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| |    Ovarian Cysts in Teens and Preteens by Marjorie Greenfield, M.D. reviewed and revised by Marjorie Greenfield, M.D. An ovarian cyst is one of the most common findings that doctors diagnose in girls and women. Many people who hear the words "ovarian cyst" are likely to assume that the condition is somewhat serious or problematic. But as you'll soon discover from this article, most cysts seen on ultrasound or diagnosed during a routine examination pose no significant threat and are instead painless, short-lived findings related to ovulation. How cysts form A cyst--defined simply as a fluid-filled sack--that develops on the ovary commonly comes about as a result of the ovulation process. It may form from the follicle in which the egg grows and matures; or the cyst may grow from the corpous luteum, a structure that makes the hormone progesterone after the egg is released from its follicle. These cysts, called functional cysts, normally grow to about 2 or 3 centimeters (about an inch) each month and then collapse and shrink down again. Even young girls who have not yet begun to menstruate can have small cysts on the ovary as part of their maturational process. Follicular cysts and corpous luteum cysts can become large--as big as a plum or even bigger--and can seem abnormal if noted during a pelvic examination or at the time of an ultrasound. However, they come from an aspect of normal ovarian function and always disappear without treatment within a month or so. Other types of cysts One way to think about ovarian cysts is to divide them into two categories: functional cysts that will resolve on their own within a few weeks and cysts that will require treatment. The most common type of cyst that will not resolve on its own is called a dermoid cyst. This cyst comes from nonmalignant tissue changes of the ovary and often contains hair, fat, and other tissues normally found in other parts of the body. There are also other noncancerous (benign) cysts or tissue growths on the ovary that can be found on examination or with ultrasound. Cancerous changes of the ovary are rare in girls and young women, but do sometimes occur. On ultrasound, these don't usually look like a simple fluid-filled sac, but are more likely to show solid components. The bottom line is that while most cysts will resolve on their own, any growth on the ovary that doesn't go away in a few weeks requires surgery to remove the tissue so that it can be examined under a microscope to rule out cancer. Symptoms The surface of the ovary doesn't have nerve endings, so cysts aren't normally painful. This explains why they often are found incidentally in girls and women who have no symptoms, during pelvic imaging studies or a pelvic examination conducted for other reasons. It sometimes happens that a girl or woman who is having pain will undergo an ultrasound as part of a work-up, and consequently, a cyst will be discovered. Often everyone--even the doctor--will then believe that the source of the problem has been identified. Not so! Keep in mind that ovarian cysts generally don't hurt unless they rupture, twist the ovary, or bleed into themselves (see below). These processes can often be identified at the time of the ultrasound. Cysts that show no indication of any of these conditions may be incidental findings related to ovulation and usually should not be considered the cause of any symptoms at all, including pain. In one ultrasound study of 12- to 17-year-old girls who showed no symptoms ovarian cysts were found in almost 20 percent of the patients. So you can see how likely it is to discover a cyst and then falsely blame it for problems that are present. In truth, further workup is needed to determine the true cause of the symptoms. How cysts may cause pain
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