Populations and Risk Factors
- Women of reproductive age (functional cysts are extremely common)
- Women with endometriosis (endometriomas or "chocolate cysts")
- Those with a history of ovarian cysts or polycystic ovarian syndrome
- Fertility treatment (ovarian stimulation increases cyst formation risk)
Causes and Pathophysiology
- Follicular cysts: A follicle fails to rupture completely during ovulation, forming a fluid-filled blister. The most common type
- Corpus luteum cysts: After ovulation, the ruptured follicle seals itself and traps hormones inside. More prone to rupture and hemorrhage
- Endometriomas: "Chocolate cysts" containing old blood. Related to endometriosis
- Dermoid cysts (teratomas): Contain tissues like hair, teeth, or bone (germ cell origin)
- Cystadenomas: Benign epithelial growths that can become very large
- Torsion mechanism: A large cyst can cause the ovary to twist on its vascular stalk, cutting off blood supply and leading to tissue necrosis and peritonitis — surgical emergency
- Rupture mechanism: Thin-walled cyst bursts, releasing fluid and potentially blood into the peritoneal cavity — can cause hemorrhagic shock
Signs and Symptoms
- Dull, intermittent, or persistent ache in the lower abdomen on the affected side
- Disrupted menstrual cycle. Irregular periods or delayed ovulation
- Dyspareunia (pain during sexual intercourse)
- Low back pain or pain radiating into the legs (large cysts pressing on lumbar plexus)
- Visible protrusion or swelling in the lower abdomen/pelvic region (very large cysts)
- Red flags: Sudden, acute abdominal pain with nausea, vomiting, and fever = torsion or rupture emergency — call 911 immediately; syncope and tachycardia suggest internal hemorrhage
CMTO Exam Relevance
- Diagnosed ovarian cysts locally contraindicate intrusive abdominal massage
- Ovarian torsion and rupture are life-threatening emergencies requiring immediate referral
- Persistent pelvic symptoms can mimic ovarian cancer — must be medically evaluated
- Differentiate MSK low back pain from referred pain caused by large cysts pressing on the lumbar plexus
- CA-125 blood test and transvaginal ultrasound are the clinical standards for diagnosis
Massage Therapy Considerations
- Local contraindication: Diagnosed cysts locally contraindicate intrusive abdominal massage — deep pressure may cause rupture
- Positioning: Clients with large cysts may find prone uncomfortable. Side-lying or supine with bolstering is preferred
- Remission: Clients with a history of cysts but no current symptoms can receive massage without restrictions
- Referral trigger: A client reporting firm pelvic swelling or pain persisting for more than a few days must be referred for diagnosis
- Caution: Large cysts can shift pelvic contents, making internal structures vulnerable in unusual locations
Key Takeaways
- Most functional cysts resolve spontaneously within one to two cycles. Large or persistent cysts require medical evaluation
- Ovarian torsion and rupture are life-threatening emergencies presenting with sudden severe pain, nausea, vomiting, and fever
- Diagnosed cysts locally contraindicate intrusive abdominal massage due to rupture risk
- Persistent pelvic symptoms can mimic ovarian cancer and must be medically evaluated
- Prone positioning may be uncomfortable. Use side-lying or bolstered supine