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Ovarian Cyst Gone!

She looked anxiously on the monitor screen while I scanned her with the ultrasound machine.

“Doc, is the cyst still there?” She asked. 

“No, it’s gone” I replied.

“Thank God!” she exclaimed joyfully.

M, 30, experienced some niggling pain on the right side of her lower abdomen 2 weeks ago. She saw me a week later when the pain started to get worse. A vaginal ultrasound scan then revealed a 3 cm cyst in her right ovary. It was filled with clear fluid with no solid components. The blood tumour marker test CA125 was normal. I told her that it was probably a functional cyst. As it was around the second half of her menstrual cycle, I told her to have a re-scan soon after her menses. The cyst has since vanished on her second scan.

What is a functional cyst?

A functional ovarian cyst is a sac that forms on the surface of the ovary during or after ovulation. It holds a maturing egg. Usually the sac empties itself after the egg is released. However, if there is disruption in the way the ovary produces or releases an egg, a functional cyst may develop.

There are two types of functional cyst, the follicular and luteal cyst.

· Follicular cyst: The cyst is formed in a follicle where the egg is not released properly during ovulation and fluid rapidly accumulates and causes a  swelling.

· Corpus luteum cyst: The cyst develops in the corpus luteum, which is the tissue that fills an empty follicle once it has released the egg during ovulation. The cyst may bleed and cause pain.

Functional ovarian cysts can occur at any age but are much more common in women of reproductive age. They are rare after menopause.

They are also different from other abnormal ovarian cysts or growth such as cancer as they usually subside without any treatment. But occasionally, the cyst can expand rapidly, become large and cause complications such as bleeding or get infected, twisted or rupture.

What are the symptoms?

Most functional ovarian cysts do not cause symptoms. The larger the cyst is, the more likely it may cause symptoms, which include:

· Lower abdominal pain which is usually mild.

· Delayed menstrual period.

· Irregular vaginal bleeding.

· Pain during or after sex.

· Frequent urination if the cyst is big and is pressing on the bladder

· Severe abdominal pain if the cyst develops complications

How is it diagnosed?

Functional cysts are diagnosed by pelvic ultrasound. The cyst will reduce in size or disappear around menstruation as in M’s case. If the cyst is big, it may take one or two cycles to resolve.

M was treated conservatively with medications for pain relief and heat pads to sooth her tense muscles and anxiety. The pain subsided with the dissolution of her cyst. She was monitored for another two menstrual cycles with no sign of recurrence. She has remained well since.

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