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Ovarian cysts — symptoms and diagnosis Symptoms Many women experience no symptoms when they have an ovarian cyst, particularly if it's small. Certain cysts grow large and may cause the abdomen to swell. Depending on where the cyst is and its size, it may put pressure on the bladder or bowels, making you need to go to the toilet more often. You may also notice abdominal discomfort and sex may be uncomfortable or painful. Your periods may be affected; they may become irregular or the bleeding may be heavier or lighter than usual. Tumours which produce hormones cause more noticeable symptoms if they are active. If they are inactive, they won't produce hormones, and there probably won't be any symptoms unless the tumour is large. If you have an active feminising tumour and have passed the menopause, you may start bleeding again. Girls who haven't reached puberty may find that their periods start early, and they may develop breasts and body hair. |
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 If you have an active masculinising tumour, your periods may stop, you may become more masculine in shape and your clitoris may grow. You may grow more facial and body hair and your voice may get deeper. Possible complications Although a woman may live with a cyst for years and not even know she has it, occasionally cysts do cause problems. If a cyst is growing on a stem, the stem may become twisted. This causes intense pain, vomiting and a rapid heartbeat. This emergency condition is called torsion (see diagram on the left) and you need to go to hospital for treatment. Some cysts can burst (rupture). If this happens, how you feel depends on what the cyst contained, whether it is infected and whether there is any bleeding. There will usually be some pain when a cyst ruptures, but it is only as severe as the pain in torsion if there is bleeding or infection. Again you need to go to hospital for treatment. Diagnosis As most cysts don't cause symptoms, they are found by chance, often on internal examination. They may also be picked up on an ultrasound scan during pregnancy or for another reason. An internal examination is the first stage in diagnosis and if something is felt, you will be sent for an ultrasound scan and referred to a gynaecologist. How long you will wait to see the gynaecologist depends on your symptoms, age and where you live. The gynaecologist will ask about your periods, age, previous pregnancies, and whether sex is painful. All of this information will help in determining the type of cyst and how much it is troubling you. You may then need to have another internal examination because the gynaecologist will want to check what your doctor has found.  This examination will be followed by an ultrasound scan to build up a fuller picture. There are two ways of scanning, using either an external or internal probe. The internal probe is shaped like a tube with a rounded end which is inserted into your vagina and moved around to get a clear picture on the screen. The external probe is flat and moved around whilst pressing on your abdomen. For this type of scan you need a full bladder so that your organs can be seen more clearly. Having such a full bladder is uncomfortable, especially if you have to wait, but it's important to hold on, otherwise your appointment may have to be rescheduled. There are pros and cons with each method. Some women find the vaginal probe embarrassing, intrusive and/or uncomfortable, but sometimes it gives a clearer picture and allows blood flow to the ovary to be visualised, which helps with the diagnosis. Maintaining a full bladder for a long time then having someone pressing down on it can also be very uncomfortable. Unfortunately, you may not be offered a choice. The scan results will add to the picture of which cyst it's likely to be. Because the ovaries are hidden away and are so close to other organs, problems in the bowel, the uterus or other organs may be confused with ovarian cysts, and diagnosis is a complicated procedure. You may feel frustrated if doctors can't tell you what's wrong immediately, particularly if you have to wait between each stage.
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Originally written by Jenny Tricker. This edition revised by Women's Health (2000).
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