The female reproductive system has two ovaries. These small glands are tucked into the lower part of the abdomen on both sides of the uterus. They are supported at the end of the fallopian tubes by tough bands of tissue.
The function of the ovaries changes over time as the female body matures. In young girls, the ovary produces small amounts of estrogen and progesterone, as well as small amounts of the male hormone androgen. At menarche (the onset of monthly menstrual periods) the production of eggs (ovulation) begins in a gradual and irregular way along with a greatly increased production of hormones.
During the 30 to 40 childbearing years, the two main functions of the ovaries are ovulation and production of female hormones. Both these functions go in cycles controlled by a complex feedback system linked to the pituitary gland.
The ovaries produce about one egg a month from sites on the ovary called follicles. Each month several follicles begin to swell and estrogen levels increase under the influence of the pituitary gland. Usually one follicle swells to maturity and the rest of the follicles shrink. The follicle which remains will rupture and release an egg (ovulation) toward the fallopian tube.
The ovulating follicle can be seen by a test called an ultrasound. This test makes pictures by using echos of sound waves. In some people more than one developing follicle can be seen. The rupture of the follicle and release of the egg occurs 14 days before the next expected period. This rupture sometimes causes lower abdominal pain that is more severe on the side of the ovulating ovary. The pain may be made worse by movement and it lasts about 24 hours.
At the time of menopause, again in an irregular and gradual way, the ovaries stop producing eggs and reduce their hormone output. Once again they become glands which produce only small amounts of estrogen, progesterone and androgens.
A cyst is a fluid filled sac that can develop in any part of the body. Most are not harmful and do not cause any discomfort. In many cases they can be ignored.
An ovarian cyst is like a fluid filled bubble in the ovary. The swelling follicle of ovulation forms a cyst which is a normal part of the woman’s cycle. Ovarian cysts are often formed from these follicles when something goes wrong with the normal cycle. These cysts usually disappear of their own accord and rarely cause problems. Other ovarian cysts are the result of diseases which may need to be diagnosed, followed or treated.
A common disease of the ovaries is polycystic ovarian disease. The prefix “poly” suggests that there are many cysts present. In these cases, a hormone imbalance and infrequent ovulation are part of the pattern. The symptoms women experience are irregular menstrual cycles and lower abdominal fullness. Polycystic disease can be detected by ultrasound of the pelvis.
A condition called endometriosis can result in similar symptoms to those of polycystic disease but the cause is quite different. In this case, the lining of the uterus begins to grow outside the uterus. This can cause cysts, abdominal pain and reduced fertility.
Sometimes an ovarian cyst may bleed, rupture or becomes twisted. These cases can become medical emergencies. Any severe lower pelvic pain that gets worse over time requires urgent assessment by a doctor either through the office or the emergency department. Many women feel the symptoms of ovulation to a greater or lesser degree. The pattern of the symptoms can help in the diagnosis between a normal monthly discomfort and a diseased ovary.
Cycts on the ovaries may or may not be cancerous. Cancerous cysts are unusual in young women but after menopause cysts have a greater risk. Doctors will follow all cysts closely to determine if there is any danger for the woman.
The ovary is situated deep within the pelvis so disease can be difficult to diagnose. A heavy feeling or intermittent pain on one or other side of the lower abdomen may be present. Often the first sign of a problem is found during an internal pelvic examination. This is why the regular pap smear examination is usually accompanied by a pelvic examination.
If an abnormality is suspected, a more precise look with an ultrasound may show if the ovary is involved. This test can be done with more precision by using a vaginal probe rather than the usual abdominal route. If the ultrasound shows a problem, several paths of treatment may be open. Sometimes the first step, especially during the reproductive years, is observation of the symptoms for several months. This can help identify serious problems that do not follow the path of the menstrual cycle. The symptoms will be steady and worsening over time.
At other times a surgical look through a laproscope is required. A laparoscopy is a test that uses a narrow instrument like a telescope, pushed through a small cut in the abdomen. Through the laparoscope the ovaries, uterus and other abdominal organs can be seen. The decision about the need for this procedure is made on an individual basis in consultation with a family doctor and gynecologist.
Ovarian cysts during the childbearing years are common and often disappear without difficulty. The wisest course for women is to understand the cyclical nature of the reproductive system and become familiar with the monthly changes. It then becomes easier to determine the differences between the normal symptoms of the menstrual cycle and those of troublesome ovarian cysts.
When a cyst develops careful management by the family doctor is enough until the problem has resolved. After the reproductive years, much closer investigation of a cyst is required to be certain the woman is not in danger.