Ovarian Dermoid Cyst: Symptoms, Causes, and Treatment

Ovarian dermoid cysts can sound alarming, especially when you first hear the diagnosis. The name alone raises questions, and often anxiety, about fertility, surgery, and long-term health. They are the most common ovarian teratoma, or type of growth or tumour, that develops on the ovaries. Fortunately, these cysts are usually benign (or noncancerous) and treatable.

Understanding what they are, how they evolve, and when they need to be treated can help you make better decisions and reduce unnecessary stress.

What Is an Ovarian Dermoid Cyst?

An ovarian dermoid cyst, medically known as a mature cystic teratoma, is a benign growth that occurs on one or both ovaries, most often on the right side (72%). It is usually a fluid-filled sac that contains sebaceous material, which is liquid at body temperature but thickens at room temperature.

Because these cysts develop from germ cells, they may also contain a mixture of different tissues, including hair, skin, fat, teeth, and even a fraction of bone.

Dermoid cysts on the ovary vary widely in size. Some are quite small, and others can grow to over 39 centimetres (cm). The majority, around 80%, are 10 cm or less. They are slow-growing and generally benign, but rarely (about 1%-2% ) may become malignant (cancerous). While they are not cancerous, large cysts can cause complications and require medical intervention.

Who Is Affected and How Common Is It?

Ovarian dermoid cysts are typically diagnosed among women aged 20-40 years old, but can occur at any age, including childhood and following menopause. These cysts are quite common, accounting for about 20% of all ovarian germ cell tumours. They account for about 70% of benign ovarian masses among women of reproductive age and around 20% of benign ovarian masses among postmenopausal women.

Note: Dermoid cysts generally develop in the ovaries and testes, but in rare cases, they may also appear in other regions of the body, such as the chest (anterior mediastinum), the lower spine area (sacrococcygeal region), or the neck.

Symptoms of an Ovarian Dermoid Cyst

The symptoms can vary widely. Some people may live for years without knowing they have one, and some, especially those with larger cysts, may experience noticeable discomfort. Common dermoid cyst ovary symptoms include:

• Pelvic pain or pressure, often on one side
• Bloating in the abdomen
• Constant feeling of fullness
• Nausea, vomiting, or constipation
• Appetite changes
• Menstrual irregularities or discomfort
• Lower back pain
• Pain during intercourse (called dyspareunia)

Other, less common dermoid cyst ovary symptoms may include frequent urination, unusual vaginal bleeding, breast tenderness, and unexplained weight gain.

Ovarian Dermoid Cysts Causes

Dermoid cysts are congenital, meaning they begin to develop before birth. They develop from germ cells that mistakenly start to grow into different types of tissue. This happens when elements of the ectodermal layer are trapped during early embryonic development. The ectoderm is the outer layer of embryonic cells responsible for forming tissues such as skin, hair, teeth, and nails.

Importantly, ovarian dermoid cysts are not caused by lifestyle factors, infections or hormonal imbalances, and there is no clear way to prevent them from developing.

Although these cysts are present early in life, they grow slowly and may not be found until adulthood, often through a routine examination or an imaging test.

Complications of Ovarian Dermoid Cyst

Many dermoid cysts are small and cause little to no disruption. But as they grow, they might cause several problems:

• Ovarian torsion (16%):

Ovarian torsion occurs when the ovary twists around its supporting ligaments. Dermoid cysts are heavier than fluid-filled cysts, increasing the risk of this painful and potentially serious condition. Symptoms can include sudden and severe pelvic pain, nausea, vomiting and fever and require immediate medical attention.

• Cyst rupture (1%-4%):

Although uncommon, rupture can release cyst contents into the abdomen, causing chronic peritonitis or irritation.

• Infection (1%):

Infection occurs in rare cases and, in difficult situations, may lead to cyst rupture.

• Malignant transformation (1%-2%):

Ovarian dermoid cysts are generally benign, but can often become cancerous over time.

Ovarian Dermoid Cyst Diagnosis

Ovarian dermoid cysts are commonly found during a pelvic exam, ultrasound or imaging examination performed for another reason. Diagnostic tools may include:

• Pelvic ultrasound (the most common initial test)
• CT scan or MRI scan (used to recognise cyst contents)
• Blood tests (sometimes ordered to rule out malignancy)

The solid components of a dermoid cyst give it a unique appearance on imaging and help distinguish it from other ovarian cysts.

Treatment of a Dermoid Cyst in the Ovary

Treatment depends on factors such as:

• The size of the cyst
• The person’s symptoms
• Age
• The risk of the cyst becoming malignant
• Fertility plans
• The characteristics of the cyst as seen on pelvic ultrasound

Ovarian dermoid cyst treatment options include:

• Watchful waiting:

Small, usually less than 6 cm, cysts without symptoms may be examined on a regular basis by ultrasound.

• Surgical removal:

Surgery is recommended for larger cysts, symptomatic cases or complications. It is usually performed via laparoscopy, a less invasive and quicker procedure that allows for faster recovery. In most cases, only the cyst is removed to preserve the ovaries and fertility.

If the cyst grows larger than 5-6 cm and involves the entire ovary, an oophorectomy is needed to remove the ovaries.

Prevention and Risk Reduction

Currently, there is no known way to prevent ovarian dermoid cysts because they form from embryonic cells. But regular gynecologic testing can help reveal cysts in the early stages before complications occur.

Paying attention and seeking medical advice early in the case of persistent pelvic pain or unusual symptoms may help avoid emergencies.

Also Read: Pelvic Inflammatory Disease & Treatment

When to Seek Medical Care

Call a doctor if you have:

• Chronic pelvic or abdominal pain
• Sudden, severe pain and nausea or vomiting
• Unexplained bloating or pressure
• Pain during sexual activities
• Changes in menstrual pain

Many women have a normal and healthy life after diagnosis and treatment, even those women who wish to be pregnant. If you have a suspicion or have been diagnosed with one, the first step is to talk to your doctor and take appropriate action to avoid complications.