What are ovarian cysts and who is the specialist who treats them?

Meet with Ulas Bozdogan, MD, FACOG

Endometriosis & Fibroids Specialist located in Hackensack, NJ and New York City, NY

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Ovarian Cysts:Ovaries release eggs for fertilization over the reproductive lifetime of a woman. From the ovary and its egg follicles are made hormones that take part in this monthly cycle. When the cycle goes off-kilter, as can happen from time to time, there is a pause in this orderly process and fluid can build up in a follicle to become a cyst. The dividing line between a follicle and a cyst is an arbitrary size of 2 centimeters (cm), because it is > 2 cm at which signs and symptoms become apparent.

Ovarian Cyst Specialist: Dr. Ulas Bozdogan is a specialist in diagnosing and in treating ovarian cysts. First, he is a gynecologist, board-certified by the American Congress of Obstetricians and Gynecologists; second, he has the thousands of hours’ and surgeries’ experience he has accrued treating them, eminently qualify him as a “specialist,” which becomes crucial when a woman wants to preserve her child-bearing potential. A specialist like Dr. Bozdogan uses the latest state-of-the-art technology, diagnostic, therapeutic, and surgical techniques.

FREQUENTLY ASKED QUESTIONS


What causes an ovarian cyst?

As above, when a follicle becomes enlarged beyond 2 cm, it is termed a cyst.

    • The most common cause of this is a hormone imbalance, that is, a dysfunction of your usual menstrual cycle. Things such as ovulation and normal follicle resorption can be delayed, causing follicular fluid to accumulate and expand within the follicle. After 2 cm in diameter, the lining over it, rich in pain nerve fibers, can distend and cause lower pelvic pain on the respective side.
    • Other causes of ovarian cysts are abnormalities with other glands (“endocrine”) that take part in the menstrual cycle, namely, the hypothalamus and pituitary glands in the brain.
    • A diabetic condition called “insulin resistance” can also interfere with the normal cycle to the point that abnormal amounts of hormones that are in the estrogen family, such as testosterone, can lead to “virilzing” (male-like) cosmetic effects, such as acne, deep voice, hairiness, and breast size reduction.
    • Genetic problems can cause strange cysts in the ovary filled with hair, bone, and even teeth. These are called “dermoid” cysts and most are benign, but if they rupture, their contents can cause peritonitis.
    • Cancer of the ovary can present as a malignant cyst, usually in an older woman. Such a cyst is not influenced by hormonal changes or manipulation.

What are the signs and symptoms of an ovarian cyst?

This depends on the nature (cause) of the ovarian cyst.

    • By far the most common symptom is pelvic pain, usually on the side of the cyst. The bigger the cyst, the more the pain because the ovary hangs on a stalk of nerves and blood vessels, and this stalk is stretched by the increased weight of the cyst.
    • Since most of them, especially in women before menopause, are hormonal or are endocrine in nature, a common symptom is irregular bleeding (irregular periods—too often, too seldom, heavy, or scant).
    • Polycystic ovarian syndrome, from the insulin-resistance that interferes with the cycle [SEE ABOVE], can present with facial hair, acne, breast-size reduction, extra oily skin, and deepening of the voice due to conversion of hormones to testosterone.
    • Cancer of the ovary is usually silent until it attains a size that is already considered dangerous, so extra vigilance is necessary when there is a family history of it.
    • A very large cystic ovary can twist on its stalk, which can cut off the blood supply resulting in death of the ovary (called “ovarian torsion”), a surgical emergency.
    • A cyst that ruptures spontaneously (and thus, “cures” itself) will result in the pain peaking and then suddenly disappearing.
    • However, if there is any bleeding from the rupture, although the bleeding is self-limited and harmless, it can still cause pain. Although the rupture will make the sharp, unilateral pain disappear, with bleeding it will be replaced by a vaguely distributed burning-type pain in your pelvis. Eventually over a couple of days this will resolve as well.
    • Painful intercourse can result from the mechanical jostling of an enlarged ovary on its tension-sensitive stalk.

Could something else cause any of these symptoms? 

Yes. Other conditions can cause similar symptoms:

    • Irritable bowl syndrome or inflammatory bowel disease.
      With so much of the abdomen providing space for the gastrointestinal organs (small and large intestines, rectum), irritation of a section on one side can mimic the pain of an ovarian cyst. 
    • Cystitis
      A bladder infection, although more centrally located in its symptomatic pain presentation, can cause the same type of tenderness seen with an ovarian cyst.
    • Appendicitis
      An inflamed appendix can mimic the pain of a right ovarian cyst, but a CT scan or ultrasound can help make the call.
    • Ectopic pregnancy.
      The symptoms of an ectopic (tubal) pregnancy can be exactly like that of an ovarian cyst—pain that is sharp, severe, pin-point, and unilateral. As with a cyst, it can also cause bleeding with the associated vaguely distributed pain throughout the pelvis. Whereas ovarian cysts are rarely dangerous, ectopic pregnancies can be fatal if not treated in time. It is important that you seek out a specialist like Dr. Bozdogan to make such an important diagnosis, and if either an ectopic—or the rare, dangerous ovarian cyst—is the issue, he has his robotic technology to remedy the emergency with minimal pain and downtime.

How are ovarian cysts treated?

An ovarian cyst, when due to a temporary hormonal dysfunction, is not a disease, but a normal variation that requires only waiting it out.

For recurrent ovarian cysts, simple birth control pills can “redesign” your cycle into a normal pattern. Either way, watchful waiting, perhaps with ultrasound surveillance for a brief period of time, is all that is needed.

If cysts come about because of an endocrine disorder, identifying and treating the primary condition will also fix the ovarian cyst problem. A specialist like Dr. Bozdogan is the appropriate person to go to for this type of diagnostic evaluation.

For life-threatening emergencies such as a hemorrhagic ovarian cyst, ovarian torsion, or even an ectopic pregnancy, surgery is the definitive therapy, best done using minimally invasive technique such as Dr. Bozdogan’s robotic approach. Today’s same-day, minimally invasive and robotic techniques, the kind in which Dr. Bozdogan is a specialist, shortens recovery time. His state-of-the-art technology also makes possible complete excision while sparing the rest of the ovary (or—in ectopic pregnancy—the tube), important if fertility is a concern.

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