Ovarian Cyst Surgery

Ovarian cysts are fluid-filled sacs that can develop in women in their reproductive years or, rarely, after menopause. The first line of treatment for ovarian cysts is diagnosing the specific type of cyst using ultrasound and blood work. The most common treatment is watchful waiting, unless the cyst is found to be large or is causing symptoms. Ovarian cysts generally go away over a few weeks without intervention.

What Is Ovarian Cyst Surgery?

Patients with large cysts, painful symptoms, or suspicious imaging may be recommended for ovarian cyst surgery. Ovarian cyst surgery is the removal of cysts from the ovaries either through small incisions (laparoscopically) or through one larger incision (laparotomy) in the abdomen. About 8% of women with ovarian cysts develop cysts large enough to require treatment

Potential Risks

As with any surgery, there are risks with ovarian cyst removal surgery, including:

• Ovarian cysts may return after surgery
• Pain may not be controlled
• Scar tissue (adhesions) may form at the surgical site, on the ovaries or fallopian tubes, or in the pelvis
• Infection
• Damage to the bowel or bladder

Purpose of Ovarian Cyst Surgery

The purpose of ovarian cyst surgery is to remove the cysts that are either causing symptoms or are cancerous. Removing the cysts does not mean they will not return over time. It’s important to discuss fertility with your doctor prior to surgery because

removing the ovaries or damaging the ovaries during surgery can affect your ability to get pregnant naturally. However, even if both ovaries are removed due to cysts, it’s still possible to carry a baby using in vitro fertilization. 

For women who are diagnosed with ovarian cancer, typically the uterus, ovaries, and fallopian tubes are removed, which would make pregnancy impossible. The risk of ovarian cancer increases with age, especially for women with ovarian cysts after menopause or with a family history of breast or ovarian cancer.

Cysts naturally occur throughout a woman’s menstrual cycle during her reproductive years. Many women do not even know they have a cyst until it causes pain or symptoms, or it is found with a diagnostic test.

Cysts can also be associated with endometriosis, in which the tissue lining the inside of the uterus grows outside of it, or polycystic ovarian syndrome (PCOS), a hormonal disorder that causes enlarged ovaries with small cysts. When the cysts are caused by either condition, it can lead to fertility issues.

Diagnosis

A cyst on your ovary can be found during a pelvic exam. Depending on its size and whether it’s fluid filled, solid or mixed, your doctor likely will recommend tests to determine its type and whether you need treatment. Possible tests include:

• Pregnancy test. A positive test might suggest that you have a corpus luteum cyst.
• Pelvic ultrasound. A wandlike device (transducer) sends and receives high-frequency sound waves (ultrasound) to create an image of your uterus and ovaries on a video screen. Your doctor analyzes the image to confirm the presence of a cyst, help identify its location and determine whether it’s solid, filled with fluid or mixed.
• Laparoscopy. Using a laparoscope — a slim, lighted instrument inserted into your abdomen through a small incision — your doctor can see your ovaries and remove the ovarian cyst. This is a surgical procedure that requires anesthesia.
• CA 125 blood test. Blood levels of a protein called cancer antigen 125 (CA 125) often are elevated in women with ovarian cancer. If your cyst is partially solid and you’re at high risk of ovarian cancer, your doctor might order this test.

Treatment

Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor might suggest:

• Watchful waiting. In many cases you can wait and be re-examined to see if the cyst goes away within a few months. This is typically an option — regardless of your age — if you have no symptoms and an ultrasound shows you have a simple, small, fluid-filled cyst.

  Your doctor will likely recommend that you get follow-up pelvic ultrasounds at intervals to see if your cyst changes in size.

• Medication. Your doctor might recommend hormonal contraceptives, such as birth control pills, to keep ovarian cysts from recurring. However, birth control pills won’t shrink an existing cyst.
• Surgery. Your doctor might suggest removing a cyst that is large, doesn’t look like a functional cyst, is growing, continues through two or three menstrual cycles, or causes pain.

  Some cysts can be removed without removing the ovary (ovarian cystectomy). In some cases, your doctor might suggest removing the affected ovary and leaving the other intact (oophorectomy).