Ovarian cysts are little sacs of fluid that form on or in a woman’s ovary. Each woman normally has two ovaries, one on each side of her lower belly. In women who are still having their monthly period, the ovaries release an egg about once a month.

Many women with ovarian cysts have no symptoms. When symptoms do happen, the individual typically experiences pain or pressure in the lower abdomen on the side of the cyst. This pain may be dull or sharp and it may be constant or come and go. Ovarian cysts can have complications which require immediate surgical interventions such as; rupturing or twisting causing a sudden sharp pain, which may be severe and sometimes associated with nausea and vomiting.

The most common causes of ovarian cysts depend upon whether one is still having menstrual periods (premenopausal) or has stopped menstruating for at least one year (postmenopausal).

For premenopausal women, the ovarian cysts usually develop as a normal body change during ovulation or pregnancy. These are non-harmful, and usually resolve a few weeks later without treatment. There are other known medical conditions which are associated with development of these cysts in premenopausal ladies such as polycystic ovary syndrome where a lot of small but harmless cysts develop in ones ovaries due to altered hormonal levels, endometriosis where a piece of the tissue that lines the womb/ uterus is found outside the womb (e.g. In fallopian tubes, ovaries, bladder, bowel, etc.). Severe pelvic infections may spread to involve the ovaries and fallopian tubes. As a result, pus-filled cysts form close to the ovaries and or fallopian tubes.

In women who have stopped having menstrual periods (postmenopausal), the most common causes of ovarian cysts in these mostly include either non-cancerous growths or fluid collection in the ovary. In postmenopausal women however, any new growths on or around the ovary are somewhat more likely to be caused by cancer than in premenopausal women and warrants more medical attention.

Cancer is a relatively uncommon cause of ovarian cysts in premenopausal women, and only less than 1 percent of new growths on or near the ovary is related to ovarian cancer.

Ovarian cysts can sometimes be diagnosed by taking the patient’s proper history of the complaints and doing an abdominal- pelvic examination, although an imaging test, usually a pelvic ultrasound, is necessary to confirm the diagnosis. This pelvic ultrasound scan uses sound waves, hence carry no risk of radiation exposure to the patient and can be safely used in pregnant mothers to create an image of one’s pelvic organs. Doctors and radiology experts can use this test to visualize these fluid-filled sacs (ovarian cysts), any other abnormal growths and other problems of the ovaries. This imaging test can also provide information about the cyst’s size, location, and other important characteristics.

Other radiology investigations such as computed tomography (CT) scan or magnetic resonance imaging (MRI) are also sometimes used, but less commonly needed in diagnosing an ovarian cyst.

Some blood tests to check for pregnancy or the possibility of cancer can be done as well.

Treatment for ovarian cysts depends largely on what is causing the cysts and the associated symptoms.

Possible management of these cysts might include; doing an ultrasoundscan imaging every couple of months. If the cysts stay the same size, get smaller, or even go away. In these cases, one usually doesn’t need to do anything to treat them.

Some types of birth control pills can be prescribed to stop some types of new cysts from growing, and for some forms of ovarian cysts or complications of the cysts such as twisting or rupture, surgery to remove the cyst(s) or the whole ovary may be done.

At Rwanda Military Hospital, outpatient gynecology clinics are run every day of the week, where patients get to meet and be reviewed by specialist gynecologists for such conditions, and proper management done to prevent late complications of various untreated gynecological conditions.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.