3 Mount Elizabeth #09-08 Mount Elizabeth Medical Centre Singapore 228510
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3 Mount Elizabeth #09-08 Mount Elizabeth Medical Centre Singapore 228510

Ovarian Cysts

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What are ovarian cysts?

Ovarian cysts are fluid-filled sacs that can develop on or within an ovary. These cysts are quite common, especially among women of reproductive age. The majority of ovarian cysts are benign, meaning they are non-cancerous and often resolve on their own without causing any significant health issues​. 

Ovarian cysts can be broadly categorised into two main types:

  • Functional cysts: these are the most common types of ovarian cysts and are typically related to the menstrual cycle. Functional cysts include:
  • Follicular cysts: these occur when the follicle (a small sac in the ovary that holds an egg) doesn’t rupture to release the egg and continues to grow.
  • Corpus luteum cysts: after the egg is released, the follicle shrinks and becomes a structure known as the corpus luteum. If the opening of the follicle seals off and fluid accumulates inside, a corpus luteum cyst can form​. 
  • Pathological cysts: these cysts arise from abnormal cell growth and are less common compared to functional cysts. Pathological cysts include:
  • Dermoid cysts: also known as teratomas, can contain various types of tissues like hair, skin, or teeth.
  • Cystadenomas: these develop from ovarian tissue and can contain a watery or mucous substance.
  • Endometriomas: these cysts form as a result of endometriosis, where tissue similar to the uterine lining grows outside the uterus and attaches to the ovary​.
Ovarian cysts are fluid-filled sacs that develop on or inside a woman's ovaries.

What causes ovarian cysts?

Ovarian cysts primarily develop due to the normal functioning of the ovaries, particularly during ovulation. The most common types of cysts, known as functional cysts, form as part of the menstrual cycle:

  • Ovulation and functional cysts: each month, during a woman’s menstrual cycle, the ovaries develop small sacs called follicles. These follicles produce hormones like estrogen and progesterone and release an egg during ovulation. A follicular cyst occurs when the follicle does not rupture to release the egg. Instead, it continues to grow, forming a cyst. After the egg is released, the follicle typically transforms into a structure called the corpus luteum. If the corpus luteum doesn’t break down and seal off, it can fill with fluid and form a corpus luteum cyst​. 
  • Hormonal imbalances: hormonal imbalances can interfere with the normal ovulation process, leading to the formation of cysts. For instance, an excess of luteinising hormone (LH) or insufficient levels of follicle-stimulating hormone (FSH) can cause follicles to develop abnormally or prevent them from releasing an egg.
  • Endometriosis: in some cases, tissue similar to the lining of the uterus can grow outside the uterus and attach to the ovary, forming a cyst known as an endometrioma. This process is often associated with chronic pelvic pain and can complicate the treatment of endometriosis​.
  • Pelvic infections: severe pelvic infections, particularly when they spread to the ovaries, can lead to the development of cysts. These are typically less common but can cause significant complications if not treated properly​.

The formation of ovarian cysts is a natural part of reproductive health for many women, with most cysts resolving on their own without intervention.

What are the symptoms of ovarian cysts?

Ovarian cysts often present with a range of symptoms, although many women may not experience any noticeable signs, especially if the cysts are small or resolve on their own. The most common symptoms associated with ovarian cysts include:

  • Pelvic pain: pelvic pain is one of the most frequently reported symptoms. The pain may vary in intensity, ranging from a dull, persistent ache to sharp, sudden pain, particularly if the cyst ruptures. The discomfort is usually felt in the lower abdomen, on the side where the cyst is located​.
  • Bloating and abdominal swelling: some women with larger cysts may notice a feeling of fullness or bloating in the abdomen. This swelling can be uncomfortable and may be accompanied by a visible increase in abdominal size​. 
  • Pain during intercourse: ovarian cysts can cause discomfort or pain during sexual intercourse, particularly if the cyst is large or if there is pressure on the surrounding tissues​. 
  • Irregular menstrual cycles: some cysts, particularly those related to hormonal imbalances, can cause changes in the menstrual cycle. This might include heavier or lighter periods than usual, or menstrual cycles that are irregular​. 

However, many ovarian cysts are asymptomatic and are only discovered during routine pelvic exams or ultrasounds conducted for other reasons. Regular gynaecological screenings are crucial for early detection and management. 

While many ovarian cysts are harmless and resolve on their own, certain symptoms should prompt immediate medical attention. If you experience severe or sudden pelvic pain, especially if it is accompanied by nausea or vomiting, this could indicate a ruptured cyst or ovarian torsion, both of which are medical emergencies. Additionally, if you notice symptoms such as significant bloating, difficulty emptying your bladder or bowels, or unexplained weight gain, it's advisable to consult a healthcare provider promptly.

an ovarian cyst may cause intense pain in your lower abdomen or back that comes on quickly.

Who is at risk of ovarian cysts in Singapore?

