You may have some questions about ovarian cysts, particularly if you are a woman in your childbearing years, because these cysts are more common among younger women.  Regardless of whether you’ve had a tubal ligation, a tubal reversal, or no surgery at all, these cysts are common findings during your physical exam or ultrasound.  Ovarian cysts are common and usually occur as a result of the normal monthly fluctuations in hormones in premenopausal women.  Since a tubal ligation reversal does not stop this hormone cycle, a tubal reversal will not stop these cysts from occurring.

Although in most cases ovarian cysts are nothing to be concerned about, occasionally they can cause pain, and in rare instances they can be cancerous.  Non cancerous cysts occur as a result of normal process or a minor abnormality that can clear up on its own.  In those circumstances Dr. Morice may recommend that you follow up in a month or two to see if the cyst has resolved on its own.  In certain circumstances Dr. Morice might recommend further imaging, medications,  or even surgery to better understand what is causing the cyst.

Because there are many different types of cysts, Dr. Morice may want to get a better understanding of what is causing yours, particularly if you are undergoing a tubal ligation reversal.  Identification can be done with an ultrasound before the tubal reversal is performed just to make sure that there isn’t anything more concerning occurring prior to your surgery.

The 5 most common types of ovarian cysts are:

-          Functional cysts

-          Endometrial cysts

-          Cystadenomas

-          Dermoid cysts

-          Polycystic ovaries

Functional cysts are the most common among young women who are cycling normally, regardless of wether they have had a tubal ligation reversal. These cysts are a normal process of menstruation and usually clear up on their own without you or Dr. Morice ever even knowing about them. There are 2 types of functional ovarian cysts. The first comes from the Graafian follicle (or sac) where the egg develops every month. It is the most common and occurs if the sac fails to break open and release its egg.  The second type of functional cyst is a simple fluid filled cyst.  Both types typically resolve on their own in one to three months.

Another remnant from the monthly cycle is a corpus luteum cyst. After the egg is released, this portion of the ovary usually disintegrates. However, if the woman becomes pregnant, for example after a tubal ligation reversal, sometimes this cyst can form if the sac seals off. This ‘sealing’ of the cyst wall results in a buildup of fluid.  Again these cysts normally resolve in a few weeks with most women remaining unaware that they’re even there. The likelihood of getting an ovarian cyst is not increased at all by a tubal reversal.

Occasionally the cysts can become enlarged and rupture. This may cause a little bit of bleeding and pain. Sometimes the blood will collect inside of the cyst itself, and this is called a hemorrhagic cyst. Although a hemorrhagic cyst can be quite painful, it is also a benign condition that can be safely watched without intervention and without concern for an underlying cancer.  As always, if you have concerns about pelvic pain or your risk for ovarian cancer you should discuss these concerns with Dr. Morice.

When is needle aspiration the best option to manage ovarian cyst(s)?

About 6% of women will have an ovarian cyst after menopause.  Factors such as age, menopausal status, size, and type of an ovarian cyst will determine the proper management of such ovarian cysts.  This information in most cases will predict whether the cysts are benign (functional), or likely to be cancerous. One option for benign cysts is needle aspiration.

Needle aspiration of ovarian cysts can sometimes be performed in the physician’s office using ultrasound guidance. The needle aspiration can be made using local anesthetic only, which is less involved than surgical operative intervention, and a patient does not require a hospital admission. Alternatively, aspiration can be done surgically, by either a laparoscopic or classical surgical approach.

There is always the risk of side effects and injury linked to the management of ovarian cysts by either medication or surgery. In the field of assisted reproductive technology (ART), and for patients having ovarian cysts after a tubal reversal, a needle aspiration is often attempted prior to a surgical intervention.  If the cysts are present during the tubal ligation reversal, they can be aspirated or removed at the time of tubal ligation reversal.

Cysts may grow and enlarge without symptoms and go unobserved until they are found on routine examination.  However, some cysts will burst during routine activities such as by sexual intercourse, any injury, or childbirth. Cysts may become bulky enough so that the following symptoms may occur:

• Severe abdominal pain
• Menstrual cycle changes, such as delayed periods, intermittent bleeding between periods, or irregular periods.  This may even occur with corpus luteum cysts and polycystic ovaries.
• Heavy menstrual flow
• Infertility; a symptom occurring in polycystic ovaries and endometrial cysts.
• Internal bleeding may occur with endometrial cysts or hemorrhagic cysts.
• Severe menstrual cramps
• Pain with sexual intercourse
• Pain during a bowel movement
• Weight gain

Note: If a cyst becomes enlarged, the woman may experience intermittent pain.  Unexpected or abrupt sharp pain may indicate that a cyst has ruptured.  The twisting distortion or break of a cyst may add to the likelihood of a torsed ovary or an infection.

Some unexpected onsets need instant medical attention, such as:

• fever,
• abdominal pain,
• vomiting and symptoms of shock such as cold,
• clammy skin
• rapid breathing

Enlarged ovaries, ovarian cysts, or polycystic ovaries are relative concerns to watch after a tubal reversal or any surgical procedure. If the above symptoms exist in a patient who has undergone a tubal reversal, it may be more concerning to the patient, but should be treated as appropriately as medically indicated. Cysts that occur after a tubal reversal should have no effect whatsoever on the likelihood of achieving a pregnancy after a tubal reversal.