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Treatment

The most appropriate treatment for an ovarian cyst depends on:

  • the type of cyst
  • your symptoms
  • your age

Pre-Menopausal Women

If you are a pre-menopausal woman, your doctor will likely suggest monitoring a functional cyst for eight weeks without any other treatment. Ninety percent of cysts begin to shrink or totally disappear within this time. You will likely be asked to return in three to four weeks for your doctor to check the cyst.

Your doctor may suggest surgically removing a cyst if:

  • it remains unchanged or grows larger during the eight-week observation period
  • it causes severe pain or complications
  • diagnostic tests show it is a type of cyst that is unlikely to disappear on its own (for example, a dermoid cyst)

Post-Menopausal Women

Most cysts diagnosed in post-menopausal women are also benign and the body often reabsorbs them within a few months. However, age is an important risk factor for ovarian cancer. To ensure that you do not have cancer, your doctor may recommend surgery to remove the cyst. The appearance of the cyst during an ultrasound will help your doctor determine the likelihood of cancer and advise you about whether or not you should have surgery. If a simple cyst can be clearly visualized on ultrasound, there is little risk and some doctors may recommend a period of watchful waiting.

Surgery

If a cyst is large, does not look like a functional cyst, and grows or continues to cause pain over a two- to three-month period, your doctor may recommend surgery. Surgery for an ovarian cyst may involve draining and removing the cyst, or it may require removing the entire ovary.

Even when it is quite large, a cyst can be removed (a cystectomy) and the surrounding tissue will usually heal with minimal surgical repair. Occasionally, a cyst will be so large that it destroys the surrounding ovary, making it necessary to remove the entire ovary.

Your doctor may also suggest removing the entire ovary if your age or the appearance of the cyst might put you at greater risk of ovarian cancer. If your doctor suspects cancer, it is important to avoid rupturing the cyst and releasing potentially malignant cells into the abdominal cavity. To avoid this, the entire ovary is usually removed.

How Will Having an Ovary Removed Affect Me?

If the size of the cyst is the issue, only a single ovary will be removed. This should not significantly affect the fertility of pre-menopausal women, since one ovary can produce enough eggs and hormones to become pregnant.

If cancer is a possibility, both ovaries may be removed. For post-menopausal women, this is often recommended when any surgery is done for ovarian cysts. Removing the ovaries before menopause does increase a woman’s risk for circulatory disease and premature osteoporosis. Some post-menopausal women also report a loss of libido (sexual desire) when the ovaries are removed. This can usually be treated with low-dose testosterone treatments. For pre-menopausal women, rapid testing for cancer cells is usually done on the removed ovary, before the surgery is completed. Both ovaries are removed only if cancerous cells are found. Your doctor should discuss this possibility with you prior to surgery. See the Ovarian Cancer section for more information on this issue.

Surgical Procedures

The surgical procedure used to remove a cyst depends on the type and size of the cyst. If there is a risk of cancer, a laparotomy (see below) is the treatment of choice.

Laparoscopic Surgery

Many ovarian cysts can be treated using laparoscopic surgery. A laparoscope is a telescope-like instrument, which can operate through a small incision. This incision is often made just below the belly button, where it will be less noticeable. A general anesthetic is used.

Surgical instruments attached to the laparoscope can be used to cut through the outer covering of the ovary, to remove the cyst. The cyst is then placed in a special pouch where it is drained and can then be easily removed through the laparoscope. An entire ovary can also be removed through the laparoscope if necessary. However, a laparotomy is usually more appropriate if cancer is strongly suspected.

Laparaoscopy is less invasive and less traumatic than open surgery. Another advantage of this procedure is the quick recovery time. Usually an overnight stay in the hospital is not necessary, and a woman can resume normal activities in a week. On rare occasions, bleeding or other complications may occur during laparoscopic surgery, which cannot be controlled with laparoscopic instruments. In this situation, a laparotomy may be used to finish the procedure.

Laparotomy

If cancer is likely, an abdominal operation called a laparotomy is usually done. For a laparotomy, a general anesthetic is used, and a larger incision, several inches in length, is made in the abdomen. While you are under anesthetic, your doctor will have the cyst tested to find out if it is cancerous. If it is not cancerous, the cyst will be removed and the ovary will be left intact. If it is cancerous, the entire ovary, or possibly both ovaries, will be removed, and the blood vessels attached to it, sutured. A laparotomy typically requires three days in the hospital and six weeks of recovery time.

You should discuss with your doctor which of these procedures is most appropriate for you. All surgeries have risks, including the risk of infection or bleeding and the possibility of damaging other organs. Damage to the pelvic muscles or organs could result in chronic pelvic pain. There are also risks associated with the use of anesthetic during surgery. All of these complications are uncommon. Antibiotics are generally given before any abdominal surgery to help prevent infection.

 

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