An ovarian cyst is a fluid-filled sac that develops on or within an ovary. They are very common among women of childbearing age and most of them are benign, meaning they are non-cancerous. Many cysts form as a normal part of the menstrual cycle and disappear on their own after a few weeks without any treatment.
Clinically, ovarian cysts are broadly divided into two groups:
While most cysts cause no trouble at all, understanding the distinction helps midwives reassure frightened patients and identify when a growth requires closer medical attention.
Functional cysts arise when normal ovarian processes go slightly off track. A follicular cyst occurs when the ovarian follicle fails to rupture and release an egg during ovulation, continuing to grow instead. A corpus luteum cyst happens after ovulation if the fluid-releasing sac seals up and accumulates fluid inside rather than dissolving.
Pathological cysts have different origins:
Many women with ovarian cysts experience no symptoms at all; the growth is often discovered incidentally during a routine pelvic ultrasound. When symptoms do appear, they usually result from the size of the cyst, pressure on surrounding pelvic organs, or bleeding into the cyst.
Common signs include a dull ache in the lower abdomen, pelvic pressure, bloating, or pain during sexual intercourse.
Medical emergencies can occur if a complication develops:
Confirming the presence and nature of an ovarian cyst relies heavily on clinical history and imaging. A bimanual pelvic examination may reveal a palpable, mobile, or tender adnexal mass, though small cysts are difficult to feel.
| Investigation | Purpose / Finding |
|---|---|
| Pelvic Ultrasound | The gold standard imaging tool; determines cyst size, location, and whether it is simple (fluid-filled) or complex (solid areas, septations). |
| Serum CA-125 | A blood marker sometimes checked; elevated levels can suggest malignancy, especially in postmenopausal women, though benign conditions also raise it. |
| Pregnancy Test | Essential rule-out test, as ectopic pregnancy or corpus luteum of pregnancy can mimic ovarian cysts. |
Midwives play a key role in preparing patients for these investigations by explaining the procedures clearly.
Management depends on the woman's age, symptom severity, cyst characteristics on ultrasound, and her desire for future fertility.
Expectant management is appropriate for most asymptomatic, simple functional cysts. The clinician simply schedules a repeat ultrasound in two to three menstrual cycles to confirm spontaneous resolution.
Medical therapy, such as oral contraceptive pills, does not make existing cysts shrink faster, but it can suppress ovulation and prevent new functional cysts from forming.
Surgical intervention becomes necessary when cysts are large, persistent, complex, causing severe pain, or suspected of being malignant. Surgical options include a cystectomy (removing only the cyst while preserving the healthy ovary, ideal for young women) or an oophorectomy (removing the entire ovary, usually reserved for postmenopausal women or severe torsion/malignancy).
Midwives caring for women with ovarian cysts focus on pain relief, psychological support, and postoperative recovery. Pain management involves administering prescribed analgesics and teaching comfort measures such as warm compresses.
For women undergoing surgery, preoperative preparation includes ensuring consent is signed, answering questions about the procedure, and calming anxiety. Postoperative care requires monitoring vital signs, checking abdominal wound dressings or laparoscopic insertion sites, assessing bowel sounds, and encouraging early ambulation to prevent deep vein thrombosis.
Midwives also educate clients on recognizing red-flag symptoms like high fever, heavy vaginal bleeding, or worsening abdominal pain that require immediate return to the clinic.