Understanding Dermoid Cyst and Abnormal Abdominal Pain

In women of reproductive age, the discovery of ovarian cysts should not be overlooked, as certain types can directly affect reproductive health. One such type is the “dermoid cyst,” which, although typically benign, can disrupt the reproductive system and make pregnancy more challenging if not properly diagnosed and managed. This is especially true for women planning to conceive or experiencing unexplained abdominal discomfort.

What is a Dermoid Cyst?

A dermoid cyst or (Mature Cystic Teratoma) is an ovarian cyst formed from abnormal growth of egg cells. Typically, these cysts are round, with thick walls, and are filled with various tissues such as skin, hair, teeth, bone, or fat. Dermoid cysts arise from totipotent cells—cells that have the potential to develop into different tissue types. These cells are usually misplaced at birth and can develop into a dermoid cyst when stimulated.

Although most commonly found in the ovaries, these cysts can also occur in other parts of the body, such as the tailbone, nose, or even the brain. Dermoid cysts can often be detected through internal examinations, ultrasound, MRI, or CT scans, and in cases of larger cysts, they may be palpated during physical exams.

Symptoms of Dermoid Cysts

In most cases, dermoid cysts do not show symptoms and are found incidentally during routine health checks or ultrasound scans. However, when the cysts grow large, they can cause the following symptoms:

• Persistent dull pain or discomfort in the lower abdomen, especially on the side where the cyst is located.
• Feeling of fullness, bloating, or a sensation of a mass in the abdomen due to the cyst pressing against organs like the intestines and bladder, which may lead to frequent urination or difficulty with bowel movements.
• Irregular menstrual cycles and increased abdominal pain before or during menstruation.
• Pain during intercourse, especially in positions that put pressure on the pelvic area.

Complications from Dermoid Cysts

Aside from the common symptoms mentioned, dermoid cysts can also lead to serious complications that may endanger a patient’s health, requiring urgent medical intervention:

1. Ovarian Torsion

This is the most common complication of dermoid cysts, where the cyst causes the ovary to twist. This results in severe pain, nausea, vomiting, and a low-grade fever. Without urgent surgical intervention, the ovary may lose its blood supply and become necrotic, requiring removal.

2. Rupture or Leakage

If a dermoid cyst ruptures or leaks, it causes inflammation within the abdomen, resulting in sudden, continuous abdominal pain. In severe cases, internal bleeding may lead to shock.

3. Infection

While rare, an infection caused by a dermoid cyst can be life-threatening. Symptoms include high fever and severe abdominal pain, which require immediate treatment with either surgery or antibiotics.

4. Malignant Transformation

Although dermoid cysts are usually benign, there is a slight risk (about 1%) that they can transform into cancer, especially in women over 45 years old or those with cysts larger than 10 cm. Regular health checks and close monitoring of any changes in size or symptoms are critical to preventing this risk.

How Dermoid Cyst Affect Fertility and Pregnancy

While a dermoid cyst is not cancerous, they can interfere with pregnancy and fertility in women of reproductive age through the following effects:

1. Pressing on Ovarian Tissue, Reduces Egg Production

When a dermoid cyst grows large, it can compress or damage ovarian tissue, reducing egg production in each menstrual cycle and potentially affecting the quality of eggs, making it more challenging to conceive naturally or through assisted reproduction methods like ICSI and IVF.

2. Interfering with Egg Retrieval for ICSI and IVF

In ICSI or IVF treatments, eggs must be retrieved from the ovaries. If a dermoid cyst is large or located near the area where the egg retrieval needle needs to be inserted, it can complicate the process, potentially causing cyst rupture or making it difficult to retrieve enough eggs, reducing the chances of a successful cycle.

3. Increased Risk of Pregnancy Complications

If pregnancy occurs while a woman has a dermoid cyst, there is an increased risk of complications, particularly ovarian torsion. As the uterus enlarges, it can pull on the ovary, leading to twisting or rupture, requiring emergency surgery during pregnancy.

Treatment for Dermoid Cysts

Dermoid cysts cannot shrink through medication or hormone treatment. Therefore, treatment usually falls into two categories:

• Small cysts without complications: The doctor may choose to monitor the cyst periodically without immediate surgery. However, any changes in size or symptoms should be watched closely.
• Larger cysts or complicated cases: Surgical intervention is necessary, with the goal of preserving the ovary. In cases where the cyst is large, the affected ovary may need to be removed. Laparoscopic surgery is commonly used as it reduces the risk of scarring and complications post-surgery.

If you’re facing reproductive health issues or have been diagnosed with a dermoid cyst and are planning to conceive, it’s essential to consult with an experienced IVF and ICSI specialist. At VFC Center, an expert ICSI clinic in Thailand, we provide personalized treatment plans tailored to your fertility goals. Our team is dedicated to offering expert care and support throughout your journey, increasing the chances of a successful and smooth pregnancy.

 

Article by DR. Sorramon Songveeratham

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