Ovarian Cysts Clinical Presentation

Updated: Dec 20, 2018
  • Author: Shannon M Grabosch, MD; Chief Editor: Nicole W Karjane, MD  more...
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Presentation

History

Most patients with ovarian cysts are asymptomatic, with the cysts being discovered incidentally during ultrasonography or routine pelvic examination. Some cysts, however, may be associated with a range of symptoms, sometimes severe, [1] although malignant ovarian cysts commonly do not cause symptoms until they reach an advanced stage.

Pain or discomfort may occur in the lower abdomen. Torsion (twisting) or rupture may lead to more severe pain. Cyst rupture is characterized by sudden, unilateral, sharp pelvic pain. This can be associated with trauma, exercise, or coitus. [1, 2] In addition, cyst rupture can lead to peritoneal signs, abdominal distention, and bleeding that is usually self-limited.

Other symptoms include the following:

  • Patients may experience discomfort with intercourse, particularly deep penetration

  • Having bowel movements may be difficult, or pressure may develop, leading to a desire to defecate

  • Micturition may occur frequently, due to pressure on the bladder

  • Irregularity of the menstrual cycle and abnormal vaginal bleeding may occur; the intermenstrual interval may be prolonged, followed by menorrhagia [3]

  • Young children may present with precocious puberty and early onset of menarche

  • Patients may experience abdominal fullness and bloating

  • Patients may experience indigestion, heartburn, or early satiety

  • Endometriomas are associated with endometriosis, which may cause dysmenorrhea or dyspareunia

  • Polycystic ovaries may be part of the polycystic ovarian syndrome, which includes hirsutism, infertility, oligomenorrhea, obesity, and acne

  • Some patients may experience tenesmus

Theca-lutein cysts are commonly bilateral and thus can cause bilateral, dull pelvic pain. [12] These cysts may be associated with excess stimulation, as is seen in pregnancy (in particular twins), a large placenta, and diabetes. Newborns may also develop theca-lutein cysts, due to the effects of maternal gonadotropins. In rare cases, these cysts may develop in the setting of hypothyroidism, owing to similarities between the alpha subunit of TSH and hCG. [12, 11]

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Physical Examination

Palpation

A large cyst may be palpable on abdominal examination, but gross ascites may interfere with palpation of an intra-abdominal mass.

Although normal ovaries may be palpable during the pelvic examination in thin, premenopausal patients, a palpable ovary should be considered abnormal in a postmenopausal woman. If a patient is obese, palpating cysts of any size may prove difficult.

Sometimes, discerning the cystic nature of an ovarian cyst may be possible, and it may be tender to palpation. The cervix and uterus may be pushed to one side.

Other masses may be palpable, including fibroids and nodules in the uterosacral ligament consistent with malignancy or endometriosis.

Other symptoms

Hemorrhage due to cyst rupture may lead to tachycardia and hypotension. Blood pressure monitoring may show orthostatic hypotension.

Some complications of ovarian cysts, such as ovarian torsion, may result in hyperpyrexia. [1]

Examination reveals moderate to severe unilateral or bilateral lower abdominal tenderness in some women with an ovarian cyst.

Some complications of ovarian cysts may result in adnexal tenderness or cervical motion tenderness. However, up to 88% of ovarian cysts may be asymptomatic and missed on pelvic exam. [25]

If hemorrhage or peritonitis ensues, the patient may present with a diffusely tender abdomen with rebound tenderness and guarding; in addition, a distended abdomen may be found on abdominal examination.

Advanced malignant disease may be associated with cachexia and weight loss, lymphadenopathy, shortness of breath, and signs of pleural effusion.

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