WHEN IS SURGERY NEEDED FOR AN OVARIAN CYST?
The appropriate treatment for an ovarian cyst depends on the type of cyst present, the symptoms you have, and whether you are premenopausal or postmenopausal. As noted before, if you are premenopausal, if you are not having bothersome symptoms, and if your cyst appears benign on sonogram, watchful waiting will often allow the cyst to dissolve by itself within 4-10 weeks. Surgery may be considered necessary if a cyst appears suspicious for cancer on the sonogram, if it causes severe pain, if it continues to grow, or if it does not go away in 8-10 weeks. In rare cases, a cyst can burst (rupture) or cause the ovary to twist around and stop blood flow to the ovary (torsion). Both of these events can cause severe pain and require the need for emergency surgery.

CAN LAPAROSCOPIC SURGERY BE USED TO TREAT AN OVARIAN CYST?
Ovarian cyst surgery can be performed using a telescope placed through the navel, called a laparoscope, and small instruments placed into the abdominal cavity near the pubic bone. Laparoscopic surgery provides the benefits of outpatient surgery and a quick recovery.

Removing the cyst, called a cystectomy, is like taking a clam out of the shell. The thinned out ovarian tissue is cut open, and the cyst is gently peeled away from inside the ovary. The cyst fluid is then removed with a suction device and the cyst, now looking like a deflated balloon, can easily be removed through the small laparoscopy incision. The ovary heals very well and usually no suturing of the ovary is needed (figs 1-5). The benefit of laparoscopic surgery is that you may leave the hospital the same day and return to normal activity within a week or two.

Figure 1: Appearance of the normal right ovary

Figure 2: Dermoid cyst within left ovary

Figure 3: Ovarian tissue is separated from cyst beneath

Figure 4: Cyst is placed in bag to remove from abdomen

Figure 5: Left ovary remains intact after surgery

We are always careful to leave as much normal ovarian tissue as possible so that the ovary can heal with healthy eggs remaining. Even for large cysts - those that are more than 3 inches in diameter - normal ovarian tissue can almost always be saved. Remember that the ovaries contain hundreds of thousands of eggs, so that the loss of a small number should not make a difference in your fertility, your hormone levels or the age at which your menopause will begin. Very rarely, if a cyst has destroyed all the normal ovarian tissue, it may be necessary to remove the entire ovary, although even in these cases we try to save some of the ovary.

WHEN IS MAJOR SURGERY NEEDED FOR AN OVARIAN CYST?
The goal of all surgery is to take care of the patient in the safest and most expeditious way possible. Based on the examination and sonogram, if the likelihood of a cyst being benign is very high, then laparoscopic surgery has the advantage of a quick and easy recovery. If there is a possibility that a cyst is cancer, more extensive abdominal surgery should be performed.

IS A HYSTERECTOMY NEEDED IF YOU HAVE AN OVARIAN CYST?
Some women are told that if a cyst that needs to be removed surgically, a hysterectomy should be performed at the same time. However, a scientific study showed the risks of surgery were greater if, in addition to removing the ovary, a hysterectomy was also performed to remove a normal uterus. This only makes sense - more surgery leads to more risk of blood loss, more risk of injury to other organs, and more time under anesthesia. Hopefully the idea of limiting surgery to just the problem area will be adopted by more gynecologists. If you have an ovarian cyst and your doctor is recommending hysterectomy, ask why they think it necessary. If you are not satisfied with the answer, you should consider getting a second opinion. The issues concerning hysterectomy are discussed fully in our book, A Gynecologist's Second Opinion.

SHOULD YOUR OVARIES BE REMOVED?
Many women are told they need to also have their ovaries removed if they must have a hysterectomy. This has been a controversial issue for many years, but until recently most doctors recommended removal of the ovaries after about age 45. The reason for this was that removal of the ovaries would prevent women from developing ovarian cancer. However, the ovaries continue to produce hormones for many years after menopause and these hormones have many long-term health benefits, as well as benefits for improved mood, prevention of vaginal dryness, preservation of skin tone and elasticity.

The ovaries continue to produce estrogen in small amounts, and testosterone in normal amounts for about 30 years after menopause. Muscle, skin and fat cells change testosterone into estrogen, and this source of estrogen appears to be responsible for the lower risks of heart disease and osteoporosis that have been found in studies of women who still have their ovaries.

We recently published an article in the renowned journal Obstetrics and Gynecology that showed a lower risk of dying before age 80 if you choose to keep your ovaries at the time you have a hysterectomy. You can find the information here.

For more information, please visit: http://www.ovaryresearch.com/