Did you know that not every cyst is bad news? In fact, a large number of cases where they show up in exams can actually be a sign of good news. You could say that in 70% of the cases when someone is concerned about cysts, it’s when an ultrasound (routine or not) has a report that says:
Presence of a cyst in the ovary (left or right) with dimensions… And anechoic appearance.
Most of the time, these cysts are perfectly normal1! The great majority of them are actually follicles maturing during ovulation. They’re called functional cysts or common cysts, which appear in every ovulatory cycle.
But there are also cysts that cause concern, like hemorrhagic cysts. Others may seem alarming simply because of the name, such as a septated cyst2.
Let’s look at the cases in which a normal benign cyst occurs:
Benign cyst
Follicular cyst
The follicular cyst is the one that appears in every cycle due to follicle development. Mature follicular cysts are between 21 and 25 millimeters. So, if the exam says it is 10mm, it means it still has to grow a little more. Follicles can also cause the ovaries to increase in size, and this is perfectly normal.
Functional cyst
The functional cyst can be follicular, but it can also be due to the corpus luteum. This term is a way to signal in the ultrasound that such a cyst is normal and part of the menstrual cycle and that the woman is healthy. In a single ultrasound there may be several functional cysts distributed in both ovaries. This may indicate that the woman has had multiple ovulation or that there was enough follicular stimulation to form several functional cysts.
Problematic cysts and treatments
Multiple cysts or multifollicular ovaries
This result may indicate that the woman has several microcysts and that she is experiencing some form of polycystic ovaries. This type of cyst can indicate that the woman is not producing enough hormones to mature the follicles that were initially stimulated. But it can also indicate the presence of PCOS (polycystic ovary syndrome).
Not every polycystic ovary means PCOS3. To diagnose it, it is necessary to have an ultrasound, as well as to analyze other symptoms. The most common symptoms of PCOS are menstrual cycle changes, such as irregular cycles and absence of menstruation for long periods. Treatment can be hormone-based (birth control pills) or with medications that control glycemic levels. However, supplements, physical exercise, and proper nutrition are also important as part of the treatment.
Another possible treatment for PCOS patients is myo-inositol. This B-complex vitamin is very important for metabolic processes, especially related to insulin. This type of imbalance can cause PCOS, and in many cases using myo-inositol is enough to greatly relieve the symptoms of the syndrome. Myo-inositol is the main ingredient in FamiSitol by Famivita, a practical way to take this vitamin every day.
There are also septated cysts, which are cysts that have more than one cavity. Due to malformation, it has a subdivided appearance, hence the name septated.
Hemorrhagic cyst
These cysts can be common, just like follicular ones. The big difference is that the follicular cyst is filled with fluid, and the hemorrhagic is filled with blood. They can also continue to grow even after ovulation.
The blood in a hemorrhagic cyst comes from the ovarian wall. These cysts can leak blood into the pelvic cavity or grow, swelling with blood and with a risk of rupture. In some cases, surgery is recommended to remove the fluid. The hemorrhagic cyst can be treated or may disappear on its own, depending on its size and condition.
Dermoid cyst
These are formed by cells from skin, fat, and other tissues that accumulate in the ovary area. These cysts can grow for years without showing any symptoms: they are painless and do not interfere with ovulation. However, over time these cysts can become problematic, as they may exceed the size of the ovaries and end up causing pain due to their weight. The treatment for this cyst is surgery, but it is only recommended if it reaches a considerable size.
Cystadenomas
These are of organic origin, just like the dermoid, but are formed from ovarian tissue. They do not present major problems, just like the dermoid cyst.
Endometrioma cyst
They are common in women with endometriosis. An endometrioma is the presence of endometrial tissue in the ovary. Treatment is usually hormonal or surgical.
Ovarian cysts can result from diseases or even just a simple ovulation cyst.
Cysts may or may not cause pain, and most of them present symptoms like bloating, pain during intercourse, pain in the lower abdomen, pain below the navel (either sudden or constant), and, in some cases, severe twinges that come and go throughout the day. Cysts can be present on either side or just one.
There is a type of cyst that can occasionally secrete HCG, the hormone exclusive to pregnancy. Although this is very rare, it can show small amounts up to 15mIU in the blood. This is one of the rare cases where a pharmacy pregnancy test can be a false positive. In these cases, it is recommended to do a quantitative beta-hCG.
A significant problem is when a cyst is more than 10 cm in diameter. In these cases, the doctor may suspect ovarian cancer and recommend treatment with an oncologist.
What is ovarian cyst surgery like?
Ovarian cyst surgery is performed through laparoscopy. The prognosis is 100% cure in cases of common and benign cysts. Some cases need treatment after surgery, such as cysts due to endometriosis or polycystic ovaries.
Cysts are common! However, it is the doctor’s job to recommend the best treatment for them, depending on the type. Some can be treated with surgery, others with birth control pills. However, all have solutions and the vast majority do not prevent pregnancy from happening.
Readers’ questions:
What does anechoic image in the ovary mean?
The word “anechoic” or “anechoic content” is nothing more than a cyst containing fluid. It should be monitored by your OB-GYN with imaging exams to check its size or to see if it disappears with the help of medication.
See also: What is the Corpus Luteum and What is Its Importance at the Start of Pregnancy?
Photo: Mixy Lorenzo, Ed Uthman
