Diseases that occur in women are becoming increasingly complex and severe, which is something every woman should pay attention to and care about in order to find ways to prevent them. One of the common diseases found in women is “cysts”, and today we will get to know this disease better.

What is a cyst?

Dr. Chanchai Laoprasitporn, Consultant Physician at the Women’s Health Center, Phyathai 3 Hospital explained that “cyst” comes from the English word “cyst”, which means “a fluid-filled sac”. Therefore, anything that has a shell and contains fluid or liquid inside is called a “cyst” in general.

How do ovarian cysts occur?

All organs inside the human body have the potential to develop cysts, whether it is the skin, fat, bones, internal organs, or even the brain. Women have a special characteristic compared to men in that they have female reproductive organs, especially ovaries, which are more likely to develop cysts. When women reach reproductive age, ovarian cysts or fluid sacs can form, which grow and then shrink and disappear according to the menstrual cycle from normal ovulation.

Types of ovarian cysts

There are 3 types of ovarian cysts or ovarian cysts:

1. Functional Cyst is an ovarian cyst that occurs from the normal function of the ovary to produce eggs, which are the female reproductive cells. It is a cyst that grows and then ruptures, releasing the egg cells. After that, the cyst gradually shrinks on its own.

2. Ovarian Tumor or Ovarian Cyst is an ovarian tumor that contains fluid inside. It can be a benign tumor that is not cancerous or a malignant tumor that is cancerous. Most tumors have specific characteristics that can help identify their type, such as a Dermoid Cyst, which often contains fluid, fat, hair, bone, and teeth. When X-rayed or examined by ultrasound, it can usually be identified as this type of tumor. Some malignant ovarian cyst tumors produce chemical markers that can be detected in high amounts in the blood, such as CA 125, which can indicate the likelihood of cancer.

3. Tumor-like condition is a cyst caused by endometriosis, where the uterine lining grows abnormally on the ovary. During menstruation, this lining bleeds and accumulates in the cyst, becoming old, thick blood with a chocolate-like color, hence called a Chocolate Cyst.

Warning signs of ovarian cysts to watch for

Dr. Chanchai provided information about “warning symptoms of ovarian cysts” in women, stating that most cases have no warning signs or symptoms and are usually detected during annual health check-ups or incidentally when investigating other conditions. However, if symptoms occur, they can be observed as follows:

Lower abdominal pain, especially if it is related to the menstrual cycle, which may suggest a chocolate cyst.
Some may feel increased urination frequency due to a sufficiently large cyst pressing on the bladder.
Some may only feel a dull ache in the lower abdomen.
Some have no symptoms but may feel or mistakenly think their abdomen is enlarged due to weight gain.
Some experience sudden lower abdominal pain from ovarian cyst torsion or rupture.
Some may have abnormal menstruation, such as heavy bleeding, spotting, or increasingly severe menstrual pain each month.

In severe cases where the cyst ruptures and blood vessels tear, it can cause internal bleeding in the abdominal cavity, which is dangerous and can be life-threatening. This shows that although this disease is not malignant cancer, it can still affect health and cause harm. Women should pay attention and if any abnormal symptoms as mentioned occur, they should see a gynecologist to find the true cause and receive prompt treatment.

How to examine if suspected ovarian cyst or lower abdominal pain

Whether during a general health check or due to lower abdominal pain, if the patient is young or has never had sexual intercourse, doctors usually perform an ultrasound on the lower abdomen. The patient is asked to hold urine to fill the bladder with urine first, so the uterus and ovaries can be clearly seen. In some cases, a transvaginal or transrectal ultrasound may be necessary for more accurate diagnosis. The ultrasound probe used for vaginal or rectal examination nowadays is small, about the size of an index finger or thumb, so it does not cause pain to the patient.

Besides internal examination and ultrasound, taking a history of abnormal symptoms and menstrual history is essential for diagnosis.

Are ovarian cysts cancerous?

Although ovarian cysts have a relatively low chance of becoming cancerous, doctors must be cautious and thorough in diagnosis, especially in women with risk factors for ovarian cancer, such as a family history of ovarian cancer, history of breast or colon cancer, or ultrasound findings of cysts with irregular borders or fluid in the abdominal cavity. If suspected, further cancer investigations will be conducted.

How to treat ovarian cysts once found?

If suspected to be a Functional Cyst, doctors will schedule follow-up examinations to see if it shrinks on its own. Some patients may be prescribed contraceptive pills or injections for a period and then re-examined. If the cyst does not shrink or grows, it indicates it is not a Functional Cyst, and treatment or surgery will be provided.

