One of the most common ovarian disorders is a cyst. Not all so-called ovarian cysts are true cysts; many are tumors. Ovarian cysts occur frequently and in a variety of sizes and types; they may be fluid-filled or solid. They range in size from less than an inch to large enough to fill the entire abdomen. They may develop at any age; 75 to 95 percent of them are benign (noncancerous).

Unless there is a complication or abnormal hormone secretion, many cysts produce no symptoms at all. They may be discovered incidentally, during routine examinations or during surgery for other, unrelated problems. Abdominal fullness and heaviness, pressure on the rectum or bladder, menstrual irregularities, pelvic pain radiating to the lower back and upper legs, and infertility are the most common symptoms. Rarely, very large cysts may become noticeable as a protuberance (bulge) in the abdomen or an increase in waist size. Cysts may present no symptoms, but their long stems may cause twisting, resulting in intense abdominal pain, which may arouse suspicion of appendicitis.

Follicle retention cysts The predominant ovarian cysts are simple follicle retention cysts, small and frequently numerous cysts containing a clear fluid. A follicle is the localized area of the ovary in which the egg matures. When ovulation does not occur, the follicle may continue to grow, forming a cystic mass that rarely exceeds two or three inches in diameter. Usually, follicle cysts disappear without treatment within two months, and they do not become malignant growths.

Corpus luteum cysts The corpus luteum is the progesterone-producing remnant of an ovarian follicle. It is formed upon release of the egg at mid-cycle and regresses with menstruation. If the corpus luteum fails to shrink away, a cyst forms and the next menstrual period is delayed. This delay in menses combined with lower abdominal pain may simulate a tubal pregnancy. Fortunately, most corpus luteum cysts are small and they resolve within a few weeks or months.

Endometrioma cysts Endometrioma cysts are composed of glandular tissue from the lining of the uterus, as can occur in endometriosis (see chapter 4). Both ovaries are involved about half of the time. Typically, the cysts contain old or degenerated blood resembling chocolate syrup. These so-called chocolate cysts may be seen with hemorrhaging into any cyst.

Cystadenoma cysts One type of ovarian cyst, the mucinous cystadenoma, is in reality a tumor. These tumors may reach enormous size - up to twenty inches in diameter - creating pressure within the abdominal pelvic cavity. Although these tumors are benign, they may become malignant (which occurs in 10 percent of cases).

Dermoid cysts Dermoid ovarian cysts are usually benign, although they may be subject to malignant change. They grow slowly and, when opened after removal, are found to be filled with a thick, yellow fatty (sebaceous) fluid. Hair, teeth, bone, skin, cartilage, and glandular material are often found partially developed in the cyst. They may show up on routine abdominal X rays; the average size is two to four inches.

Tumors A tumor is a swelling or abnormal growth of tissues having no useful function in the body. Ovarian tumors are generally classified as malignant or benign. Benign tumors are isolated growths that generally do not spread to other parts of the body and usually do not return after being surgically removed. Ovarian tumors may arise from misplaced endometrial tissue or from the ovarian tissues. Malignant cells from other organs may travel to the ovarian area; an example is Krukenberg tumor, which usually originates in the stomach.

Symptoms of an ovarian tumor usually do not present themselves until the tumor is fairly well advanced. Tumors in the early stage are usually found during routine pelvic exams. Malignant tumors must be detected and treated as early as possible. They tend to spread to other parts of the body and are likely to reappear after surgical removal.

Typically, small, noncancerous cysts among premenopausal women that are causing no severe pelvic pain or other symptoms are left untreated.

Traditional Treatments

Birth Control Pills If the cysts continue to appear after several menstrual cycles have passed, your doctor may suggest taking birth control pills to try to repress the cysts.

Surgery Large and/or painful cysts are frequently removed surgically, especially among postmenopausal women who have a higher risk of ovarian cancer. In some cases, the cyst itself is all that needs to be removed; in others, the entire ovary may need to be removed.

Diet In the Burton Goldberg Group's book Alternative Medicine, the authors speculate that toxemia (toxin contamination) of the liver is a possible root cause for the cysts - a theory not scientifically proven. While their theory has not been medically accepted, health practitioners espousing this theory recommend various dietary changes that are generally healthy and in any event excellent recommendations for overall good health. Whether or not they will specifically lead to a healthier liver and thus eliminate ovarian cysts, however, remains to be seen. Those who follow the diet should avoid coffee, cigarettes, alcohol, fried foods, and sugar, but incorporate organically grown vegetables, especially beets and carrots, and fruit, especially lemons.

Others who agree that cysts are nature's method of purifying the body of toxins suggest helping speed up this process by replacing all caffeine-laced drinks such as coffee, tea, and colas with at least eight glasses of spring water throughout each day. Again, even though this is not a medically proven treatment for ovarian cysts, it is a dietary change that has little risk to the human body and is in fact recommended by many doctors for basic good health.

