Cysts are very commonly found in women who have polycystic ovary syndrome and are, in fact, one of the defining characteristics of the disease. However, women who don’t have PCOS can also get ovarian cysts.
Every month, a single egg follicle in the ovary develops and eventually releases the egg in a process known as ovulation. Sometimes, ovulation will not occur and the follicle will continue to grow larger and larger as the fluid inside of it builds up. If the wall of the follicle weakens, a tiny hole can form as the fluid starts to leak into the pelvic cavity. This fluid can be irritating and sometimes causes a great deal of pain. The pain will likely subside after a few days. Quite often, a woman doesn’t even realize that she even has an ovarian cyst.
Anytime you are experiencing severe abdominal or pelvic pain, it should be immediately evaluated by your doctor or in the emergency room if you are not able to promptly see your doctor. There are many other conditions that can mimic the symptoms of a ruptured ovarian cyst, which can be very serious if not treated. This can include appendicitis, an ectopic pregnancy or even internal bleeding.
When you arrive at the hospital, the doctor will likely want to draw some blood and perform an ultrasound to see inside your belly. If you had a ruptured ovarian cyst, the ultrasound will show some fluid around the ovary, and may even show the empty sac. An ultrasound can also help the doctor look for more serious conditions like internal bleeding. Such bleeding can occur if a blood vessel in the wall of the cyst ruptures, causing a lot of pain as the cyst fills with blood. Sometimes, large ruptured hemorrhagic cysts do need to be removed surgically.
Sometimes the cyst will grow so large that it begins to press on other organs or nerves, which can also cause discomfort even if the cyst hasn’t ruptured. In that case, the ultrasound will show a large black circle on the ovary.
Once an ovarian cyst has ruptured, no treatment is usually required, though sometimes pain medication is prescribed to help manage the discomfort. If the cyst has not ruptured, treatment varies according to the entire clinical picture. If it is causing a lot of pain, is quite large, or looks suspicious on the ultrasound, surgery to remove the cyst may be recommended.
If the cyst is small and does not look concerning to the physician, they will likely recommend that you have the cyst monitored for a few months to make sure that it goes away on its own. Sometimes, taking a month or two of birth control pills can help shrink the cyst. If you are especially prone to these small cysts, the doctor may suggest that you continue to take the birth control pill in order to help prevent a cyst from reoccurring.
McCance, Kathryn L. and Huether, Sue E. Understanding Pathophysiology. Mosby. St. Louis MO, 2003.