A Comprehensive Guide on Ovarian Cysts: How do they affect fertility? 

Introduction

Ovarian cysts are fluid-filled sacs that form on or within the ovaries. There are several types of ovarian cysts, and while they are usually harmless, they can sometimes lead to complications that affect a woman’s health and fertility. 

Reproductive health plays a vital role in Singapore, particularly in light of the country’s declining birth rate [1]. Early detection and management of ovarian cysts can help women who are planning to conceive prevent complications and protect their fertility. It is also important to understand the symptoms of ovarian cysts in case of a rupture or other side effects that may affect health and well-being.  

Keep reading to learn more about ovarian cysts, including their causes, symptoms, diagnosis, treatment options, and how they relate to fertility. 

What are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that form on or inside the ovaries. They are common among women of all ages and are often harmless, typically resolving on their own without the need for medical intervention. However, some cysts may cause symptoms or complications, particularly if they grow larger or rupture.

The size of an ovarian cyst [2] is an important factor in determining its impact. Smaller cysts are typically asymptomatic and less likely to cause problems, while larger cysts may increase the risk of pain or complications such as torsion or rupture.

Understanding the type and size of a cyst is important for effective management and ensuring it does not affect fertility and reproductive health.

Types of Ovarian Cysts

Functional Cysts: These are the most common type and are linked to the menstrual cycle. They include:

• Follicular cysts: Often forming when the follicle fails to release an egg.
• Corpus luteum cysts: These develop after the egg is released.

Pathological Cysts: These are less common and may require medical attention. They include:

• Dermoid cysts: Made up of various tissues such as hair or skin and are also known as teratomas.
• Cystadenomas: Usually grow on the ovarian surface and contain a watery substance.
• Endometriomas: Cysts are associated with endometriosis when tissues similar to the uterine lining grow outside the uterus and attach to the ovary​.

Why do Ovarian Cysts develop?  

Ovarian cysts can develop due to various reasons, including:

• Hormonal imbalances: Disruptions in hormone levels can lead to the formation of functional cysts.
• Menopause: Postmenopausal women can be at risk of cysts that are more likely to be malignant. 
• Underlying conditions:
  • Polycystic Ovary Syndrome (PCOS): A hormonal condition that affects women of reproductive age, often causing multiple small cysts in the ovaries and infertility.
  • Endometriosis:  A condition where tissue and cells similar to the uterus lining grow outside the uterus, sometimes leading to the development of endometriomas.
• Other factors:
  • Genetic predisposition: Having a family history of hormonal imbalances or ovarian cysts. 
  • Pregnancy: Corpus luteum cysts [3] can form in early pregnancy.
  • Pelvic infections that spread to the ovaries.
  • Fertility treatments: Those that stimulate ovulation, such as clomiphene (Clomid) [4], may increase the risk of ovarian cysts.
  • History of ovarian cysts: Those who have had ovarian cysts in the past are more likely to develop them again. 

How do you know if you have Ovarian Cysts?

Ovarian cysts are usually asymptomatic and go unnoticed. However, when symptoms occur, they may include:

• Sharp or sudden pelvic pain
• Abdominal bloating or a sense of fullness in the stomach
• Irregular or missed periods
• Heavy bleeding and pain during periods
• Pain during sexual intercourse
• Frequent urination or discomfort with bowel movements 

If symptoms suggest the presence of an ovarian cyst, your doctor may use the following methods to confirm the diagnosis: 

Pelvic Exam

During a routine pelvic exam, your doctor or gynaecologist may suspect the presence of an ovarian cyst. The doctor will check for any lumps or changes in the ovaries that may indicate a cyst.

Imaging Tests

To confirm the presence and characteristics of an ovarian cyst, imaging techniques are usually used, including:

• Pelvic Ultrasound: The most common and effective method for diagnosing ovarian cysts, a transvaginal ultrasound provides clear images of the ovaries. A small probe is inserted into the vagina, allowing the doctor to assess the cyst’s size, location, and whether it’s fluid-filled or solid.
• CT Scan or MRI: These imaging tests may be recommended when more detailed images are needed, particularly for complex cysts.

Blood Tests

If an ovarian cyst is confirmed through ultrasound, blood tests may be ordered for further evaluation:

• Pregnancy Test: Since ovarian cysts are common during pregnancy, a pregnancy test can help rule it out as the cause of symptoms.
• CA 125 Test: This blood test measures the level of cancer antigen 125, a protein that can be elevated in ovarian cancer. However, elevated CA 125 levels can also occur in non-cancerous conditions like endometriosis or pelvic infections. This test is usually recommended for postmenopausal women or if the cyst seems suspicious.

Do Ovarian Cysts need to be removed? 

Whether an ovarian cyst requires surgical removal depends on its size, type, symptoms, and potential risks. Many ovarian cysts, particularly functional ones, are harmless and often resolve within a few menstrual cycles. Small functional cysts usually disappear without intervention and are frequently monitored through regular ultrasound scans. If a cyst does not cause pain, discomfort, or interfere with daily life, your gynaecologist may opt for a monitoring approach.