In Singapore, several factors can increase the likelihood of developing ovarian cysts. Women of reproductive age are the most commonly affected group, as the formation of functional cysts is closely tied to the menstrual cycle. However, other specific factors can heighten the risk:

  • Hormonal imbalances: women who experience hormonal disruptions, such as those related to polycystic ovary syndrome (PCOS), are at a higher risk of developing ovarian cysts. This condition can lead to the formation of multiple cysts due to irregular ovulation​. 
  • Endometriosis: women with endometriosis, a condition where tissue similar to the lining of the uterus grows outside of it, are more likely to develop endometriomas, a type of ovarian cyst. 
  • Pregnancy: ovarian cysts can form during pregnancy, typically as corpus luteum cysts, which are necessary to support the early stages of pregnancy. These cysts usually resolve on their own but can sometimes persist and require monitoring​. 
  • Previous ovarian cysts: women who have had ovarian cysts in the past are more likely to develop them again. 
  • Use of fertility treatments: certain fertility treatments, particularly those that stimulate ovulation, such as clomiphene (Clomid), can increase the risk of developing ovarian cysts.
  • Menopause: while ovarian cysts are more common in women of reproductive age, postmenopausal women are also at risk, particularly of cysts that are more likely to be malignant.

How are ovarian cysts diagnosed?

At Dr. Ma Li's clinic, we diagnose ovarian cysts through a combination of physical exams, imaging tests, and sometimes blood tests. Here’s how our healthcare experts identify and assess ovarian cysts:

  • Pelvic exam: the healthcare providers usually suspect an ovarian cyst during a routine pelvic exam. During this check-up, they feel for any lumps or changes in the ovaries.
  • Imaging tests: to confirm the presence and details of an ovarian cyst, our healthcare team utilise imaging tests, such as:
    • Pelvic ultrasound: this is the most common test for diagnosing ovarian cysts. A transvaginal ultrasound involves inserting a probe into the vagina to get clear images of the ovaries. This helps determine the cyst’s size, location, and whether it’s filled with fluid or solid.
    • CT Scan or MRI: these tests are less common but our doctor may recommend these if more detailed images are needed.
  • Blood tests: if an ultrasound confirms an ovarian cyst, our doctor might order blood tests to learn more:
    • Pregnancy test: our doctor may recommend a pregnancy test which can help rule out pregnancy as the cause of symptoms. This is because ovarian cysts are quite common during pregnancy.
    • CA 125 test: This blood test measures the level of cancer antigen 125, a protein that can be elevated in ovarian cancer. However, high CA 125 levels can also be caused by non-cancerous conditions like endometriosis or pelvic infections. This test is usually recommended for postmenopausal women or if the cyst appears suspicious.
Regular screenings help detect ovarian cysts early and monitor their characteristics.

What are the treatment options for ovarian cysts in Singapore?

The treatment of ovarian cysts depends largely on the type, size, and symptoms of the cyst. Many ovarian cysts, particularly functional ones, do not require immediate intervention and may resolve on their own. However, for cysts that persist, cause symptoms, or pose potential risks, your doctor may recommend the following treatment options:

  • Monitoring: for many women, particularly those with functional cysts, our recommended approach is monitoring. Functional cysts, such as follicular or corpus luteum cysts, often resolve without treatment within one to three months. During this period, the doctor may recommend follow-up ultrasounds to monitor the cyst’s size and appearance. 
  • Medications: hormonal medications, particularly oral contraceptives, are often prescribed to prevent the formation of new ovarian cysts, especially in women who experience recurrent cysts. Birth control pills work by preventing ovulation, which is the process that leads to the formation of most functional cysts. While these medications can reduce the likelihood of new cysts forming, they do not typically shrink existing cysts. This treatment option is particularly useful for women with conditions like polycystic ovary syndrome (PCOS)​.
  • Surgical options: our doctor may recommend surgery if the cyst is large, persistent, symptomatic, or has suspicious features that suggest it could be cancerous. The type of surgery depends on the cyst’s characteristics:
  • Laparoscopy: this minimally invasive procedure is often used to remove smaller, benign cysts. During a laparoscopy, a surgeon makes a small incision in the abdomen and inserts a camera to view the ovaries. The cyst is then removed using specialised instruments.
  • Laparotomy: for larger cysts or those suspected to be cancerous, a laparotomy may be recommended. This procedure involves a larger abdominal incision, which allows the surgeon to remove the cyst or, in some cases, the entire ovary. If malignancy is confirmed, additional treatment may be required​. 
  • Hysterectomy (womb removal): in severe cases where other treatment options are not viable, the doctor may recommend a hysterectomy, which involves removing the uterus to prevent the recurrence of ovarian cysts.

The appropriate treatment depends on multiple factors, including the cyst’s size, whether it causes symptoms, and the patient’s overall health and reproductive plans. 

If you're experiencing symptoms of ovarian cysts or have concerns about your reproductive health, schedule an appointment with Dr. Ma Li for comprehensive diagnosis and appropriate treatment options.

FAQs

Frequently asked questions

Most ovarian cysts do not affect fertility, especially functional cysts, which often resolve on their own. However, cysts related to conditions like endometriosis or polycystic ovary syndrome (PCOS) might impact fertility, so it’s essential to consult with your healthcare provider for personalised advice.
A ruptured ovarian cyst can cause sudden, severe pelvic pain, along with symptoms like nausea and vomiting. In some cases, it may lead to internal bleeding, which requires immediate medical attention. If you experience these symptoms, seek emergency care.
Yes, ovarian cysts can recur, especially if they are related to hormonal imbalances or conditions like PCOS. Hormonal treatments, such as birth control pills, can help prevent the formation of new cysts.
No, surgery is not always necessary and many cysts resolve on their own. Surgery is generally reserved for cysts that are large, persistent or have suspicious features that could indicate malignancy.
While you can’t prevent all ovarian cysts, taking hormonal contraceptives can reduce the likelihood of new cysts forming by preventing ovulation. Regular check-ups with your healthcare provider are also important for monitoring your ovarian health.
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