Similarly, in their book Prescription for Nutritional Healing, Dr. James F Balch and Phyllis A. Balch write that environmental factors and diet seem to play important roles in the development of tumors. In his experience, some tumors have reduced in size - and others have actually disappeared - after patients changed their diets with vitamins and minerals. His suggestions for reducing the size of tumors include:

• taking two garlic capsules with meals

• including enough raw fruits and vegetables to account for 50 percent of the diet

• eating nuts and seeds, whole grains, yogurt, and yogurt products

In Essential Supplements for Women, Reuben and Priestley state that some cysts appear in order to build a protective wall around toxic materials in the body. They therefore suggest that a woman who is told she has an ovarian cyst should quickly and completely overhaul her diet to rid her body of the toxins. Among the items that should be drastically reduced: sugar, coffee, non-herbal tea, sodas, white flour, salt, dairy products, and any refined foods. Women with ovarian cysts should consume the following:

• pure filtered water instead of tap water

• organically grown fresh fruits

• organically grown green and orange vegetables

• whole grains, nuts, seeds, and sprouts

Exercise To further rid the body of toxins, experts encourage regular exercise prescribed by a health care provider. Healthy young women are usually instructed to perform exercise that is vigorous enough to produce heavy sweating. Besides leaving the body via sweating, toxins also exit via urination; thus, health authorities remind women with cysts to drink plenty of water an hour or so after exercise.

Nutritional Therapy Nutritional therapists suggest 50 to 100 mg per day of vitamin B complex to help detoxify the liver in conjunction with 800 lU per day of vitamin E.

POLYCYSTIC OVARY

Polycystic ovary syndrome, also known as Stein-Leventhal syndrome, is an uncommon disorder characterized by multiple cysts. Doctors believe it is caused by a massive thickening of the cells around the ovary. The cysts may produce male sex hormones, leading to scant bleeding or stoppage of menstruation, excessive hairiness, and obesity. Because women with polycystic ovary syndrome often have high estrogen levels and irregular periods, they are at increased risk of heavy periods at menopause and, subsequently, are at increased risk of uterine cancer.

Traditional Treatments

Drugs Drug treatment includes doctor-prescribed clomiphene, progestins, luteinizing hormone, or oral contraceptives. The hormone progesterone is sometimes recommended to restore hormonal balance and decrease the risk of uterine cancer.

Surgery In rare cases, surgical removal of a piece of ovarian tissue is performed.

INFECTION

Inflammation of an ovary (oophoritis) may be caused by infection reaching the ovary by way of the uterine (fallopian) tube. Tuberculosis, mumps virus, and streptococcal infections of the ovary are common, and the ovary may also become infected by gonorrhea (see chapter 7, "Sexually Transmitted Diseases"). Fever and pain, sometimes accompanied by swelling, are the usual symptoms.

Traditional Treatments

Drugs Sulfa drugs and antibiotics usually eliminate the infection, but if it fails to respond to such treatment, surgery may become necessary.

Surgery Surgical removal of an ovary is called oophorectomy, or ovariectomy. Bilateral oophorectomy refers to the removal of both ovaries.

OVARIAN CANCER

While it can occur at any age, cancer of the ovary occurs mainly in women over the age of forty-five; it is the fifth most common form of cancer among women and the fourth leading cause of cancer death in women. According to the American Cancer Society, in 1995 an estimated 26,600 women were diagnosed with ovarian cancer, and 14,500 women died from the disease. Because there are no reliable methods of early detection, the disease is rarely caught at a curable stage. One third of ovarian cancer cases are potentially curable. Approximately 50 of every 100,000 women have the disease, while one in 70 will develop it in her lifetime. By contrast, about one in nine women will develop breast cancer.

Ovarian cancer is three times more common among women who have never had children, and it is less prevalent among those who have taken birth control pills; thus hormones probably play some role. It is also predominant among women with a family history of ovarian, breast, and gastrointestinal tumors, as well as a personal history of breast cancer. Exposure to talc and/or asbestos may also be a contributing factor.

A growth that starts in the ovary is referred to as primary; one that spreads to the ovary from some other part of the body (such as the breast) is called secondary. In most cases, ovarian cancer causes few or even no symptoms until it is widespread. When symptoms do occur, they may be similar to those of an ovarian cyst. The first symptom is usually slight abdominal discomfort and bloating. This may be followed by digestive upset (such as nausea and vomiting), abnormal vaginal bleeding, and excessive fluid in the abdominal cavity. The symptoms of advanced ovarian cancer include weight loss, massive amounts of abdominal fluid, movement of the cancer to other organs, and shortness of breath.

If the growth is confined to the ovaries, 60 to 70 percent of patients survive at least five years. If the growth is more widespread, only about 10 to 20 percent of patients survive five years.

Traditional Treatments

Surgery Surgery is almost always performed to remove the cancerous growth or as much of the malignant tissue as possible. This usually involves removal of the ovaries, fallopian tubes, and uterus (hysterectomy).

Radiation Therapy Surgery is usually followed by radiation therapy. Radiation therapy by itself also can be very effective in shrinking large tumor masses that are causing symptoms.

Chemotherapy Chemotherapy is most often used in advanced cases; it is also being investigated for possible preventive use following surgery for localized tumors. In a study published in the January 4, 1996 issue of The New England Journal of Medicine, researchers found that women who took the new chemotherapy drug Taxol (paclitaxel) with the older agent cisplatin survived a median of thirty-eight months, versus twenty-four months with the older cisplatin and cyclophosphamide.

Drugs In advanced cases, the prescribed drugs commonly used in combination include cyclophosphamide, doxorubicin, and platinum-containing agents.