The female reproductive system has two ovaries. These small olive-shaped glands are tucked into the lower part of the abdomen on both sides of the uterus. They are positioned at the end of the fallopian tubes and supported by tough bands of tissue.
The function of the ovaries changes over time as the female body matures. In young girls, the ovaries make small amounts of the hormones estrogen and progesterone. They also make small amounts of the male hormone androgen. This changes at menarche, the beginning of monthly menstrual periods. Hormone production jumps and the ovaries begin to produce eggs in a gradual, irregular way.
A woman is usually fertile (able to become pregnant) for 30 to 40 years. During this time, the ovaries have two main functions – releasing eggs (ovulation) and making female hormones. Both are done with help from the brain.
The ovaries produce eggs from sites called follicles. Each month, several follicles begin to swell. Usually one follicle swells to maturity, while the other follicles shrink. The follicle that remains will rupture, releasing an egg toward the fallopian tube.
Ultrasound tests can show the ovulating follicle. Ultrasounds make pictures of the inside of the body using the echo of sound waves. In some women, more than one developing follicle can be seen. The rupture of the follicle and release of the egg occurs about 14 days before the next expected period. This may cause lower abdominal pain that is more severe on the side of the ovulating ovary. The pain lasts about 24 hours and may be made worse by movement.
At menopause the ovaries stop making eggs and reduce hormone output. Again, the process is irregular and gradual. The ovaries return to being glands that produce only small amounts of estrogen, progesterone and androgens.
A cyst is a fluid-filled sac that can develop in any part of the body. Most are not harmful or uncomfortable, and in many cases can be ignored.
An ovarian cyst is a fluid-filled mass on the ovary. The swelling follicle of ovulation forms a cyst that is a normal part of the woman’s cycle.
If something goes wrong with this cycle, the cyst may remain. These cysts usually disappear on their own and rarely cause problems. Others can be caused by disease and need to be diagnosed, followed or treated.
One common disease of the ovaries is polycystic ovarian disease. The prefix ‘poly’ means that many cysts are present. In these cases, a hormone imbalance and infrequent ovulation are part of the pattern. Women experience irregular menstrual cycles and a feeling of fullness in the lower abdomen. An ultrasound of the pelvis can identify polycystic disease.
Endometriosis is another common condition with symptoms similar to those of polycystic disease. However, the cause is quite different. In this condition, the lining of the uterus begins to grow outside of the uterus. This can cause cysts, abdominal pain, and reduced fertility.
Other types of cysts can grow on an ovary. Dermoid cysts are an example. They can grow to be very big, and contain abnormally-formed teeth, hair, and fat. Often, surgery is needed to remove the cysts and make sure they are not cancerous. In some cases, these cysts can be quite large.
Severe infection of the reproductive tract (pelvic inflammatory disease or PID) can cause pus-filled cysts.
It is normal to feel concern about whether a cyst could be cancerous. Ovarian cancer involves a growth on the ovary, which may have an unusual type of cyst along with it. The radiologist interpreting the ultrasound should be able to tell if it is an ordinary cyst or something more concerning. Sometimes, a second ultrasound done a few weeks later can help confirm the diagnosis.
Ovarian cysts sometimes bleed, rupture, or become twisted. This is a medical emergency. Any severe pain in the lower pelvis area that gets worse over time requires urgent assessment by a doctor. If you feel something is wrong, visit your doctor’s office or the emergency department immediately. Many women are aware of their usual pattern of ovulation. Explaining the difference can help your doctor tell the difference between normal monthly discomfort and a diseased ovary.
While cancerous cysts are unusual in young women, the risk increases after menopause. Doctors will monitor cysts carefully to decide whether there is any danger.
Since the ovaries are deep within the pelvis, disease can be difficult to diagnose. A heavy feeling or pain that comes and goes on one or the other side of the lower abdomen may be present. The doctor will feel around the pelvis and do an internal exam to check for masses on or near the ovaries.
If something unusual turns up, an ultrasound can help identify whether or not the ovary is involved. Placing a probe in the vagina gives more precise results than the usual method of using the probe on the surface of the abdomen.
If the ultrasound shows a problem, several paths of treatment are possible. Usually nothing specific needs to be done aside from offering pain medication, if it is needed. During the reproductive years, the first step is often to observe symptoms for several months. This can help identify serious problems that do not follow the path of the menstrual cycle.
Such symptoms will be steady and get worse over time. Doctors sometimes prescribe birth control pills to help reduce the chance of new cysts forming.
A gynecologist (a specialist in the female reproductive system) may be needed to help with diagnosis and treatment. Sometimes, a surgical look through a laparoscope is required. A laroscope is a slim instrument, similar to a telescope. The test involves inserting it through a small cut in the abdomen. The ovaries, uterus and other abdominal organs can be seen through the laparoscope.
During the childbearing years, ovarian cysts are common and usually cause no difficulty. Still, it is a good idea to remain aware of the regular monthly pattern of your menstrual cycle. This makes it easier to tell the difference between a normal cycle and symptoms of troublesome ovarian cysts.
Often, an ovarian cyst is no cause for concern. Your doctor will watch it carefully to ensure that the problem resolves. After menopause, much closer investigation of cysts is required to be certain that there is no danger.