An ovarian cyst is a larger fluid-filled sac or follicle or corpus luteum (more than 3cm in diameter) persists and continue growing on or in an ovary. A cyst can vary in size from a few centimeters to the size of a large melon. Ovarian cysts may be thin walled and only contain fluid (known as a simple cyst) or they may be more complex, containing thick fluid, blood or solid [1].

Ovarian cysts, incidence of 20% of women developing at least one pelvic mass in their lifetime [2]. Age incidence in patients with ovarian cysts is commonly seen in age group between 30 and 39 years the prevalence for simple ovarian cyst is 48 percent out of 100 patients, unilocular simple ovarian cysts are functional ovarian cysts and resolve spontaneously with therapy by 3 to 6 months oral contraceptive [3]. Cystic lesions of the ovary are a common gynecological finding. They are very common and mostly benign during adolescence. Many ovarian cysts are asymptomatic and found incidentally on routine pelvic examination [4].

The exact cause of the ovarian cysts is not known, but among the reasons that help in the occurrence of ovarian cysts are genetic factors, increase the androgens, body resistance to insulin, the presence of infections and obesity [5]. In the normal case, the ovaries produce hormones that control the functions of the body which are estrogen and androgen, and in women with cystic conditions, the androgen hormone is higher than estrogen [6].

Among the complications of ovarian cysts are weight gain, type 2 diabetes, cardiovascular disease high cholesterol, uterine cancer and infertility [7]. Health- related quality of life (HRQoL) was defined the World Health Organization (WHO) as people's perceptions of their status in life [8].

QoL comprises four dimensions: physical and motor skills, mental state, social and economic conditions, and somatic perception (e.g., symptoms, especially pain). Importantly, the concept draws attention to the need to distinguish between an objective state of health (as determined by observed symptoms) and the subjective experience of the patient (i.e., HRQoL) concerning that state using objective and subjective methods of assessment (3)

Advanced practice nurse can facilitate quality of care and manage treatments effectively to improve quality of life, reduce pain, and prevent further progression of the disease. Practice recommendations include timely diagnosis, pain management, infertility counseling, patient education, and support for quality-of-life issues [9].

Aim of study

The study aimed to assess health-related quality of life among women with ovarian cysts.

Study Design

A descriptive study design was used.

Study Setting

The study was conducted at gynecological outpatient clinic and endoscopic unit in Zagazig university hospital within six months of data collection during the period of 22th march 2022 to 22 the September 2022.

Study Sample

A convenient sample was used for this study. All women (200) who were diagnosed with ovarian cyst at any age group during six months.

Tools For Data Collection

Tool (1): Structured interview questionnaire: developed by the researcher to collect the following data:

• Sociodemographic characteristics: the first part of the questionnaire which was concerned with personal data of the study subjects as age, residence education level, occupation and marital of status
• Physical and Biological Assessment: it was concerned with any complaint in women with ovarian cyst as: severity of pelvic pain, heaviness and fullness in abdomen, nausea and vomiting, breast pain and tenderness, dysmenorrhea, faintness, burning in urination appetite decrease and backache.

Tool (II): Numeric pain rate scales {pelvic pain} : [10] Pain scoring system: 0= No pain 1-3= Mild pain 4-6=Moderate 7-10= Severe

Tool (III): Quality of life in women with ovarian cyst: it was adopted of [11] to assess the quality of life for women with ovarian cyst. The questionnaire consisted of 14 items:

• Psychological Health: The patients would answer with never, Sometimes or Always on 4questions about: Reaction when diagnosing of ovarian cyst, feeling of frustration with ovarian cyst, feeling sad and worry about disease, difficulty to adapt with ovarian cyst and feeling to isolated
• Physical Health: The patients would answer with never, Sometimes or Always on 5 questions about: The extent of your ability to carry out daily activities during the normal day, inability to travel, feeling sickness and fatigue, effect on sexual desire and effect of pharmacotherapy on health condition
• The social Health: The patients would answer with never, Sometimes or Always on 3 questions about: Effect of disease on family relationship, effects of disease on their relationship with others and establish a new relationship and need support from family and friends

Quality of life scoring system

It scored as follows: if the response was never (0), if it was sometimes (1) and if it was always (2).

Administrative design: An official permission letter was obtained from the Ethical Committee of faculty of nursing at Zagazig University to the administrator of gynecological outpatient clinic and endoscopic unit in Zagazig university hospital.

The aim of the study was explained to them to obtain their cooperation.

Ethical consideration: Official permission from the study setting was obtained for the fulfillment of the study. Oral consent was taken from each woman in order to participate in the study and confidentiality was assured. The principal investigators have kept individual data as private information safely. There was no extra fee to be paid by the participants and the investigators covered all the costs in this regard.

(Ethical code): M.D. ZU.NU.R/154/12/10/2021.

Statistical Analysis

Data were checked, entered and analyzed using SPSS version 23 for data processing. Data were expressed as number and percentage for qualitative variables and mean + standard deviation (SD) for quantitative one.

Table 1: Distribution of studied women according to their =demographic data (n = 200).