However, some cysts may need surgical removal under specific circumstances. These include: 

• Persistent or growing cysts: If a cyst does not resolve or continues to enlarge, your gynaecologist may advise removal to eliminate complications.
• Painful or symptomatic cysts: Cysts causing pelvic pain, bloating, or irregular periods may require intervention.
• Complex or pathological cysts: Dermoid cysts, cystadenomas, or endometriomas may need to be removed to prevent complications or assess for malignancy.
• Cysts with suspected malignancy: Large cysts, especially in postmenopausal women, may be surgically removed for further evaluation to rule out ovarian cancer.
• Complications: If a cyst ruptures, causes ovarian torsion, or results in severe pain, immediate medical attention and surgical intervention may be necessary.

Surgical approaches for ovarian cysts include:

• Laparoscopy: A minimally invasive procedure ideal for smaller or uncomplicated cysts.
• Laparotomy: Open surgery for larger or more complex cysts.

How are Ovarian Cysts treated without surgery?

Ovarian cysts can be managed and treated in several ways without surgery. These include: 

• Hormonal therapy, such as birth control pills, may be prescribed to prevent the formation of new cysts.
• Pain management, lifestyle adjustments, and monitoring through regular check-ups.

Consulting a gynaecologist is essential to determine the best course of action based on your circumstances. Early detection and management can prevent complications and protect reproductive health.

What does a ruptured Ovarian Cyst feel like?

A ruptured cyst is a medical emergency. If you experience these symptoms, seek immediate medical assistance. A ruptured ovarian cyst usually causes:

• Sudden and severe abdominal or pelvic pain.
• Nausea or vomiting.
• Light-headedness or fainting.
• Heavy vaginal bleeding.

Do Ovarian Cysts cause infertility?

While many ovarian cysts do not impact or directly cause infertility, certain types [5] can make it more difficult for women to get pregnant. However, for most women, timely treatment and fertility-focused care can help preserve or restore fertility. Here are some ways that ovarian cysts can lead to fertility issues: 

• PCOS: Causes hormonal imbalances and irregular ovulation, which can lead to infertility.
• Endometriomas: Linked to reduced ovarian reserve and implantation issues.
• Surgical considerations: Repeated surgeries to remove cysts may damage ovarian tissue and reduce egg supply.

Can you prevent Ovarian Cysts from developing?

While not all ovarian cysts are preventable, you can take steps to reduce your risk, especially if you already have risk factors such as hormonal imbalances or a family history of ovarian cysts. These include:

• Maintaining a healthy lifestyle: Following a healthy and balanced diet, exercising regularly, and managing stress effectively can boost your health and prevent ovarian cysts from developing.
• Regular gynaecological check-ups: Early detection through routine screenings is essential, so make it a point to schedule regular appointments with your gynaecologist. 
• Taking hormonal birth control: Your gynaecologist may prescribe birth control medication to regulate ovulation and prevent cysts.
• Paying attention to your menstrual cycle: Keep aware of menstrual irregularities or unusual recurring symptoms to stay aware of your current reproductive health.  

Conclusion

Ovarian cysts are a common aspect of women's reproductive health that are usually harmless but can occasionally lead to serious complications. It is important to take note of any unusual symptoms and seek gynaecological care regularly. Early detection and timely treatment can help manage cysts, alleviate symptoms, and reduce their impact on fertility.

If you have concerns about ovarian cysts or fertility, consult Dr Ma Li in Singapore for guidance and personalised treatment. Specialising in advanced gynaecological surgery, early intervention, and the long-term management of gynaecological conditions, she is dedicated to healing and empowering women through comprehensive care and support. Contact us today to book a consultation. 

Frequently Asked Questions

What does ovarian cyst pain feel like?

If an ovarian cyst causes symptoms, you may experience pressure, bloating, swelling, or pain in the lower abdomen on the side where the cyst is located. The pain can vary in intensity, from sharp to dull, and may come and go. If a cyst ruptures, it can cause sudden and intense pain that requires immediate medical attention.

Do ovarian cysts go away?

Many functional ovarian cysts don’t require treatment and typically resolve on their own within 8 to 12 weeks. If you have recurrent cysts, your doctor may recommend birth control pills (oral contraceptives) to reduce the risk of developing new cysts in the future.

Can a cyst come out during your period?

A cyst can rupture or burst during your period, which can result in sudden, sharp pain and vaginal bleeding. If you experience severe pain and abnormal bleeding during your period, it’s important to seek medical attention right away.

Do ovarian cysts become cancerous? 

Many ovarian cysts typically disappear without causing symptoms, requiring little to no treatment. While it’s uncommon, some ovarian cysts can become cancerous. Regular check-ups and monitoring are essential for early detection and proper management.

References

1. Kearney. (2023, December 1). Solving Southeast Asia’s looming fertility crisis: IVF as a path toward hope. Retrieved from: https://www.kearney.com/industry/health/article/solving-southeast-asia-s-looming-fertility-crisis-ivf-as-a-path-toward-hope
2. Healthline. (2023, November 27). What Size Is Normal for an Ovarian Cyst? Retrieved from: https://www.healthline.com/health/ovarian-cyst-size
3. Cleveland Clinic. (2023, December 5). Corpus luteum cyst. Retrieved from: https://my.clevelandclinic.org/health/diseases/22340-corpus-luteum-cyst
4. WebMD. (n.d.). Clomid oral details. Retrieved from https://www.webmd.com/drugs/2/drug-11204/clomid-oral/details
5. Mayo Clinic. (2023, August 3). Ovarian cysts and infertility.  Retrieved from: https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/expert-answers/ovarian-cysts-and-infertility/faq-20057806