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.