An adnexal cyst is a general term for a mass or growth in the adnexa, the area encompassing the ovaries, fallopian tubes, and surrounding connective tissues near the uterus. While discovering such a mass can be concerning, many adnexal cysts are benign and resolve without intervention. Understanding these cysts, their typical behaviors, and the specific signs that might indicate a need for medical evaluation can provide clarity and reduce undue worry.
What Are Adnexal Cysts?
Adnexal cysts are fluid-filled sacs that develop within the reproductive structures next to the uterus, including the ovaries, fallopian tubes, and supporting tissues. While the term broadly describes any fluid-filled mass in this region, most originate in the ovaries.
These cysts are a common gynecological finding, occurring in individuals of all ages. The majority are non-cancerous and often do not cause any symptoms. Their size varies significantly, from very small to several centimeters, and they may be discovered incidentally during routine pelvic examinations or imaging tests.
Common Symptoms and Causes
When symptoms do occur, they are typically mild. These may include a dull ache or pressure in the pelvic region, abdominal bloating, or a feeling of fullness. Some individuals might experience mild, intermittent pain, sometimes felt on one side of the lower abdomen.
The most frequent causes of adnexal cysts are linked to the normal menstrual cycle, leading to functional cysts. For instance, a follicular cyst forms if a fluid-filled sac, called a follicle, fails to rupture and release an egg during ovulation, continuing to grow. Another type, a corpus luteum cyst, develops after an egg is released if the sac reseals and fills with fluid. These functional cysts typically resolve on their own within one to three menstrual cycles.
Signs That Warrant Medical Attention
While many adnexal cysts are harmless, certain signs indicate a potential complication and necessitate prompt medical attention. Sudden, severe pelvic pain is a warning sign, especially if it is sharp and localized to one side. This intense pain might be accompanied by nausea, vomiting, or dizziness, suggesting a more serious issue.
Rapid abdominal swelling or persistent, increasing abdominal discomfort should also be evaluated by a healthcare professional. If a cyst ruptures, it can cause sudden, sharp pain, often on one side of the lower abdomen, along with symptoms like lightheadedness or weakness due to potential internal bleeding. Another serious complication is ovarian torsion, where the ovary twists on its supporting tissues, cutting off its blood supply. This condition presents with severe, acute pelvic pain, typically on one side, and is often accompanied by severe nausea and vomiting. Ovarian torsion requires immediate medical intervention to preserve the ovary. For individuals who have gone through menopause, any newly discovered adnexal cyst or existing cyst that grows or causes symptoms warrants evaluation, as the risk of malignancy is slightly higher in this age group.
Diagnosis and Treatment Approaches
The initial step in diagnosing an adnexal cyst involves a pelvic examination, followed by imaging studies. Transvaginal ultrasound is the common imaging technique used to visualize the cyst, determine its size, location, and whether it is fluid-filled or solid. This imaging can help distinguish between simple, usually benign cysts and more complex ones that might require further investigation. In some cases, other imaging, such as an MRI or CT scan, may provide more detail.
Blood tests may be performed, including a pregnancy test to rule out an ectopic pregnancy, which can mimic adnexal mass symptoms. A blood test for cancer antigen 125 (CA-125) may be ordered, especially if malignancy is suspected, such as in postmenopausal individuals or with suspicious ultrasound features. However, CA-125 levels can be elevated due to various non-cancerous conditions, so it is not a definitive diagnostic tool.
Treatment approaches for adnexal cysts vary depending on several factors, including the cyst’s size, type, symptoms, and the individual’s age. For many small, asymptomatic, or functional cysts, a “watchful waiting” approach is common, monitoring the cyst with repeat ultrasounds to see if it resolves. Hormonal medications, such as birth control pills, may be prescribed to prevent new cysts from forming, though they do not shrink existing ones. If a cyst is large, causes persistent symptoms, or has features concerning for malignancy or complications (like rupture or torsion), surgical removal may be recommended. Surgery is often performed using minimally invasive laparoscopic techniques, which involve small incisions.