A review of ovarian cyst in Gynaec practice

Introduction: Physiologic & functional Ovarian Cysts are most commonly seen in reproductive age group but also to be seen in any age group from infancy to postmenopausal period. Incidence of Ovarian Cyst in gynaec OPD at attending OPD in Dr.V.R.K Hospital is 0.6%. The study was conducted to evaluate the percentage of regression of ovarian cyst with 3 months OCPs (Category II 3 menstrual cycles — either underwent ultrasound follow-up for 3 months or administration of OCP (oral combined pills for 3 months). Methodology: A prospective study was conducted in which women presenting with complaints such as abdominal pain, bloating, menstrual irregularities, or those found to be asymptomatic but diagnosed wit h ovarian cysts were evaluated. Diagnosis was established using pelvic ultrasonography (USG) and serum CA-125 levels. Women with ovarian cysts identified on USG were further assessed with CA -125 to exclude pathological conditions. Patients diagnosed with f unctional ovarian cysts were administered oral contraceptive pills (OCPs) for a period of three months, after which follow -up pelvic USG was performed to assess regression.

Out of about 32 women studied for 3 months: CA125 levels were normal in fu nctional cysts. Ovarian cyst in all 32 cases were of functional type. CA125 levels were raised in Endometriotic cysts. The abnormal cases were ruled out. Regression of functional ovarian cysts was seen with OCP administration. There’s also a small hand -drawn pie chart at the bottom of the page, likely showing data distribution visually.

Combined oral contraceptives significantly promote regression of functional ovarian cysts by suppressing ovulation. CA -125 evaluation is essential to differentia te benign from malignant or complex cysts. Conservative management with OCPs remains an effective first -line option in reproductive -age women.

Ovarian cyst, Functional cyst, Follicular cyst, Pelvic ultrasonography, CA-125, Reproductive age women, Conservative management, Gynecology practice

Among the most common gynecological disorders seen in women of all ages, from childhood to postmenopause, ovarian cysts rank high. They can be physiological, functional, or pathological, and the y depict sacs filled with fluid either inside or outside the ovary. Cysts in women of childbearing age often develop normally during the ovulatory cycle and serve a useful purpose [1, 2]. Follicle cysts and corpus luteal cysts are the two main types of fu nctional ovarian cysts. If the follicle doesn't burst or the sac doesn't disintegrate after ovulation, a follicular cyst will form. Common characteristics of these cysts include thin walls, lack of eyes, and a diameter of 3 -5 cm. Corpus luteal cysts, on th e other hand, are often bigger, have thicker walls, and can often be associated with bleeding. While the majority of functional cysts do not cause any symptoms and disappear on their own, a small percentage of women may have dysmenorrhea, bloating, abdominal pain, or irregular periods. Women who visited the gynecology outpatient department (OPD) at Dr. V.R.K. Hospital had a 0.6% incidence of ovarian cysts [3-5]. Although most cysts are harmless, it is important to distinguish them from endometriotic, hemorrhagic, or malignant cysts. To this day, ultrasonography and serum CA -125 estimate are the diagnostic evaluation's lynchpins, helping to differentiate between functional and abnormal cysts. Medications or close observation are typically the first lines of d efense against functioning ovarian cysts [6-8]. Because they reduce gonadotropin secretion, which in turn suppresses ovulation, combined oral contraceptive pills (OCPs) are quite popular because they help existing cysts to recede and prevent new cysts from forming. Despite mixed results from earlier research, the use of OCPs to resolve cysts remains a topic of active clinical interest [9-11]. International Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com ~ 110 ~ This study aimed to examine the correlation between clinical presentation, sonographic findings, and CA -125 level s in order to assess the regression of functional ovarian cysts after OCP treatment in reproductive-aged women.