In emergency cases such as ruptured ovarian cysts or ovarian cyst torsion, which can occur in both Functional Cysts and ovarian tumors, patients experience severe pain and require emergency surgery. Except in cases where a Functional Cyst ruptures with minimal internal bleeding, observation in the hospital may be possible, and if symptoms improve, the patient can be discharged.

For non-emergency surgery, once the doctor is confident that the cyst is not a Functional Cyst, such as a large chocolate cyst or cysts affecting fertility, or ovarian tumors, the doctor will plan the surgery method, such as open abdominal surgery or laparoscopic surgery. The surgery may involve removing only the cyst, one ovary, both ovaries, or even the uterus, depending on the patient’s age, cyst type and size, and fertility considerations.

Laparoscopic ovarian cyst surgery

Laparoscopic surgery is a technological advancement that facilitates surgery in narrow spaces, reduces blood loss, lessens postoperative pain, and allows patients to recover and return home faster.

The essential equipment for laparoscopic surgery includes a small camera and lens (about 3-5 mm) that transmit images to a screen, allowing the surgeon to see a magnified and clearer view than the naked eye. Small surgical instruments are used, such as tissue graspers, cauterizing tools, cutting or suturing instruments. Additionally, carbon dioxide gas is used to inflate the abdominal cavity to create space for surgery.

After surgery, patients will have three small abdominal wounds, each 0.5-1 cm in size. Patients can walk, eat, and be discharged the next day. After about 1-2 weeks, they can return to work or even play sports.

Key points of laparoscopic ovarian cyst surgery

All surgeries carry risks, including ovarian cyst surgery. Dr. Chanchai Laoprasitporn, Head of the Women’s Health Center at Phyathai 3 Hospital, mentioned three key points:

The laparoscopic surgical equipment must be ready and in good condition.
The surgeon and surgical team must be well-trained and experienced in laparoscopic surgery.
The surgeon must carefully select appropriate cases where laparoscopic surgery benefits the patient more than conventional surgery and provide advice on the pros and cons of both methods, reaching a mutual decision with the patient before proceeding.

Postoperative care after ovarian cyst surgery for good recovery

Avoid activities that strain the abdominal muscles for about 6 weeks.
Keep the wounds dry until fully healed (about 7 days).
During recovery, engage in mild exercise such as walking.
Take medications as prescribed and attend follow-up appointments.
If abnormalities occur, such as fever, wound swelling, redness, wetness, or increased abdominal pain, see a doctor immediately without waiting for the scheduled appointment.

Can you have sexual intercourse after ovarian cyst surgery?

After surgery, doctors usually recommend abstaining from sexual intercourse for about 4-6 weeks. Once the body has recovered and the doctor confirms it is safe, normal sexual activity can resume.

What to do if pregnant and have an ovarian cyst?

If a large ovarian cyst is detected during pregnancy, there is a risk of torsion. Without surgery, there is a risk of miscarriage. Doctors usually plan surgery during the second trimester because it is safer for the fetus than other pregnancy stages. If the cyst is small (not exceeding 5 cm) and ultrasound findings strongly suggest it is not ovarian cancer, monitoring during pregnancy is possible, and treatment can be considered during cesarean section or after delivery, depending on the doctor’s discretion.

How to prevent ovarian cysts?

The causes of ovarian cysts that are not Functional Cysts are not clearly known. Some types are related to genetics. Currently, reliable data shows that most malignant ovarian cyst tumors originate from abnormal cells of the fallopian tube lining that detach and attach to the ovary, growing into ovarian cancer. Statistics show that women who have had tubal ligation have a lower risk of ovarian cyst cancer than those who have not. Therefore, women who do not want children or cannot have children and require abdominal surgery often have both fallopian tubes removed to prevent ovarian cancer in the future.

Maintaining good health is the best prevention. Regular exercise, adequate rest, stress management, nutritious diet, and maintaining a healthy weight help balance hormone production in women.

Although many women have no symptoms, early-stage ovarian cysts are often unnoticed until the cyst grows large or complications arise. Screening with ultrasound and internal examination can detect cysts and other reproductive system diseases simultaneously, such as cervical cancer screening. Therefore, women should have annual health check-ups to prevent serious diseases. Detailed health examinations to detect abnormalities help ensure better treatment outcomes before the disease progresses beyond control.

Ovarian cysts: How dangerous are they for women?