Ovarian Cysts Treatment Program

Ovarian cysts are fluid-filled sacs or pockets that develop on or within the ovaries. While they are common in women of reproductive age and often benign and asymptomatic, some cysts can cause pain, menstrual irregularities, or complications that require medical or surgical intervention. Ovarian cysts can occur as a normal part of the menstrual cycle or may result from underlying gynecological conditions. 

Most ovarian cysts are discovered incidentally during routine pelvic examinations or imaging studies. Understanding their origin, classification, and behavior is essential for choosing the most appropriate management strategy—whether observation, hormonal therapy, or surgery. 

FOR PATIENTS EXPERIENCING SUSPECTED OVARIAN TORSION, IT IS CRITICAL TO SEEK IMMEDIATE MEDICAL ATTENTION AT THE NEAREST EMERGENCY FACILITY, AS URGENT SURGICAL INTERVENTION MAY BE REQUIRED TO PRESERVE OVARIAN FUNCTION AND PREVENT COMPLICATIONS. 

Why Cuba 

In Cuba, the management of ovarian cysts is guided by a comprehensive, patient-focused approach that emphasizes the preservation of ovarian function, prevention of complications, and the relief of symptoms such as pelvic pain, menstrual irregularities, or pressure-related discomfort. Each case is approached individually, following an evidence-based clinical framework that involves detailed evaluation of cyst characteristics—including size, appearance, growth pattern, and potential impact on fertility or surrounding pelvic structures. 

Patients undergo a full gynecological assessment, which may include transvaginal ultrasound, advanced imaging, and laboratory markers to differentiate between functional, benign, and potentially neoplastic cysts. Special consideration is given to a woman’s age, reproductive goals, and prior treatment history before determining the most appropriate care pathway. 

Causes of Ovarian Cysts 

Ovarian cysts can develop for various reasons. The most common causes include: 

• Hormonal fluctuations during the menstrual cycle 
• Ovulation-related cyst formation (e.g., follicular cysts or corpus luteum cysts) 
• Endometriosis (leading to endometriomas or “chocolate cysts”) 
• Benign tumors or neoplasms (e.g., dermoid cysts or cystadenomas) 
• Polycystic Ovary Syndrome (PCOS), characterized by multiple small cysts on the ovaries 
• Pregnancy, which may sustain corpus luteum cysts longer than usual 
• Pelvic infections, which can cause tubo-ovarian abscesses if severe 

Types and Classification of Ovarian Cysts 

Ovarian cysts are broadly categorized into functional and pathological types, based on their origin and characteristics. 

Functional Cysts (Most Common, Usually Benign) 

• Follicular Cyst 
  • Forms when a follicle fails to release an egg. 
  • Typically resolves spontaneously within one or two cycles. 
• Corpus Luteum Cyst 
  • Develops after ovulation when the corpus luteum seals and fills with fluid or blood. 
  • May cause pain or bleeding but usually resolves without treatment. 
• Pathological Cysts 
• Endometrioma 
  • Associated with endometriosis. 
  • Contains thick, old blood; often referred to as “chocolate cysts.” 
• Dermoid Cyst (Mature Teratoma) 
  • Contains multiple tissue types (hair, skin, teeth). 
  • Typically benign but may grow large or cause torsion. 
• Cystadenoma 
  • Fluid-filled (serous) or mucous-filled (mucinous). 
  • Can grow very large and may cause pressure symptoms. 
• Polycystic Ovaries 
  • Multiple small cysts present due to hormonal imbalance. 
  • Associated with PCOS, a metabolic and endocrine disorder. 

Symptoms of Ovarian Cysts  

While many ovarian cysts are asymptomatic, symptomatic cysts may present with: 

• Pelvic or abdominal pain (sharp or dull) 
• Bloating or abdominal fullness 
• Irregular menstrual cycles 
• Pain during intercourse 
• Frequent urination or bowel changes (if the cyst exerts pressure) 
• Sudden severe pain (suggestive of rupture or ovarian torsion) 
• Unexplained infertility in some cases 

Diagnosis of Ovarian Cysts 

A thorough diagnostic approach includes clinical assessment, imaging, and, when indicated, blood tests. 

Pelvic Examination 

• May reveal a palpable mass or tenderness.

Transvaginal and Transabdominal Ultrasound 

• First-line imaging to evaluate cyst size, content (fluid, solid, mixed), and vascular flow. 
• Helps distinguish between benign and suspicious cysts.

MRI or CT Scan 

• Used for complex or indeterminate cysts. 
• Provides detailed tissue characterization. 

Tumour Markers (e.g., CA-125) 

• Ordered if the cyst appears suspicious for malignancy. 
• Interpretation is age-dependent, as levels may be elevated in benign conditions like endometriosis. 

Conservative (Non-Surgical) Treatment 

Most ovarian cysts, particularly functional cysts, resolve on their own without intervention.  

Conservative management may include: 

• Observation and Repeat Ultrasound: Especially for asymptomatic, small (<5 cm), simple cysts in premenopausal women. 

• Hormonal Contraceptives: May prevent formation of new functional cysts by inhibiting ovulation. 

• Pain Management: NSAIDs for mild to moderate discomfort. 

• Lifestyle Modifications: Maintaining a healthy weight and balanced hormones can support ovarian health.

Regular follow-up is important to ensure resolution or stability of the cyst. 

Surgical Treatment Options 

Surgery may be indicated in the following situations: 

• Cyst size ≥5–10 cm, especially if persistent or growing. 
• Complex or solid components on imaging, suggesting possible malignancy. 
• Severe or persistent pelvic pain 
• Cyst rupture or hemorrhage 
• Ovarian torsion (surgical emergency) 
• Infertility associated with cystic lesions such as endometriomas. 
• Postmenopausal cysts, especially if not resolving, due to higher malignancy risk. 

Types of surgical treatment include: 

Ovarian Cystectomy (Minimally Invasive Preferred) 

• Removal of the cyst only, preserving healthy ovarian tissue. 
• Performed laparoscopically in most cases. 
• Recommended for benign cysts in women wishing to retain fertility. 

Oophorectomy (Minimally Invasive or Open, Depending on Severity) 

• Removal of the entire ovary, performed when the cyst is large, recurrent, or suspicious for malignancy. 
• May be unilateral or bilateral, depending on clinical findings. 
• Can be performed laparoscopically or via open surgery, based on complexity. 
• In postmenopausal women, oophorectomy may also be recommended to reduce the risk of ovarian cancer.

Salpingo-Oophorectomy (Minimally Invasive or Open, Depending on Severity) 

• Involves removal of the ovary and fallopian tube on one or both sides. 
• Commonly performed when malignancy is suspected, or when there is a tubo-ovarian abscess, hydrosalpinx, or extensive pelvic infection. 
• May also be indicated in women with genetic cancer syndromes (e.g., BRCA mutations) as a risk-reduction procedure. 

Laparoscopy (Minimally Invasive) 

• Preferred surgical method for most benign cysts. 
• Offers shorter recovery, less pain, and lower adhesion risk. 
• Involves small incisions and use of a camera-guided instrument. 

Laparotomy (Open Surgery) 

• Required for very large cysts, suspected malignancy, or complex pelvic anatomy. 
• Involves a larger abdominal incision and longer recovery period. 
• Allows for more thorough exploration and staging if cancer is found.