From the Guidelines
Yes, a left ovarian cyst can cause generalized abdominal pain and nausea. Ovarian cysts are fluid-filled sacs that develop on or within the ovaries, and while they often cause localized pain on the side where they're located, the discomfort can spread throughout the abdomen. This happens because the peritoneum (the membrane lining the abdominal cavity) can become irritated by a large or ruptured cyst, leading to widespread pain. Nausea commonly accompanies this pain due to the proximity of the ovaries to the digestive organs and the shared nerve pathways that transmit pain signals.
Diagnosis and Treatment
The diagnosis of ovarian cysts typically involves ultrasound imaging, which can accurately diagnose benign adnexal lesions, including simple cysts, hemorrhagic cysts, endometriomas, and dermoids, as well as extraovarian cystic lesions such as paraovarian cysts, hydrosalpinx, and peritoneal inclusion cysts 1. Treatment depends on the size and type of cyst, ranging from watchful waiting with over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) for small, simple cysts, to hormonal contraceptives to prevent new cysts, or surgery for large or complex cysts.
Risk of Malignancy
Recent studies have shown that simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer 1. A meta-analysis by Parazzini et al demonstrated that in 987 unilocular cysts removed surgically in premenopausal women, the risk of malignancy was 0.6% 1. Similar findings were found by Valentin et al, with a rate of malignancy of 0.5% in 981 surgically resected lesions.
Emergency Situations
If you experience severe sudden pain, fever, vomiting, or signs of shock, seek immediate medical attention as these could indicate a ruptured cyst or ovarian torsion requiring emergency intervention. Ultrasound imaging can help diagnose ovarian torsion, with a sensitivity of 79% and a specificity of 76% 1. Signs of ovarian torsion on US include ovarian tissue edema, absence of intraovarian vascularity, and absence of arterial flow.
Management
For premenopausal women, simple cysts, including paraovarian and paratubal cysts < 5 cm, do not need to be followed 1. For cysts greater than 5 cm, follow-up in 8-12 weeks is recommended to confirm its functional nature or to reassess for cyst wall abnormalities. If the cyst persists or enlarges, management by a gynecologist is suggested. In postmenopausal women, no further management is suggested in cysts up to 3 cm, while cysts greater than 3 cm but less than 10 cm require at least 1-year follow-up showing stability or decrease in size.
From the Research
Generalized Abdominal Pain and Nausea
- A left ovarian cyst can cause generalized abdominal pain and nausea, as seen in a case report of a twisted ovarian cyst in an 11-year-old girl who presented with sudden-onset generalized abdominal pain and nausea 2.
- Ovarian torsion, which can occur with a left ovarian cyst, presents with sudden onset of severe colicky unilateral pain radiating from groin to loin, and may be accompanied by nausea and vomiting 3.
- A spontaneous rupture of a mature ovarian cystic teratoma can also cause chemical peritonitis, leading to symptoms such as abdominal pain, nausea, and vomiting 4.
Symptoms of Ovarian Cysts
- Ovarian cysts may be asymptomatic, but presenting symptoms can include pelvic pain, pressure symptoms, discomfort, and menstrual disturbance 3.
- Functional cysts can be linked with irregular vaginal bleeding or menorrhagia, and ovarian torsion is most common in the presence of an ovarian cyst 3.
- Symptoms suggestive of a malignant ovarian cyst include weight loss, persistent abdominal distension or bloating, early satiety, pelvic or abdominal pain, and increased urinary urgency and frequency 3.
Diagnosis and Treatment
- Abdominal ultrasound and computed tomography scans can be used to diagnose ovarian cysts, but may not always determine the origin of the cyst 5, 6.
- Laparoscopic surgery is considered a gold standard modality for minimally-invasive ovarian cystectomy/oophorectomy, but can be challenging in cases with adhesional obstruction 5.
- In cases of ovarian torsion or rupture, emergency surgical intervention may be necessary to prevent further complications 2, 4.