniformly dark round structure. Normal physiological cysts (and these are the majority) will come and go throughout a woman’s reproductive years.

Pain and ovarian cysts:

Contrary to popular belief, cysts are usually painless. Even when they grow significantly bigger, sometimes up to a size of big orange or bigger, the tendency is to remain painless. Every practising gynaecologist will have encountered a situation where a woman presenting with pelvic pain whose scan shows an ovarian cyst will sit down convinced that this is the source of her problem.

Sadly, in the vast majority of cases, that is not so. It can be very difficult to persuade her otherwise, especially when you are not in a position to give her a credible alternative explanation.

It needs to be stated again and very firmly that ovarian cysts rarely cause pain.

Types of ovarian cysts

Functional or ‘normal’ cysts come in two forms. These are called:

· Follicular cysts

· Corpus luteum

A follicle is the part of the ovary that will normally develop an egg, usually released half way through a menstrual cycle. Sometimes the follicle does not release the egg. Instead, it continues to fill with fluid, gradually increasing in size. This can get up to 5 cm, sometimes slightly larger than this. It can persist for several weeks, even months. It is typically painless.

A corpus luteum, on the other hand, is a small bag of fluid left behind when the follicle releases an egg. In other words, it is the remnant structure after ovulation. It is usually filled with fluid but sometimes the process of ovulation can cause slight haemorrhage within the cyst. In such a case, the cyst will be filled with watery fluid mixed with blood. It is then, descriptively called a haemorrhagic cyst. Despite this, it remains painless. Corpus luteum cysts are of similar sizes to follicular cysts. They can also persist for weeks. This is why women will be commonly found to have these small or moderate sized cysts which are of no clinical significance. This is particularly the case for women not on the pill.

Functional cysts are also called ‘Physiological’ cysts. They are normal and not a disease.

Benign Ovarian Cysts

Dermoid Cysts: These cysts, also called mature cystic teratomas, are not uncommon. They are mostly benign. Ovaries are just one of the sites in the body where dermoid cyst can be found. They can form anywhere. They are found in both sexes. Rarely, malignant dermoid cysts are found.

As the name suggests, a dermoid ‘cyst’ contains mainly mature skin tissue. This will have hair follicles and in fact, one of the commonest findings within a dermoid cyst is a clump of hair. These cysts can also contain a variety of other body tissues including teeth, bone, fat, thyroid tissue, cartilage and more. A lot of patients are freaked out when they are informed of these findings but that is the nature of these benign tumours. Whilst it is not strictly necessary to remove a dermoid cysts; many doctors and, in fact, most patients prefer to have them out once diagnosed. A dermoid cyst is usually diagnosed accurately using an ultrasound scan. Often, the diagnosis is made as an incidental finding during an unrelated operation such as a caesarean section.

Dermoid cysts can be diagnosed at any age. When diagnosed later in life, it simply means the cyst has been there for years undiscovered. This is because they are typically symptom-less.

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cysts rarely cause symptoms

Ovarian cyst

Womb (uterus)

Ovarian Cysts: An overview