Reproductive and Sexual Health Handbook

Anatomically each ovary is approximately 4cm in length, 2cm in width and 8mm in thickness in women of reproductive age, and smaller before puberty and after the menopause. The ovaries are typically located on either side of the uterus seated in the ovarian fossa. The tubal extremity is attached to the ovarian fimbria of the fallopian tube and to a fold of the peritoneum – the suspensory ligament of the ovary. The uterine end is attached to the lateral angle of the uterus immediately behind and below the uterine tube by the ligament of the ovary.⁽¹⁾

The ovary is responsible for oocyte maturation and release (ovulation) and the production of steroid hormones. In a woman who is ovulating the release of follicle stimulating hormone (FSH) from the anterior pituitary (in response to hypothalamic gonadotrophin-releasing hormone or GnRH production) stimulates the growth of a cohort of ovarian follicles, usually only one of which develops and becomes ‘dominant’. In turn, the granulosa cells of these ovarian follicles produce the hormone oestradiol. Increasing levels of oestradiol trigger a surge of luteinising hormone (LH) that causes the dominant follicle to ovulate. This then becomes the corpus luteum which secretes the hormone progesterone as well as

Ovarian cysts are common, occurring in 6.6 per cent of premenopausal and 5-17 per cent of postmenopausal women. ^{(2) (4)}

Most ovarian masses in premenopausal women are functional cysts (usually derived from physiological ‘follicles’) and other common causes include endometriomas and benign tumours (usually ‘cystadenomas’). Large ovarian cysts are an established risk factor for ovarian torsion. Other causes of ovarian masses include dermoid cysts, theca lutein cysts (which can result from ovarian stimulation as well as gestational trophoblastic disease), corpus luteal cysts (especially in early pregnancy), tubo-ovarian abscesses (resulting from pelvic infection) and ovarian malignancy (of which there are several distinct types). Up to 10 per cent of women will have some form of surgery during their lifetime for the presence of an ovarian mass. ⁽²⁾

In premenopausal women almost all ovarian cysts are benign and many are also asymptomatic. Asymptomatic cysts are common, with one study finding a prevalence of 6.6 per cent among premenopausal women. ⁽²⁾ Where symptoms are present, the overall incidence of an ovarian cyst in a premenopausal female being malignant is approximately 1:1000 increasing to 3:1000 at the age of 50.⁽⁴⁾

Ovarian cysts in a premenopausal woman that are ‘simple cysts’, unilateral, unilocular and less than 5cm in diameter have a low risk of malignancy (less than 1 per cent). ⁽⁴⁾, ⁽⁶⁾, ⁽⁷⁾

Ovarian cancer is the eighth most common cancer and the sixth most common cause of cancer death affecting women in Australia.⁽⁸⁾ There were 1,365 new diagnoses and 905 deaths from ovarian cancer in Australia in 2015. Ovarian carcinoma has an overall incidence of 9.7/100,000 in Australia. ⁽⁹⁾

Polycystic ovary syndrome (PCOS) affects 8-13 per cent of Australian reproductive-aged women. ⁽¹⁹⁾It is a major public health concern with a significant undiagnosed burden of disease and reproductive, metabolic and psychological health consequences. ⁽¹⁹⁾

The diagnosis of PCOS remains challenging and controversial and several recognised phenotypes and variants exist. Ovulatory dysfunction, hyperandrogenism (clinical and/or biochemical) and polycystic ovarian morphology on ultrasound are the hallmark features of this condition and this is reflected in the diagnostic criteria employed by current International Guidelines.⁽¹⁹⁾

See Premature ovarian insufficiency in Chapter 11: Menopause.

Family Planning NSW factsheet:

Polycystic Ovary Syndrome (PCOS)

National Health and Medical Research Council – International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Copyright Monash University, Melbourne Australia 2018. Available at: https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf

Jean Hailes factsheets:

For Women’s Health – Health topics A to Z Polycystic Ovary Syndrome (PCOS) PCOS Health Professional Tool 

Cancer Australia resources:

Assessment of symptoms that may be ovarian cancer: a guide for GPs  Familial Risk Assessment FRA-BOC Appropriate referral for women with suspected ovarian cancer Drake R, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students E-Book. Elsevier Health Sciences; 2009. Borgfeldt C, Andolf E. Transvaginal sonographic ovarian findings in a random sample of women 25 – 40 years old. Ultrasound Obstet Gynecol. 1999;13(5):345-50. Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. East Melbourne, Victoria; 2016. Royal College of Obstetricians and Gynaecologists, The British Society for Gynaecological Endoscopy. Management of Suspected Ovarian Masses in Premenopausal Women. RCOG/BSGE Joint Guideline. Report No.: 62. [Internet]. 2011 [updated 2011 Nov 1]. The Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. 9th ed. East Melbourne, Victoria: RACGP; 2018. Royal College of Obstetricians and Gynaecologists. The Management of Ovarian Cysts in Postmenopausal Women. Report No.: 34 [internet]. 2003 [updated 2016 July]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_34.pdf. Yeoh M. Investigation and management of an ovarian mass. Aust Fam Physician. 2015;44(1-2):48-52. Cancer Council Australia. Understanding Ovarian Cancer: A guide for people with cancer, their families and friends. [internet]. Sydney, NSW: Cancer Council Australia; 2003 [updated 2018 April]. Available from: https://www.cancer.org.au/content/about_cancer/ebooks/cancertypes/Understanding_Ovarian_Cancer_booklet_April_2018.pdf. Australian Institute of Health and Welfare (AIHW). Cancer data in Australia. Cat no.: CAN 122. [internet]. Australian Government; 2018 [Updated 2019