Ovarian cysts are fluid-filled, sac-like structures within an ovary. They can form for numerous reasons. The most common type is a follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve on their own over the course of days to months. Cysts can contain blood (hemorrhagic or endometrioid cysts) from injury or leakage of tiny blood vessels into the egg sac. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are called dermoid cysts.

Most cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one. The pain can be caused from rupture of the cyst, rapid growth and stretching, bleeding into the cyst, or twisting of the cyst around its blood supply. In order to diagnose a cyst an ultrasound must be performed. Ultrasound is an imaging method that uses sound waves to produce an image of structures within the body. Ultrasound imaging is painless and causes no harm.

Cysts can also be detected with other imaging methods, such as CAT scan or MRI scan (magnetic resonance imaging).

Most ovarian cysts in women of childbearing age are follicular cysts (functional cysts) that disappear naturally in 1-3 months. Although they can rupture (usually without ill effects), they rarely cause symptoms. They are benign and have no real medical consequence. They may be diagnosed coincidentally during a pelvic examination in women who do not have any related symptoms. All women have follicular cysts at some point that generally go unnoticed.

A follicular cyst in a woman of childbearing age is usually observed for a few menstrual cycles because the cysts are common, and ovarian cancer is rare in this age group. Sometimes ovarian cysts in menstruating women contain some blood, called hemorrhagic cysts, which frequently resolve quickly.

The ideal treatment of ovarian cysts depends on the woman’s age, the size (and change of size) of the cyst, and the cyst’s appearance on ultrasound.

Treatment can consist of simple observation, or it can involve evaluating blood tests such as a CA-125 to help determine the potential for cancer (keeping in mind the many limitations of CA-125 testing described above).

The tumor can be removed either with laparoscopy, or if needed, an open laparotomy (using and incision at the bikini line) if it is causing severe pain, not resolving, or if it is suspicious in any way. Once the cyst is removed, the growth is sent to a pathologist who examines the tissue under a microscope to make the final diagnosis as to the type of cyst present.

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Hot flashes are experienced by many women undergoing menopause. A hot flash is a feeling of warmth that spreads over the body, but is often most strongly felt in the head and neck regions. Hot flashes may be accompanied by perspiration or flushing. Hot flashes usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, hot flashes are thought to be due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels.

Hot flashes occur in up to 40% of regularly menstruating women in their forties, so they often begin before the menstrual irregularities characteristic of menopause even begin. About 80% of women will be finished having hot flashes after five years. Sometimes (in about 10% of women), hot flashes can last as long as 10 years.

Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

Traditionally, hot flashes have been treated with either oral (by mouth) or transdermal (patch) forms of estrogen. Hormone therapy (HT), also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens or a combination of estrogens and progesterone (progestin). Both oral and transdermal estrogen are available either as estrogen alone or estrogen combined with progesterone (see the Hormone Replacement Therapy article). All available prescription estrogen replacement medications, whether oral or transdermal, are effective in reducing the frequency of hot flashes and their severity. Generally, these medications decrease the frequency of hot flashes by about 80 to 90%.

However, long-term studies (the NIH-sponsored Women’s Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

The decision in regard to starting or continuing hormone therapy, therefore, is a very individual decision in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman’s own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.

There are alternative treatment options….

While none of these drugs is as effective as estrogen, studies show that non-estrogen drugs may have up to 70% of the effectiveness of estrogen therapy when treating hot flashes.

Selective serotonin reuptake inhibitors (SSRI’s): This class of medication is used to treat depression and anxiety. In clinical studies, however, low doses of SSRI’s have been shown to be effective in decreasing menopausal hot flashes. The SSRI that has been tested most extensively is venlafaxine (Effexor), although there is also evidence showing that paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac) can be effective in controlling hot flashes. Clonidine: Clonidine (Catapres) acts in the brain to decrease blood pressure. It has a long history of being used for blood pressure control, but it has potentially annoying side effects, such as dry mouth, constipation, drowsiness, or difficulty sleeping. Clonidine effectively relieves hot flashes in some women but is completely ineffective in others. Clonidine is available in pill or patch form.

Megestrol acetate (Megace): This medication is a type of progesterone, a female hormone. It can be effective in relieving hot flashes, but can only be taken over the short term (for several months). Serious effects can occur if the medication is abruptly discontinued, and megestrol is not usually recommended as a first-line drug to treat hot flashes. Megestrol use can also lead to weight gain.

Studies of another form of progesterone, medroxyprogesterone acetate (Depo-Provera), which is administered by injection, have also shown that this medication may be useful in treating hot flashes. This drug can be used long-term but may have side effects that include weight gain and bone loss. Gabapentin: Gabapentin (Neurontin) is a drug that is primarily used for the treatment of seizures that appears to be moderately effective in treating hot flashes. The drug is well tolerated by most women, but often causes drowsiness.

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