Is Surgical Removal Necessary for an Ovarian Cyst?
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Discovering an ovarian cyst, regardless of its size or severity, can cause stress and confusion for any woman, especially if the cyst is significantly impacting your day-to-day life. The treatment approach for ovarian cysts varies based on the individual situation, and deciding whether surgical removal is necessary depends on several factors.

Ovarian cysts are relatively common, occurring in 8% to 18% of women, both before and after menopause. Most of these cysts are benign, indicating that they are non-cancerous. However, in rare instances, a cyst may become cancerous or lead to severe complications for the patient. Twisted ovaries or ruptures can result in intense pain, necessitating immediate medical attention.

Given the multitude of possibilities, it’s understandable if you’re uncertain about the next steps after discovering an ovarian cyst. Begin by carefully considering any recommendations provided by your doctor. They possess the expertise to offer a clearer understanding of your cyst’s condition and whether intervention is required.

In the face of an ovarian cyst, booking an appointment with your doctor is crucial. Their insights will guide you in making informed decisions about the course of action for your specific situation.

When should you choose ovarian cyst surgical removal?

Fortunately, for most ovarian cysts, surgery is not a necessary treatment. These cysts often resolve on their own, typically without symptoms or complications. However, surgical removal may be the best treatment course in specific situations. For instance, if the cyst is on the larger side, actively growing, non-functional, causing pain, or persists for more than two menstrual cycles, your gynaecologist may suggest surgery.

In specific cases, an ovarian cystectomy can remove the cyst without removing the entire ovary. However, there are situations where removing the whole ovary might be the safest option, known as an oophorectomy.

Although rare, some cystic masses may be cancerous, requiring referral to a gynecologic cancer specialist. The necessary surgical treatment can vary, with some cases necessitating a total hysterectomy involving the removal of ovaries, uterus, and fallopian tubes. For other cancerous cysts, radiation or chemotherapy may be the better option.

If an ovarian cyst develops post-menopause, top gynaecologists in London typically recommend surgical removal.

Functional and Non-functional Ovarian Cysts

Understanding the contrast between functional and non-functional ovarian cysts is quintessential, as it profoundly impacts the most suitable treatment approach.

Functional Cysts: Follicular and Corpus Luteum

Functional cysts manifest in two primary forms: follicular and corpus luteum cysts, originating within the menstrual cycle.

A follicular cyst may arise when the follicular sac, where an egg grows, fails to release the egg. Typically, these cysts resolve spontaneously within two menstrual cycles.

Alternatively, a corpus luteum cyst occurs when the follicular sac releases an egg, but fluid accumulates. While these cysts often self-resolve, they can be more discomforting than typical follicular cysts and may lead to bleeding.

Overall, functional cysts represent a benign form of growth. Treatment is often unnecessary in cases where the cyst is small and asymptomatic. However, if menstrual issues or pain arise, your gynaecologist might recommend birth control pills, which can prevent the formation of new cysts.

Monitoring the cyst through periodic ultrasound studies ensures it resolves without complications.

Non-Functional Ovarian Cysts: Dermoid, Cystadenoma, Endometrioma, & Malignant

When a woman acquires a non-functional ovarian cyst, it does not result from the release of an egg or her menstrual cycle. While most non-functional cysts are non-cancerous, exceptions do exist.

Non-functional ovarian cysts pose complications, such as a twisted ovary or rupture. Sometimes, the sheer size of the non-functional ovarian cyst alone can cause pain or discomfort for the patient.

Let’s explore the four distinct types of non-functional ovarian cysts:

  1. Dermoid Cysts

Dermoid cysts are generally benign, though they have the potential to rupture or twist the ovary. Interestingly, these cysts are present from birth rather than developing later in life. Dermoid cysts are unique in composition, including hair, skin, muscle, or organ tissue.

  1. Cystadenomas

Large cysts developing on the exterior of the ovaries, cystadenomas, despite their size and associated discomfort, are typically benign. Their growth does not necessarily indicate malignancy.

  1. Endometriomas

Usually benign, endometriomas develop due to an excess of uterine lining tissue. Despite the discomfort they may cause, these cysts aren’t indicative of malignancy.

  1. Malignant Cysts

As a woman ages, the likelihood of cysts becoming cancerous or malignant increases. Although rare, adopting a “watch and wait” strategy is essential for early detection. Persistent ovarian cysts, especially post-menopause, necessitate routine ultrasound screenings to identify tumours or signs of cancer.

What Size Does an Ovarian Cyst Need to Reach for Removal?

Ovarian cysts typically start small, often causing minimal symptoms or discomfort. However, once they reach a specific size, they can lead to complications requiring surgical intervention. Surgery becomes a consideration when an ovarian cyst reaches dimensions of 50 to 60 millimetres, equivalent to roughly 2 to 2.4 inches.

Nevertheless, these measurements serve as guidelines rather than strict rules for cyst removal. For instance, a doctor may not remove a simple benign cyst until it exceeds 4 inches in size. Conversely, if a cyst shows signs of malignancy, removal becomes imperative regardless of its smaller size.

Recovering from Ovarian Cyst Removal Surgery

The recovery time following surgery to remove ovarian cysts depends on whether the patient undergoes laparoscopy or laparotomy.

Laparoscopy, which entails a small incision, boasts a shorter recovery period. Typically, patients can resume their daily routines within a day. However, they should refrain from strenuous activities for about a week.

In cases where cancer is suspected, laparoscopy might not be the optimal choice. Instead, some patients may undergo laparotomy. This procedure offers a clearer view of the female pelvic organs and abdominal muscles, involving a larger incision in the abdomen.

After undergoing a laparotomy, patients can expect a hospital stay lasting approximately two to four days. Full recovery to resume day-to-day activities takes around four to six weeks.

Does Ovarian Cyst Surgical Removal Really Work?

If you undergo oophorectomy (ovary removal surgery), it eliminates existing cysts, eradicating the possibility of future ovarian cyst development.

While preserving the ovary, a cystectomy maintains fertility, but it does not eliminate the risk of new cysts forming, whether on the same ovary or the opposite one.

To mitigate the likelihood of new ovarian cysts, your physician may recommend the use of birth control pills.

Vivek Nama
Vivek Nama

I'm a Consultant Gynaecologist and Lead Gyn Oncologist at Croydon University Hospital. I pride myself on delivering compassionate and cost-effective care to all my patients. Patient satisfaction and experience are quintessential pillars of all my predominant decisions. With over 18 years of experience in gynaecology and gynaecological oncology, I strive to offer an evidence-based approach to my practice. It has been made effortless through my research activities and the many national and international presentations. If you are concerned about your gynaecological condition, I will be able to help you.