Ovarian Cyst Rupture – symptoms and causes

Ovarian cysts are fluid filled sac-like structures in the ovary. The cysts may develop during any stage of the woman’s life – right from infancy to the post menopause period. However, these develop, more commonly and for no apparent reason, during the periods. There are two categories of cysts:

• Functional cysts, which develop because of problems in the menstrual cycle. These cysts develop when either the follicle does not release the egg (follicular cyst), or the follicle does not discharge its fluid after the egg is released (corpus luteum cyst). Functional cysts are benign and usually harmless.
•  Pathological cysts, on the other hand, are not related to menstrual cycle. They are caused by abnormal growth of the cells that create eggs or abnormal growth of cells that form outer lining of the ovary. The abnormal growth blocks the blood supply to the ovary, or it may burst. Pathological cysts are usually benign, but some could be malignant. There are three types of such cysts:

o   Dermoid cysts: These cysts may contain hair, skin, or teeth tissue, and are rarely cancerous. o   Cystadenomas: These cysts are filled with water or mucous like fluid. o   Endometriomas: Sometimes, cells from the inner lining of the uterus, called endometrium, start growing outside the uterus.                                Some of this tissue attaches to the ovary and forms a cyst. This type of cyst is blood filled. o   Polycystic ovaries: Here, the follicles fail to rupture a number of cysts are formed on the ovaries. Generally, ovarian cysts do not have any symptoms and the cysts resolve in no time. If symptoms are present, they are usually mild. Some of the symptoms include –

• Menstrual irregularities
• Lower abdominal distention
• Vague pelvic pain and lower back pain
• Occasional pain during sexual intercourse

Problems begin when the ovarian cysts rupture. Chances of ovarian cyst rupture are high in women with polycystic ovaries. If there is bleeding when the cyst ruptures, it is a medical emergency and surgery may be required. Ovarian cyst rupture is a complication in which the cyst ruptures causing intense pain and internal bleeding in the pelvic region. Symptoms of ovarian cyst rupture 1. Intense abdominal pain A ruptured cyst causes a sharp, sudden, and for some women, a numbing pain in the lower abdominal area. Pain usually occurs on the side of the body where the cyst ruptures. Studies have reported that right sided ruptures of ovarian cysts are predominant. Researchers speculate that this may be because of the difference in the structure of the blood vessels of the ovaries that creates higher pressure within the right ovary, causing right sided cysts more likely to rupture. [1] Read here Abdominal pain in women – when should you worry? 2. Bleeding Ruptured cysts are more likely to happen at the time of the periods. So, it is not uncommon to miss it as a symptom of ruptured cyst. Bleeding from a ruptured ovarian cyst is a frequent and well known complication. If bleeding is significant, however, it could be potentially catastrophic. Among the bleeding cysts, functional cysts (either follicular or corpus luteal type) are most common. Corpus luteal cysts, in particular, have highly vascular walls, and this may cause significant bleeding, say researchers. [2] Read more about Fenugreek or methi seeds – a natural way to treat ovarian cysts and PCOS A study reported that a distorted shape of the cyst was more commonly seen in ruptured endometrial cyst, but rupture of an ovarian cyst with discontinuity of the cyst wall and bleeding in the peritoneal cavity (the space between the inner lining of the abdominal wall and the abdominal organs), were more commonly seen in ruptured corpus luteal cysts than in endometrial cysts. [3] 3. Abdominal pressure and distention Cysts take up a lot of space in the abdominal area and pushes the adjoining organs causing the pressure and fullness. Although the pressure reduces a bit after the cyst ruptures, abdominal distention continues since the fluid leaks into the area, causing even more bloating. 4. Dizziness, nausea, vomiting, and low grade fever are some of the other common symptoms of ruptured cyst. Causes of ovarian cyst rupture Generally, larger ovarian cysts tend to rupture. There could be many causes as to why cysts rupture including –

• Hormonal fluctuations: Hormonal fluctuations and menstrual cycle are the most common cause of cyst rupture. Functional cyst ruptures are harmless and do not require medical attention.
• Pregnancy: The risk of cysts rupturing increases during pregnancy. Spontaneous haemoperitoneum, or rupture of ovarian cysts due to non-traumatic cause, can be life threatening, especially if it occurs in the later stages of pregnancy. [4]
• Anti-coagulation therapy: Women taking anticoagulants or those with a clotting factor deficiency are also at increased risk of corpus luteum rupture due to coagulation abnormalities. [5]
• Sexual intercourse: Sometimes, larger cysts can burst or start leaking during or right after intercourse. This is one of the most common causes of cyst rupture.
• Constipation: Straining for a bowel movement puts pressure on the cyst and it may rupture.
• Trauma
• Sudden movement while exercising, playing a sport, and even bending down to pick up objects can cause the cyst to rupture.

Many other conditions can show symptoms of ruptured ovarian cysts. These include:

• Appendicitis
• Ectopic pregnancy
• Internal bleeding, such as from haemorrhaging liver or spleen

Although no treatment is usually required if the ovarian cyst ruptures, pain medication is sometimes prescribed to alleviate the discomfort. Reference

1. Hso W.-K., Wang Y.-F., Wu H.-H., Tsai H.-D., Chen T.-H., Chen M. Ruptured Corpus Luteum with Hemoperitoneum: Case Characteristics and Demographic Changes Over Time. Taiwanese Journal of Obstetrics and Gynecology. 2009, 48 (2), pp. 108-112.

2. Choi HJ, Kim SH, Kim SH, et al. Ruptured Corpus Luteal Cyst: CT Findings. Korean Journal of Radiology. 2003;4(1):42-45. doi:10.3348/kjr.2003.4.1.42.

3. Choi, Na Jung et al. "Ruptured Endometrial Cysts As A Rare Cause Of Acute Pelvic Pain". Journal of Computer Assisted Tomography 35.4 (2011): 454-458.

4. Maya ET; Srofenyoh EK; Buntugu KA; Lamptey M. Idiopathic spontaneous haemoperitoneum in the third trimester of pregnancy. Ghana Med J.  2012; 46(4):258-60.
5. Gupta N; Dadhwal V; Deka D; Jain SK; Mittal S. Corpus luteum hemorrhage: rare complication of congenital and acquired coagulation abnormalities. J ObstetGynaecol Res.  2007; 33(3):376-80.

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