Is it necessary for ovarian cysts to be removed?

You may know a thing or two about ovarian cysts, whether because you have them (or used to) or know someone who does (or did). After all, they are really common in women our age.

"Ovarian cysts are extremely common in women during their reproductive years. Women develop one or more eggs [follicles] during each menstrual cycle, which can appear as cysts on an ultrasound," says Dr Andy Tan, a consultant at the Department of Obstetrics & Gynaecology at Singapore General Hospital.

He says that these sacs filled with liquid or semi liquid content in an ovary are typically "physiological" in nature. This means that they are follicular cysts that occur during each menstrual cycle and are less than 3cm in diameter.

But how do you know if you have them, and more importantly, what can be done if you do?

Symptoms of ovarian cysts

As it turns out, most women with ovarian cysts are asymptomatic. However, depending on the sizes and nature of the cysts, they may also exhibit a wide range of symptoms.

"These include pain or discomfort in the lower abdomen, severe acute pain due to a cyst rupture or torsion, abdominal fullness and bloating, pelvic pressure causing urinary frequency and bowel disturbance, cyclical menstrual pain, pain during sexual intercourse and abnormal menstrual period," says Dr Tan.

Discovered that you have a few yourself? There's no need to freak out—they are benign in 90 percent of the surgically managed cases and resolve spontaneously up to 80 percent of the time. But if they don't, then yes, you may have something to worry about.

"If they are persistent, it could be a sign of ovarian tumour. The different types are categorised into their origin cell lines and they are usually explained to the patient as clear cysts, blood cysts or ovarian tumour."

They are usually non-threatening, but...

Not all ovarian cysts need to be removed—physiological cysts do not require surgery unless sudden complications occur like internal bleeding. The ones that may need immediate medical attention or surgery are cysts that are haemorrhaging (actively bleeding), ruptured or infected.

"Cysts with features suggesting possible signs of cancer will require surgery. Benign or non-cancerous cysts may also be removed if they are either increasing in size or already significantly large," says Dr Tan.

"Endometriosis cysts may be removed to improve the woman's chances of fertility. Dermoid cysts, while benign, can suddenly twist, cutting off the blood supply to the ovary, causing sudden and severe pain. These cysts need urgent surgery as a delay can cause the entire ovary to lose its function."

While there are exceptions, ovarian cysts generally do not affect a woman's fertility.

"In the event of an ovarian torsion [twisting], the ovary may be compromised if she does not undergo surgery immediately. This can result in a death of body tissue of her ovary."

Want to find out if you have these cysts? Just schedule a checkup with your gynae. Most can be accurately diagnosed using pelvic ultrasound imaging alone, but some types such as a solid tumour or endometriotic cysts may require other a CT scan or MRI for further evaluation.