Ovarian cysts, which are among the most common women's problems regardless of age, can also negatively affect reproductive health. Prof. Dr. Orhan Ünal, Yeditepe University Koşuyolu Hospital Gynecology and Obstetrics, Gynecological Oncology Specialist, emphasized that those who are considering pregnancy should be examined and have their ovaries, uterus, and cervix checked beforehand, and said that the presence of a disease that will prevent treatment during pregnancy should also be investigated.

Ovarian cysts are fluid-filled sacs inside the ovary. However, the fluid can be in the form of an abscess, blood, cancer cell content, or clear liquid content, and the risk and importance of the cyst change according to the content of the cyst. The probability of a cyst or mass in the ovary during pregnancy ranges from 1/81 to 1/8000. Prof. Dr. Orhan Ünal said that with the widespread use of ultrasonography for pregnancy follow-up and anomaly screening in the baby, the rate of detecting ovarian cysts during pregnancy has increased, and reminded that 90 percent of non-complex ovarian masses less than 6 cm detected in the first 16-18 weeks of pregnancy are functional, that is, natural cysts.

It Can Occur at Any Age

Age is not a factor in the emergence of ovarian cysts. Normal or physiological follicle cysts that cannot crack in girls with ovulation problems can grow to 5-10 cm every month and can be seen in small numbers in 0.5-1 cm sizes, which we call polycystic ovaries. Cysts originating from embryological tissue may appear in the ovary at 15-20 years of age or even earlier. Prof. Dr. Orhan Ünal underlined that cysts seen in reproductive age and after menopause should be evaluated, followed up by ultrasound and even imaging methods such as MRI or tomography should be applied. However, detailed examinations such as the evaluation of tumor markers (CA 125) in the blood may be required.

Malignant Ovarian Cyst Progresses Insidiously

Ovarian cysts usually progress insidiously and do not show any symptoms unless they show excessive growth and put pressure on the organs in the abdomen, such as the bladder or intestine. For this reason, a malignant ovarian cyst can only be detected at an advanced stage in a woman who does not have annual check-ups. Prof. Dr. Orhan Ünal, who said that this situation brings the treatment to a difficult point, continued his words as follows:
“The biggest risk created by the growth of ovarian cysts is that the cyst rotates from the stem – which we call the torsion of the cyst - due to its size and weight and the ovarian tissue is damaged by disrupting its nutrition. In this case, there is a risk of losing one of the ovaries, especially in women who desire pregnancy at a young age. In this emergency, which causes symptoms similar to perforated appendicitis, the patient has to apply to the emergency clinic with extreme abdominal pain and a hardened abdomen. If left untreated, it can become life-threatening.” 

Pay Attention to Hormonal Cysts!

Pointing out that ovarian cysts do not prevent pregnancy as long as they do not cover all of both ovaries and reduce the existing ovarian reserve, Prof. Dr. Orhan Ünal made the following statement:
“In some cases, pregnancy can be seen in bilateral cysts. Because the tissues other than the ovarian cyst are normal, the ovary continues to function and the ovulation, which we call monthly cracking, may continue. However, in cysts that occur in connection with hormonal interaction, such as polycystic ovarian syndrome and chocolate cysts caused by endometriosis, ovulation cannot occur and the function of conception may be prevented when there are cysts since hormone production or functioning of the ovary is mostly impaired.

For this reason, those who are considering pregnancy should be examined in advance, have their ovaries, uterus, and cervix checked, and investigate the presence of a disease that will prevent treatment during pregnancy. Prof. Dr. Orhan Ünal gave the following information about what needs to be done apart from this: “If smears are not taken regularly or not taken at all, vaginal smears should be taken for examination, and ovaries and uterus should be examined by ultrasound. If there is an abnormal condition according to the results obtained in the imaging, it should be evaluated, and if it creates an obstacle to pregnancy or the continuation of the pregnancy, it is important to have the treatment performed. In addition, it is important to perform routine blood count, blood sugar, urinalysis, rubella history, and thyroid examination and tests before the pregnancy, and if there are existing complaints, it is important to perform tests for them.”

Pay Attention to Ovarian Cyst During Pregnancy!

Stating that the majority of cysts that occur during pregnancy, in general, are benign and regress spontaneously in the following weeks of pregnancy, Prof. Dr. Orhan Ünal said, “Most of the benign or malignant ovarian cysts detected during pregnancy are unilateral. Cysts that do not regress after 16 to 18 weeks have a higher risk of growth. Persistent large cysts can cause complications such as torsion, rupture, bleeding, or difficult delivery. Therefore, it is very important for the physician following up on such cysts to schedule the operation without complications. The probability of these cysts getting worse is around 1-8 percent.”
Stating that severe pain may occur due to ovarian cyst torsion, that is the rotation of the cyst from its stem, Prof. Dr. Orhan Ünal said, “The stress factor caused by pain can trigger premature birth or miscarriage. At the same time, depending on the size of the ovarian cyst or complications that may occur in the cyst, the threat of miscarriage or premature birth pain may begin. Cysts do not have a harmful effect such as creating an anomaly directly on the baby. However, some negative effects may occur if the baby is born prematurely, with an indirect effect by causing premature birth or miscarriage.”

How Should Cysts During Pregnancy Be Followed Up?

Yeditepe University Hospital Obstetrics and Gynecology, Gynecological Oncology Specialist Prof. Dr. Orhan Ünal, who said that there is no difference in the follow-up of endometriosis or chocolate cysts compared to other cysts during pregnancy, gave the following information about follow-up and treatment:
“The 'CA 125' value, which we call a tumor marker that is observed to be high in malignant cysts, is also high in these cysts and causes concern. Examining a tumor marker called 'HE 4', which is not thought to be affected by a pregnancy, is important in terms of evaluating the possibility of endometriosis and cancer, which are seen very rarely. In the polycystic ovary, it may only require conception treatment. When observed together with pregnancy, no special follow-up is required, and it is sufficient to continue with normal pregnancy follow-up.”

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