Adolescent Ovarian Cysts
Pediatric and Adolescent Gynecologists have special training and expertise in this area. Ovarian cysts are fluid-filled sacs that forms on the ovaries. The ovaries are the small organs on each side of the uterus that produces eggs and female hormones. Normal ovaries have lots of small cysts in them, and this is the sign of a “healthy ovary.”
What are Adolescent Ovarian Cysts?
Ovarian cysts may occur in females of all ages but are most common between puberty and menopause. Some fluid-filled sacs develop during the normal menstrual cycle (period). These cysts often go undiagnosed or will dissolve on their own. They are typically small (approximately 2 to 20 mm), but they can grow larger.
What are the different types of Adolescent Ovarian Cysts?
There are two main classes of ovarian cysts: functional (physiologic) and nonfunctional.
Functional cysts are part of the normal menstrual cycle. During the beginning of a typical menstrual cycle, fluid-filled pockets (follicles) grow on the ovary, and each contains an egg. All but one follicle stops growing, and the rest are absorbed back into the ovary. The remaining follicle produces estrogen and progesterone (primary female sex hormones), and it will release the egg during ovulation.
Types of functional cysts include the following:
- Follicular cyst – this is the most common type of functional cyst. A follicular cyst forms when an egg is maturing on the ovary. Antral follicles are the small pea-sized cysts that are always there. Sometimes a follicular cyst can become abnormally large (> 5 cm) but this is rare.
- Corpus luteum cyst – After ovulation, a cyst can form on an ovary kind of like a “bruise.” Most often this is asymptomatic, but it occasionally can cause some minor pain.
Nonfunctional cysts are not related to the menstrual cycle. Types of nonfunctional cysts include the following:
- Cystadenomas – The cysts will develop on the ovary’s surface and are filled with thin, watery fluid or a thick, mucous-like material. These are usually benign.
- Dermoid cysts (teratomas) – The cysts form from embryonic cells and can contain hair, skin or teeth. These are usually benign but can become large (>4 cm), and they can twist, causing pain.
- Endometriomas – The cysts develop due to endometriosis. Uterine endometrial cells grow outside the uterus, which can attach to the ovaries and form cysts.
What are the signs and symptoms of Adolescent Ovarian Cysts?
Symptoms of functional cysts are rarely noticed, and they often disappear on their own within two or three menstrual cycles. If a cystadenoma or a dermoid cyst becomes large (over 4-5 cm), it can move the position of the ovary.
Complications may occur in some cases and can include the following:
- Ovary rupture – Large cysts (larger than 4-5 cm) may cause the ovary to leak, which can lead to hemorrhaging and pain.
- Hemorrhage – Internal bleeding may occur if the cyst ruptures.
- Torsion (twist) – Cysts can move the ovary, causing it to twist on its pedicle or blood supply. Torsion causes severe pain, nausea and vomiting. It can also lead to a decrease or stoppage of blood flow to the ovary, and the need for emergency surgery.
How are Adolescent Ovarian Cysts diagnosed?
If you suspect your daughter has ovarian cysts, her doctor will first take a medical history and conduct a physical exam. A pelvic exam will not be required, but her doctor will want to know when her last period was and how regular her periods have been.
Additional tests may include pelvic imaging studies such as:
What are the causes of Adolescent Ovarian Cysts?
Most ovarian cysts develop as a result of the normal menstrual cycle.
- Endometriosis – Uterine endometrial cells grow outside the uterus, which can attach to surrounding tissues and ovaries and form cysts.
- History of ovarian cysts – While it is not always the case, girls are more likely to develop ovarian cysts if there is a history of other cysts.
- Pelvic infection – Cysts can develop if a severe infection spreads to the fallopian tubes and ovaries.
How are Adolescent Ovarian Cysts treated?
Small cysts can be observed and are most often normal; larger ones may require removal. Sometimes the cyst enlarges to an abnormal size and may require excision. Often, this can be done with a minimally invasive (laparoscopic) approach by a Pediatric and Adolescent gynecologist that saves the associated ovary. If the cyst is very large, a larger incision may be required to remove it.
Ovarian tumors in children are most often benign but can be malignant.
Ovarian tumors and cysts occasionally cause twisting of the ovary and fallopian tube. In these cases, they are found when a patient is evaluated for abdominal pain. Twisted ovaries require prompt surgery to prevent damage to the ovary from lack of circulation.