Ovarian cysts in pregnancy

Ovarian cysts are small, fluid-filled sacs that develop in the ovaries. Most are harmless. However, some of these ovarian cysts could lead to some problems such as ruptures, bleeding, pain. Sometimes surgery may also be needed to remove them.

The ovarian cysts

Ovarian cysts develop predominantly in women of childbearing age.

They are very common, affecting women of all ages. They are mostly functional cysts, produced by hormonal fluctuations that occur during the menstrual cycle.

Usually the cysts are benign, and disappear on their own within a few weeks, without the need for treatment.

While it is quite common for ovarian cancers to have cysts, they are not typically cancerous per se.

Indeed, on the contrary: in this regard it must also be said that it is easier for cancerous ones to occur during the fertile years of a woman’s life, rather than during pregnancy.

Ovarian cysts, especially in young women, are not an obstacle to pregnancy.

The ovaries

To learn more about the topic of cysts of the ovaries (ovarian cysts), it is helpful to know the functions that the ovaries perform.

This is because these cysts are small sacs, filled with liquid, which form precisely on the surface of the ovaries, which ovaries are – as is known – the female sexual glands (gonads).

Women normally have two ovaries, whose function is to store and release egg cells. Each ovary (or ovary), about the size of a walnut, sits on either side of the uterus. Through a process called ovulation, one of your ovaries releases an egg each month.

Ovulation occurs approximately in the middle of a woman’s menstrual cycle.

The oocyte is enclosed in a sac (called a follicle) where it grows while estrogen (a hormone released by the ovary) prepares the uterus for the implantation of any fertilized egg thus initiating pregnancy.

This cycle repeats itself every month. If the egg is not fertilized, the contents of the uterus are expelled during menstruation.

The first day of bleeding is considered the first day of the new menstrual cycle.

What do ovarian cysts look like?

When observed through an ultrasound, ovarian cysts appear to us as bubbles.

They usually contain only fluid, and are enclosed within a very thin wall: these are the characteristics that identify what is called a simple cyst.

If the follicle does not rupture and then release the egg, the fluid becomes trapped and can form an ovarian cyst.

Usually this only occurs in one ovary.

The smallest cysts, those about 1 centimeter in diameter, may normally be present during follicle formation.

Ovarian cysts in pregnancy

About one in every thousand women develops an ovarian cyst during pregnancy.

When cysts appear, they typically do so in the 2nd trimester of pregnancy . In this regard it must be said that,

  • although when they appear they may cause some concern, it is important to bear in mind that in most cases, they are asymptomatic cysts that do not endanger either the mother or the child;
  • most of the cysts that have a diameter of less than 5 centimeters do not in fact cause any problems during pregnancy, resolving themselves before – or just after – the birth;
  • when, on the other hand, the cysts exceed 12 cm in diameter, it is usually necessary to treat them for preventive purposes,
  • instead, for those between 5 and 10 cm in diameter, it is difficult to decide whether to cure them or let them run their course: the doctor will have to carefully consider the risk of possible complications due to the rupture of the cyst by comparing it with the risks associated with possible surgery.

You might be interested in: Second trimester pregnancy

Symptoms of ovarian cysts

In pregnancy, the symptoms of a cyst are the same as those of a cyst forming in a non-pregnant woman, and consist of,

  • pelvic pain,
  • cramps,
  • some swelling
  • from pain during intercourse.

Of course, there is always the possibility that a pregnant woman, especially a first time pregnancy, mistakes these symptoms as consequences of the pregnancy itself.

Cysts, or ectopic pregnancy

If ovarian cysts are suspected, an ultrasound (abdominal or transvaginal) should be performed immediately.

This ultrasound will be able to identify where the cyst is located, and will be able to distinguish between an ovarian cyst and an ectopic pregnancy.

We remind you that  ectopic pregnancy  (which occurs in cases of embryo implantation in sites other than the uterine cavity) is a very dangerous occurrence, and its symptoms consist of – copious and sudden bleeding – pain in the pelvic area and lower back – from nausea – from cramps on one side – from a symptom also of functional ovarian cysts (those cysts linked to the menstrual cycle and therefore concerning women of childbearing age), that of the corpus luteum ( this corpus luteum is an endocrine gland whose main function is to produce progesterone).

But not only that: since cancerous bodies are often recognizable by their characteristic appearance, an ultrasound can also help the doctor evaluate the possibility that the cyst is cancerous.

The incidence of ovarian cancer is equal to one in twenty-five thousand pregnancies. The most common types of cysts that develop in pregnancy are,

  • cystadenoma (a tumor in which the tissue proliferates forming cystic cavities lined with epithelium),
  • dermoid cyst (a benign tumor, also called a teratoma, which develops mainly in the ovaries),
  • the corpus luteum cyst.

The treatment of ovarian cysts

After ruling out more serious conditions, your doctor will continue to monitor the location, size and number of cysts.

If the cyst does not grow or multiply, it is very likely that no treatment is needed.

The “management” of an ovarian cyst has become easier with the advent of modern imaging techniques, such as high-resolution ultrasound, magnetic resonance, transvaginal gynecological Doppler ecocolor.

The twists and ruptures of the cysts

The main problem with cysts (even benign ones) concerns the possibility that they will then grow larger and rupture, or that they will turn back on themselves.

  • A ruptured ovarian cyst usually causes sudden, sharp pain on one side of the lower abdomen.
  • Ovarian torsion is nothing more than the rotation of the ovary on its vascular pedicle which produces usually sudden, intermittent, unilateral pain located in the lower abdomen. It is more likely to occur in a woman who has been diagnosed with polytheistic ovary syndrome or Stein-Leventhal syndrome (a condition characterized by enlarged ovaries). The risk of ovarian torsion increases 5-fold during pregnancy, with an incidence of 5 in 10,000.

Rupture or torsion of a cyst can cause such sudden and severe pain to the mother that it can cause a miscarriage or premature labor.

If the cyst grows beyond 6 centimeters, that becomes a potential problem. In these cases the options are,

  • to wait to see if the cyst shrinks on its own,
  • to evaluate whether it is necessary to remove it surgically.

Usually a two-week period is expected, after which a decision is made.

The most suitable period in pregnancy to operate on them is the second trimester – ideally between the 14th and 16th week – when the implantation of the embryo is safest.

Cysts or tumors can be removed up to the 28th week of gestation, after which the risk of premature labor becomes too high.

However, regardless of the stage of pregnancy, any cyst that has malignant (cancerous) characteristics requires immediate intervention.

Ideally, the cyst can be treated via a laparoscopy, which is minimally invasive.

Only rarely, if the cyst is too large, does an incision need to be made and the cyst removed by cystectomy. 

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.

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