Ovarian Cysts and Endometriomas

In reproductive life, almost every month, ovaries form tiny fluid-filled sacs or “follicles” that generate estrogen and progesterone hormones. These release an egg during ovulation when they burst. If a follicle continues to grow without releasing an egg, it is called a “functional cyst“. In short, ovarian cysts are sacs full of fluid that develop inside ovaries or on their surfaces. They are generally asymptomatic but can turn problematic if they twist or rupture. They may or may not be associated with endometriosis.

Can endometriosis cause ovarian cysts?

Ovarian endometriosis, when cystic, is referred to as an endometrioma; however, not all ovarian cysts are classified as endometriomas.

Functional cysts may occur in all reproducing women. They are a natural result of ovulation and usually regress in about 60 days on their own. If the cyst bleeds inside, it is called a hemorrhagic ovarian cyst. Functional simple cysts can be either follicular or luteal. Follicular cysts occur when the follicle does not release an egg and instead fills with fluid. Luteal cysts, on the other hand, occur when the corpus luteum formed after ovulation collects fluid. 

Complex cysts, on the other hand, have nothing to do with ovulation and can cause pain. These are generally benign, but there may be a risk of cancer, especially in post-menopausal women.

What are the symptoms?

There is a significant symptom overlap between cysts and ovarian endometriomas making diagnosis difficult. Most cysts are small and typically do not cause symptoms. However, when they grow larger, they may pose risks, such as twisting (ovarian torsion) or rupturing. This can lead to severe pain and require urgent medical attention.

Ovarian cysts and endometriomas share similar symptoms, including pelvic pain that can range from dull to severe, painful intercourse (dyspareunia), constipation, frequent urination, painful urination (dysuria), bloating, heavy periods (menorrhagia), irregular periods (oligomenorrhea), and, in some cases, infertility.

How do doctors diagnose ovarian cysts? 

Endometriomas and certain ovarian cysts may also share the same imaging features and symptoms, leading to potential misdiagnosis.

Pelvic or transvaginal ultrasound can provide initial insights into the nature of the cyst such as its size, volume, and internal structure. Imaging techniques provide several classifications and parameters to assess the malignancy potential of cysts. However, sometimes it is difficult to fully differentiate between hemorrhagic ovarian cysts and endometriomas based on ultrasound alone.

It is only possible to reach a definitive diagnosis of endometriomas and differentiate it from other ovarian cysts through laparoscopic ovarian cystectomy followed by histopathological examination of the tissue sample.

How about treatment?

Most cysts regress on their own. However, the treatment for endometriomas and other ovarian cysts depends on factors like size, symptoms, and whether they pose any risks. It may not be necessary to treat small cysts that do not cause symptoms. It may be sufficient to just monitor them over time. For larger cysts, or those causing pain or complications like twisting or rupture, or other specific ultrasound and clinical parameters, surgery may be necessary.

Endometriomas, which are cysts caused by endometriosis, often require laparoscopic surgery to remove them. This is especially important if they are causing significant pain or fertility issues.

In some cases, hormonal treatments may help manage symptoms. However, surgery remains the most effective way to remove endometriomas and confirm the diagnosis.

It’s important to work with a doctor to determine the best treatment plan based on the individual case.

During laparoscopic ovarian cystectomy, preserving normal ovarian tissue and vascular perfusion is essential for maintaining ovarian function and fertility, ensuring optimal reproductive health with minimal ovarian reserve loss.

In rare cases, the removal of one or both ovaries (oophorectomy) may be necessary. This could be due to concern about cancer, large cysts, severe ovarian torsion, multiple or recurring endometriomas, or a high risk of adhesions. Removing only one ovary (unilateral oophorectomy) still preserves fertility. This is an important decision, and your doctor will discuss all treatment options with you carefully.

Do you have ovarian cysts? Have you seen a doctor about endometriosis? Please leave a comment on our post on Facebook or Instagram to share your story.

Further reading

You may also wish to explore the latest literature available on Endonews for further insights:

IPost Surgery Endometrioma Recurrence

Ovarian endometriomas revisited

Impact of Endometriosis Subtypes on Increased Ovarian Cancer Risk

Ovarian Endometrioma Does Not Affect Egg Quality, Study Suggests

Recommendations of experts on transvaginal ultrasonography