A prospective, randomized study was conducted in the Department of Gynecology, Dr. V.R.K. Hospital, from January 2023 to December 2023. The study population included women presenting to the gynecology outpatient department (OPD) with symptoms suggestive of ovarian cysts or those diagnosed incidentally on ultrasonography (USG). A total of 6,527 women attended the gynecology OPD during the study period. Out of these, 110 patients were diagnosed with ovarian cysts based on pelvic USG. Inclusion Criteria  Women of reproductive age (adolescent to premenopausal).  Functional ovarian cysts measuring <7 cm in diameter.  Cysts with thin walls, unilocular structure, and clear fluid content.  Serum CA-125 levels 7 cm).  Postmenopausal ovarian cysts.  Suspected malignant ovarian masses. Diagnostic Evaluation All patients underwent pelvic USG to assess cyst size, wall thickness, septations, and internal echoes. Measured in all patients to differentiate functional cysts from endometriotic or neoplastic cysts. Patients with elevated CA -125 (>300 I U/ml) were excluded from the functional cyst group. Intervention Patients with functional ovarian cysts (n = 96) were divided into two groups: 1. OCP group (n = 48): Received combined oral contraceptive pills for three consecutive menstrual cycles. 2. Control group (n = 48): Kept under conservative observation without medical therapy. Follow-up USG was performed after three months to evaluate cyst regression. Outcome Measures  Regression or persistence of ovarian cysts on follow -up USG.  Correlation of CA-125 levels with different types of ovarian cysts.  Age-wise distribution of ovarian cysts.

During the study period (January -December 2023), 110 patients were assessed for ovarian cysts. Outpatient gynecology patients had a 0.6% overall incidence of ova rian cysts. Although fewer occurrences were found in adolescents and postmenopausal women, the reproductive age group (21 -40 years) accounted for the bulk of ovarian cyst diagnoses. Age Distribution The age group of 31 -40 years old women had the highest frequency of ovarian cysts, followed by the 21 -30 year old women. In women under the age of 20 and above the age of 50, only a small number of cases were identified. Table 1: Age distribution of patients with ovarian cysts (January- February 2023) Age group (years) No. of patients 10-20 3 21-30 25 31-40 45 41-50 15 51-60 3 >60 3 Ovarian cysts are more prevalent in women of childbearing age, as the age group between 31 and 40 years old had the highest number of cases (45 patients). Distribution of Ovarian Cysts by Age Women between the ages of 21 and 30 had the greatest frequency of ovarian cysts (54 cases), followed by those between the ages of 31 and 40 (51 cases). Women who had gone through menopause had the lowest incidence. Table 2: Age-wise distribution of ovarian cysts (January-February 2023) Age group (years) No. of ovarian cyst cases 10-20 9 21-30 54 31-40 51 41-50 17 51-60 1 >60 0 Ovarian cysts are most common in women between the ages of 21 and 40, which is close to the reproduct ive age, according to the study's authors. Monthly Distribution of Cases The majority of cases concentrated in the 21 -40 year old age category, as also shown in the monthly analysis. Table 3: Age distribution of patients with ovarian cysts (April 2023) Age group (years) No. of patients 10-20 3 21-30 14 31-40 32 41-50 9 51-60 3 >60 3 The age range of 31 -40 years old continued to have the highest number of reported cases, demonstrating that this is the demographic most impacted by the disease. Table 5: Age distribution of patients with ovarian cysts (June 2023) Age group (years) No. of patients 10-20 5 21-30 33 31-40 31 41-50 15 51-60 6 >60 - International Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com ~ 111 ~ Additionally, the pattern that was present in June showed that the 21 -40-year age group had the gr eatest number of cases, while women who were above the age of 50 had very few occurrences. Correlation with CA-125 Levels CA-125 estimation was performed for all patients to differentiate functional from pathological cysts. The findings were as follows: Fig 1: Distribution of ovarian cysts among study participants  Functional ovarian cysts: Normal or slightly reduced CA - 125 levels.  Adolescent age group: Predominantly normal CA-125.  Perimenopausal age group: Normal to mildly raised CA - 125.  Endometriotic cysts: Significantly raised CA-125.  Hemorrhagic cysts: Mild elevation of CA-125.  Malignant cysts: Markedly elevated CA-125 (>300 IU/ml). Functional cysts were consistently associated with normal CA - 125 levels, while raised CA-125 was indicative of endometriotic, hemorrhagic, or malignant cysts.

