Do All Ovarian Cysts Need to be Removed?

Ovarian cysts are common especially in women of reproductive age. Most of these cysts are simple, harmless and disappear naturally within a few menstrual cycles. They rarely cause pain, interfere with daily life, or require surgery. However, some cysts can be more problematic. A small percentage may grow large, rupture, twist (a condition known as torsion), or exhibit complex features that warrant medical attention.

What Are the Signs of Problematic Ovarian Cysts?

Ovarian cysts frequently go unnoticed, especially if they are small, as they often do not present with noticeable signs or symptoms. However, as cysts grow larger, their size and location can lead to discomfort, pain and other noticeable symptoms. Common symptoms include:

• Sharp, Persistent Lower Abdominal Pain When a cyst is large or causes ovarian torsion, you may experience sharp pain that radiates to your back and, in rare cases, to the thigh. The sensation is often described as something that is "pulling" or "twisting" inside.
• Bloating or a Heavy Abdominal Sensation Large cysts can cause persistent abdominal expansion that does not respond to dietary changes or exercise.
• Frequent or Urgent Need to Urinate Large cysts can compress the bladder, causing urinary symptoms. If the cyst grows and presses against the bladder, one may experience frequent urination, urgency to urinate or trouble fully emptying the bladder.
• Unusual Menstrual Changes (Heavy, Irregular, or Missed Periods) Sometimes, ovarian cysts can interfere with one's menstrual cycle, leading to irregular or heavier periods.
• Sudden, Severe Pain in the Pelvis A ruptured ovarian cyst often causes sudden, sharp, and intense stabbing pain in the lower abdomen, unlike the gradual build-up of menstrual cramps.
• Nausea, Dizziness, or Fever Associated with Pain When larger ovarian cysts rupture, they can cause intense pain, nausea, vomiting, weakness, dizziness, fainting, and fever.

When Is Ovarian Cyst Removal Necessary?

Gynaecologists may deem ovarian cyst removal necessary when:

• There Is Suspicion of Cancer The risk of ovarian cancer increases with age and certain ultrasound features. Post-menopausal women face higher cancer risks, making any new cyst potentially suspicious.
• The Cyst Grows Too Large Larger cysts may be considered for surgery, especially if they cause symptoms, show complex features, or raise concerns about malignancy.
• Symptoms Affect Daily Life When pain from an ovarian cyst affects one’s daily life, it should be treated.
• The Cyst Is a Concerning Type For simple cysts, it is usually acceptable to adopt a watchful waiting approach as these cysts rarely become cancers. Some other types, however, carry greater risks and may need to be removed.

What Are the Benefits of Minimally Invasive Ovarian Cyst Removal?

Modern surgical advancements now offer laparoscopic surgery for ovarian cyst removal. This minimally invasive approach offers several benefits, such as:

• Less ScarringLaparoscopic ovarian cyst removal only involves smaller incisions and fewer stitches, resulting in less noticeable scarring than traditional open surgery.
• Less Risk of Bleeding ProblemsLaparoscopic surgery offers enhanced visualisation, allowing surgeons to precisely identify and seal blood vessels instantly with advanced tools like electrocautery.
• Less Risk of InfectionThe smaller incisions found in laparoscopic surgery greatly reduce the risk of wound infection. Since the wounds are small, they heal faster and provide less opportunity for infection to take hold.
• Faster Recovery TimePatients generally experience a faster recovery process, with a shorter hospital stay and a quicker return to normal activities.
• More Precise SurgeryLaparoscopic cameras offer unprecedented visualisation by magnifying the surgical field greatly, allowing surgeons to navigate the surgical site more precisely.
• Less Post-Surgery PainSmaller incisions mean less post-operative pain, making recovery more comfortable.

At GynaeMD Women’s & Rejuvenation Clinic, we offer specialised care for women with simple, complex, or recurring ovarian cysts. Contact us at 6733 8810 or email us at gynaemd@singnet.com.sg to schedule a consultation.