Pregnancy is a period of immense joy and anticipation, but for some women, it can come with additional complexities. One such complexity is dealing with an ovarian cyst. While the word "cyst" can be alarming, it's essential to understand what it means in the context of pregnancy and how to manage it effectively.
Ovarian cysts are fluid-filled sacs developed on the ovaries. They are relatively common and can occur in women at any stage of life. During pregnancy, the most common types of cysts seen are:
Functional Cysts: These are typically harmless. They form under the influence of hormones and often resolve on their own without treatment.
Dermoid Cysts: These contain different types of tissues of the body, like fat cells, hair, or teeth, and can grow quite large. They are rarely cancerous.
Cystadenomas: These cysts sometimes grow large and contain mucus or fluid. They are generally harmless. They are cancerous in 1-5% percent cases.
Endometriomas: These are cysts filled with blood, associated with endometriosis and can be painful. They are also harmless growths.
Most ovarian cysts are found during regular prenatal ultrasounds, which is a routine part of pregnancy care. It's important to remember that most cysts are harmless and don't affect pregnancy. Your doctor will discuss any necessary follow-up steps with you. The size, type and growth rate of the cyst will guide the management approach.
About 20% of the lesions are not adequately visualised by regular ultrasound. In such cases, a 3D transvaginal ultrasound or MRI may be required (Please note that MRI is generally safe in pregnancy. However, contrast media may not be completely safe)
Some blood tests called tumour markers, such as CA125, AFP, LDH, and HCG, are done for non-pregnant patients to rule out cancer in ovarian cysts. These are usually elevated in pregnancy and thus have limited utility and validity.
Pain and Discomfort: Larger cysts can cause pelvic pain or discomfort. In some cases, they might twist (a condition known as ovarian torsion), leading to severe pain and requiring emergency treatment.
Rupture: Although rare, cysts can rupture, causing sharp pain and potentially leading to complications such as bleeding.
Impact on Pregnancy: Generally, most ovarian cysts do not interfere with pregnancy. However, in rare cases, very large cysts might affect the growing uterus or pose a risk during delivery.
Malignancy: it will be reassuring to know that less than 1% of ovarian cysts in reproductive age are cancerous.
Management of ovarian cysts during pregnancy is often conservative, especially if the cysts are small and asymptomatic. Here are some common approaches:
Regular Monitoring: Frequent ultrasounds to monitor the size and appearance of the cyst.
Pain Management: Over-the-counter pain relief, like acetaminophen, is usually recommended. It’s important to avoid NSAIDs like ibuprofen and diclofenac during pregnancy.
Surgical Intervention: In rare cases, if the cyst is causing significant pain, is suspected to be malignant, or is at risk of complications like torsion or rupture, surgical removal might be considered. Ideally, this is done in the second trimester when it is safest for both mother and baby.
Most women with ovarian cysts during pregnancy go on to have healthy pregnancies and deliveries. Having an ovarian cyst does not necessarily mean that you have to undergo a caesarean delivery. Your doctor will assess your condition in the postpartum stage, and the cyst will often be re-evaluated. If necessary, further treatment can be planned.
Remember, your healthcare team is there to back you each step of the way, guaranteeing your and your baby's wellbeing.
Navigating pregnancy with an ovarian cyst can be challenging, but with proper care, support, and information, you can manage this journey confidently and healthily. Trust your body, stay connected with your doctor, and cherish this incredible journey to parenthood.
