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Ovarian cysts — treatment If the scan shows a small cyst and you haven't yet reached your menopause and aren't on the pill, you are likely to have a functional cyst. As long as it isn't causing pain or other symptoms, most doctors will suggest waiting a month or two to see if it goes away on its own. You may also be offered the pill while you are waiting, as some doctors believe it improves the chances of the cyst disappearing. Although the pill doesn't seem to help once you have a functional cyst, it may help to prevent them in the first place. If you keep on getting functional cysts, it might be worth considering it as a preventative measure. If your doctor suggests the pill for other types of cysts, or as treatment for an existing functional cyst, it is worth asking for an explanation or a second opinion if you're not happy. Surgery Only functional cysts will disappear on their own; other cysts may need surgery. Your doctor will discuss with you the pros and cons of surgery. |
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If your cyst is discovered in pregnancy and is causing symptoms or is large, it will need to be removed. As with non-pregnant women, this will involve a general anaesthetic, but care will be taken to protect the baby and your other reproductive organs. You may be offered a laparoscopy at first to get a better view of the cyst. Depending on what's found, a technique called laparoscopic fenestration may follow. Using the same small cuts as an ordinary laparoscopy, the cyst is removed by draining its contents. These are sent to the laboratory for analysis. Recovery is much the same as for ordinary laparoscopy. If there are concerns that the cyst may burst and spill during removal you may be advised to have a laparotomy, a more serious operation which involves a much larger cut across the top of the pubic hairline. This gives the surgeon better access to the cyst. The entire cyst is removed and sent for analysis during the operation to check that it isn't cancerous. Whether the surgeon removes anything else largely depends on your age, whether she or he believes in keeping women's organs and on what you have consented to before surgery. If you are under forty, s/he is likely to recommend leaving the ovary intact, particularly if you want children. Even if the ovary is badly damaged by the cyst and only a small part remains, that part can still go on working normally. If you are over forty, the risk of developing cancer increases and, as a preventative measure, your doctor may recommend removing one ovary (oophorectomy) or both (bilateral oophorectomy) along with your fallopian tubes (salpingectomy) and your womb (hysterectomy). Some doctors believe that even if you don't have cancer, it's worth removing all your reproductive organs to prevent the possibility of cancer developing in the future. Women who have a family history of ovarian cancer should discuss with their doctor whether they are at increased risk and if ovarian removal is justified (see the page on ovarian cancer for more information). In women not at particular risk of developing ovarian cancer it has been estimated that about 200 oophorectomies would have to be carried out to avoid one case of ovarian cancer. It is important to remember that removing both ovaries will cause a premature menopause, if you haven't reached menopause. Even after menopause, the ovaries continue to produce small amounts of hormones that influence sexual health. A hysterectomy involves a long recovery period afterwards. You need to be quite clear about your own views and needs before the operation. Making the decision Not surprisingly, many women are reluctant to undergo a major operation simply to prevent something which may never happen. Such a decision cannot be taken lightly. Before discussing surgery with your doctor, it is worth preparing a list of questions, to make sure that you are given all the options and have enough information to make an informed choice. Questions to ask your doctor about surgery:
If you want to ask questions, but you feel nervous, take a friend or partner with you for support. Having someone there also helps you to remember what was said afterwards. Reading some of the leaflets or books or contacting one of the organisations in the resources section might give you more information to help you make the decision. If the doctor disagrees with your preference, you have the right to a second opinion. Ask your GP to refer you to another gynaecologist. Recovery The length of recovery depends on the type of operation. Laparoscopic fenestration will probably take a week, whilst a hysterectomy can take a few months. You will not be able to drive or lift anything heavy for several weeks after a laparotomy, and even laughing and sneezing can be painful around the stitches for a while. You may be left with longer term abdominal discomfort after a laparotomy. This is caused by adhesions (scar tissue) which can stick internal organs together. Adhesions can also block your fallopian tubes which would affect your fertility. On a more positive note, all the symptoms apart from voice changes caused by masculinising tumours will disappear once the tumour is removed.
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Originally written by Jenny Tricker. This edition revised by Women's Health (2000).
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