Gynecological conditions including ovarian cysts are common in reproductive-age women. The gynecology OPD had 0.6% ovarian cysts, which is similar to other hospital -based research. Most of the 110 c ases (87%) were functioning ovarian cysts, while complicated, torsion, and postmenopausal cysts were rare. One case of ovarian cystadenocarcinoma was also found, reinforcing the significance of rigorous evaluation and discrimination between benign and mali gnant ovarian tumors [12- 14]. Functional ovarian cysts result from follicular rupture failure or corpus luteum persistence following ovulation. Though thin - walled, unilocular, and self -limiting, these cysts can cause pain, bloating, and menstrual abnormal ities. Our study found that functional cysts were more common in women aged 21 -40, when ovulatory activity is highest. The lower number of instances in teens and postmenopausal women supports the hormonal theory of functional cysts [15-17]. In this trial, 48 women with functioning ovarian cysts got combination OCPs for three menstrual cycles and 48 were conservatively handled. OCP patients had higher cyst regression. This supports the well -established mechanism of OCPs, which restrict ovulation by blocking GnRH secretion and lowering FSH and LH. The absence of the LH surge precludes ovulation and subsequent cyst production, therefore aiding regression of existing functional cysts. In our study, the 21 -30-year age group had the most cysts, which correlates w ith peak reproductive activity. Unmarried women (30%) also had ovarian cysts, demonstrating that marital status does not protect against them. Women with parity 3 had the highest incidence (35%). Parity did not directly affect functional ovarian cysts [18-20]. The serum CA -125 test helped identify functional cysts from unhealthy ones. Our investigation found normal CA -125 levels in functioning ovarian cysts but increased levels in 8 individuals. Cystadenocarcinoma (3 instances) had markedly elevated CA - 125 values, while endometriotic and hemorrhagic cysts had modest elevations. This suggests that CA -125 should be included in ovarian cyst diagnostics to rule out malignancy and other complex disorders [21-23]. Most reproductive -age ovarian cysts are function al and disappear naturally or with OCP, according to previous studies. These data support OCPs as an effective and conservative treatment method, as do our results. We found that complicated cysts, endometriotic cysts, and malignancies can appear as International Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com ~ 112 ~ functional cysts on imaging, highlighting the necessity for USG and CA-125 screening [24-26].

This study shows that ovarian cysts, both functional and physiological, can be regressed after three menstrual cycles of taking combined oral contraceptiv e pills. The effectiveness of OCPs as a non -invasive, conservative treatment choice was demonstrated by the large number of patients who had full or partial remission. Suppressing the hypothalamic -pituitary- ovarian (HPO) axis, which stops ovulation and low ers the chance of cyst development and persistence, is the mechanism by which it helps. In addition, the study highlights the significance of serum CA -125 estimation in distinguishing benign functional cysts from pathological or cancerous versions, which s hould be done in all women who report with ovarian cysts. Better patient outcomes and fewer needless surgical procedures are possible results of early detection and proper care. As long as the possibility of malignancy is ruled out through proper diagnostic examination, functional ovarian cysts, which are prevalent in reproductive -age women, can be conservatively treated with OCPs. Conflicts of Interest None. Funding None.

