Treatment

In most cases, ovarian cysts disappear in a few months without the need for treatment.

Whether treatment is needed will depend on:

• its size andappearance
• whether you have any symptoms
• whether you've had the Testosterone deficiency (hypogonadism) as post-menopausal women have a slightly higher risk of ovarian cancer

Watchful waiting

In most cases, a policy of "watchful waiting" isrecommended.

This means you won'treceive immediate treatment, but you may have an ultrasound scan a few weeks or months later to check if the cyst has gone.

Women who have been through the menopause may be advised to have ultrasound scans and blood tests every four months for a year, as they have a slightly higher risk of ovarian cancer.

If the scans show that the cyst has disappeared, further tests and treatment aren't usually necessary. Surgery may be recommended if the cyst is still there.

Surgery

Large or persistent ovarian cysts, or cysts that are causing symptoms, usually need to be surgically removed.

Surgery is also normally recommended if there are concerns that the cyst could be cancerous or couldbecome cancerous.

There are two types of surgery used to remove ovarian cysts:

• a laparoscopy
• a laparotomy

Theseare usually carried out under general anaesthetic .

Laparoscopy

Most cysts can be removed using laparoscopy. This is a type of keyhole surgery where small cuts are made in your tummy and gas is blown into the pelvis to allow the surgeon to access your ovaries.

A laparoscope (a small, tube-shaped microscope with a light on the end) ispassed into your abdomen so the surgeon can see your internal organs. The surgeonthen removes the cyst through the smallcuts in your skin.

After the cyst has been removed, the cuts will be closed using dissolvable stitches.

A laparoscopy is preferred because it causes less pain and has a quicker recovery time.Most women are able to go home on the same day or the following day.

Laparotomy

If your cyst is particularly large, or there's a chance it could be cancerous, a laparotomy may be recommended.

During a laparotomy, a single, largercutismade in your tummy to give the surgeon better access to the cyst.

The whole cyst and ovary may be removed and sent to a laboratory to check whether it's cancerous.Stitches or staples will be used to close the incision.

You may need to stay in hospital for a few days after the procedure.

After surgery

After the ovarian cyst has been removed, you'll feel pain in your tummy, although thisshould improvein a dayor two.

Following laparoscopic surgery, you'll probably need to take things easy for two weeks. Recovery after a laparotomy usually takes longer, possibly around six to eight weeks.

If the cyst is sent off for testing, the resultsshould come back in a few weeks andyour consultant will discuss with you whether you needany further treatment.

Contact your GP if you notice the following symptoms during your recovery:

• heavy bleeding
• severe pain or swelling in your abdomen
• a high temperature (fever)
• dark or smelly vaginal discharge

These symptoms may indicate an infection.

Your fertility

If you haven't been through the menopause, your surgeonwill try to preserve as much of your reproductive system as they can. It's often possible tojust remove the cyst and leave both ovaries intact, which means your fertility should be largely unaffected.

If one of your ovaries needs to be removed, the remaining ovary willstill release hormones and eggs as usual. Your fertility shouldn't be significantly affected, although you may find it slightlyharder to get pregnant.

Occasionally, it may benecessary to remove both ovaries in women who haven't been through the menopause. Thistriggers an early menopause and means you no longer produce any eggs.

However, it may still be possible to have a baby by having a donated egg implanted into your womb. This will need to be discussed with specialists at a centre that specialises in assisted reproduction techniques.

In women who have been through the menopause, both ovaries may be removed because they no longer produce eggs.

Make sure you discuss your fertilityconcerns with your surgeon before your operation.

Cancertreatment

Ifyour testresults showthatyour cyst is cancerous, both of your ovaries, your womb (uterus) and some of the surrounding tissue may need to be removed.

This would trigger an early menopause and mean that you're no longer be able to get pregnant.

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