1. El-Beree SA, Salama KM, Mostafa ST, Mohamed AS. Are the combined ora l contraceptive pills needed for management of the simple ovarian cysts in reproductive women? A randomized controlled study. Benha J Appl Sci. 2021;6(4):219-224. 2. Grimes DA, Jones LB, Lopez LM, Schulz KF; Cochrane Gynaecology and Fertility Group. Oral cont raceptives for functional ovarian cysts. Cochrane Database Syst Rev. 2014;(4):CD006134. 3. Christin-Maitre S, et al. Clinical management of functional ovarian cysts: a prospective and randomized study. J Obstet Gynaecol Res. 2000;26(2):82-86. 4. Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts —systematic review. Obstet Gynecol. 2006;108(1):177-183. 5. Rossi EL, et al. Oral contraceptive pills for simple ovarian cysts: long -term observational outcomes. Eur J Obstet Gynecol Reprod Biol. 2003;110(2):203-207. 6. Taskin O, Young DC, Mangal R, Aruh I. Prevention and treatment of ovarian cysts with oral contraceptives: a prospective randomized study. J Gynecol Surg. 1996;12(1):21-27. 7. Altinkaya SO, Talas BB, Gungor T, Gulerman C. Treatm ent of clomiphene citrate -related ovarian cysts in a prospective randomized study. J Obstet Gynaecol Res. 2009;35(5):940 - 945. 8. Celik HB, Ongen Z, Beksac MS, et al. Effect of combined oral contraceptives on functional ovarian cysts: long -term follow up. Int J Gynaecol Obstet. 2005;90(1):55-60. 9. Mammolenti GA, et al . Mechanism of luteal regression in functional ovarian cyst resolution. Hum Reprod. 2004;19(6):1438-1444. 10. Rosenthal AN, et al. Functional ovarian cyst prevalence in asymptomatic women: a cross -sectional study. Ultrasound Obstet Gynecol. 2001;18(6):595-599. 11. Milenkovic D, et al . Risk factors for functional ovarian cysts: a case -control study. Epidemiology. 1996;7(5):547 - 549. 12. Persec L, et al . Functional ovarian cysts in premenopausal healthy women and th e effect of contraception: a cross - sectional study. J Obstet Gynaecol. 2003;123(3):456-460. 13. Rosenfield RL, et al . Prevalence and natural history of functional ovarian cysts in adolescents. J Clin Endocrinol Metab. 2002;87(6):2620-2623. 14. Scholten OG, et al . Functional ovarian cysts and sonographic features in adolescents. J Clin Endocrinol Metab. 2008;93(6):2238-2244. 15. Rana M, Nasa P. An overview of ovarian cysts. Int J Pharm Sci Res. 2020;11(11):5434-5440. 16. Manzur-Smuck M, et al . Benign ovarian cysts with rais ed CA-125 levels: do we need to evaluate the fallopian tubes? Indian J Lab Physicians. 2021;13(1):14-19. 17. Jassim TN, Ibrahim RT, Jasim MH, et al . Comparing the physical characteristics of ultrasound and magnetic resonance imaging to diagnose ovarian cysts. arXiv. 20241;2403.06019. 18. Wallace WHB, Kelsey TW. Human ovarian reserve from conception to the menopause. arXiv. 2011;1106.1382. 19. Kelsey TW, Dodwell SK, Wilkinson AG, et al . Ovarian volume throughout life: a validated normative model. arXiv. 2013;1304.6613. 20. Neelgund S, Hiremath P. A retrospective study of ovarian cysts. Int J Reprod Contracept Obstet Gynecol. 2016;5(1):223-227. 21. Panwar A, et al. Epidemiology of ovarian cyst presentation in low -resource settings: a tertiary care review. J Obstet Gynaecol India. 2018;68(3):189-194. 22. Ghasemi F, Mirzaee S, Amini P. Comparison of hormone therapy with expectant management in the clinical management of functional ovarian cysts: a randomized clinical trial. Adv Nurs Midwifery. 2019;28(1):48-54. 23. Mostafa A, Saleh SA, Sana d ZF. Different modalities in the management of functional ovarian cysts. Menoufia Med J. 2015;28. 24. Ertürk N, et al. Natural course of functional ovarian cysts in women of reproductive age. Eur J Obstet Gynecol Reprod Biol. 2009;146(1):25-28. 25. Valbusa S, et al . Changes in CA -125 levels following treatment of functional ovarian cysts. Clin Chim Acta. 2011;412(11-12):940-944. 26. Raffi F, et al . Impact of body mass index and lifestyle factors on functional ovarian cyst development: a case - control study. J Mazandaran Univ Med Sci. 2014;24(2):102- 107. How to Cite This Article Fathima N, Vanamala VG, Rajinipriya. A review of ovarian cyst in Gynaec practice. International Journal of Clinical Obstetrics and Gynaecology . 2025; 9(5): 109-112. Creative Commons (CC) License This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution -NonCommercial-ShareAlike 4.0 International (CC BY -NC-SA 4.0) License, which allows others to remix, tweak, and build upon the work non -commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.