Table (1) shows 54% of women in the age group 17-50 years, with an average age of 28.94 ± 6.637 years. Moreover, 81.5% and 49.5% were rural and had a secondary education. Also, 78.5% of them are housewives.

Table 2: Distribution of the studied women according to their manifestation (n=200).

Table 2 shows that 41% and 52.0% of the women complained of abdominal heaviness and fullness and loss of appetite, respectively. Additionally, women complained of burning with urination (37%), nausea and vomiting (22%), dysmenorrhea (15.5%), breast pain and tenderness (13.5%), and back pain (11%), respectively.

Figure 1: Distribution of the studied women according to their level of pelvic pain (n=200).

Figure 1 shows that 64.3% and 25.1% of the women had moderate and severe pelvic pain, respectively. While 7.5% and 3.0% of them had mild and no pelvic pain.

Figure 2: Distribution of the studied women according to their intensity of pain that interferes with normal physical activities (n=200).

Figure 2 shows that more than half of the women (51.5%) had severe pain that interfered with their normal physical activities. While a third of them (35.5%) were experienced moderate pain that interfered with their normal physical activities.

Figure 3: Distribution of the studied women according to the level of quality-of-life domains (n=200).

Figure (3) illustrates that 69.5% & 64.0% of women had average level regarding psychological and physical health. While, 68.0% of them had good level regarding social health.

Table 3: Distribution of the studied women according to the relationship between pain and level of QoL domains (n=200).

Table (3) shows that there is a significant relationship between moderate pain and average of psychological health domain (P <0.000). Also, there is a significant relationship between low pain and physical health as well as high level of social health with severe pain.

Table 4: Distribution of the studied women according to the relationship between Pelvic Pain and level of QoL (n=200).

* P < 0.05 (significant)

Table (3) shows that there is a significant relationship between severe pelvic poor quality of life (P <0.001). Also, there is a significant relationship between moderate pain and good quality of life.

Ovarian cysts can be caused by many reasons. Ovarian cysts arising due to endocrine disorders are mostly benign and usually do not require any surgical intervention unless they present with acute features like torsion, hemorrhage, or rupture [12]. Malignant transformation of an ovarian cyst is very rare with [13]. Ovarian cysts can occur at any age but are more common in reproductive years and increase in menarche females due to endogenous hormone production [14].

In the current study, age ranged from 17-50 years with a mean value of 28.94±6.637 years. This result was matched with [13] study which revealed that the age of ovarian cysts patients ranged between 16 to 58 years with a mean value of 33.44 ± 9.300 years. In [15] study, the age ranged from 10 to 40 years with the majority of the patients ranged from 21 to 30 years. Mean age in [16] study was 26.2 ±5.9. Simple cyst detection slightly more common for women ages 55–59 (16%) than for women in older age groups (13%) in [17] study.

Regarding education level in the present study, higher number of the patients 99(49.5%) finished secondary school. In agreement to our result, [17] study stated that higher number among ovarian cyst patients completed secondary school. In contrary to our results, majority of the patients were illiterate 9 (64.2%) in [15] study.

Regarding occupation in the current study, 157(78.5%) were housewives, 40(20.0%) were working, and 3(1.5%) were student. Similarly, [18] did not observe clear associations between work characteristics and ovarian cancer incidence or mortality.

However, [19] reported a case of ovarian cancer had been exposed to asbestos significantly, so they determined that ovarian cancer in the patient is highly correlated with the occupational exposure of asbestos and environmental exposure is a possible cause as well.

Regarding marital status in the present study (19.0%) were single, (68.5%) were married and (12.5%) were divorced. Duration of married was ranged from 1- 27 years with a mean value of 10.31±6.182 years.

Our result agreed with [20] study which showed that 165 were married (67.4%) out of 244 patients diagnosed with ovarian cysts. Similar results reported in [15] study where 64.2% were married.

[18] results suggested higher ovarian cancer risk among socially isolated and widowed women, particularly when such psychosocial stressors were experienced a decade before diagnosis or were sustained over time. In agreement to our study, dysmenorrhea was in 4 (4.9%) in [13]. Nausea and vomiting were observed in many patients and also due to this the pelvic pain became worst in ovarian cysts in [15]. The signs and symptoms of ovarian cysts may include pelvic pain, dysmenorrheal, and dyspareunia. Other symptoms are nausea, vomiting, or breast tenderness, fullness and heaviness in the abdomen and frequency and difficulty emptying of the bladder [23]. When ovarian cysts are large, they may cause abdominal discomfort. If pressing on the bladder it may also cause frequency of urination [24].

The present study showed that majority had moderate physical pain during the past four weeks which had slight discrepancy with normal physical activities. [13] study reported that the most common presenting complaint was lower abdominal pain in 51 (63%) women. Similar results reported in [20] study where the most common clinical presentation was abdominal pain in 142 patients (58.2%) cysts.

Health Related Quality of Life was significantly decreased in women with ovarian cyst. Thus, women with suspected or diagnosed ovarian cysts should seek immediate medical help because early diagnosis and treatment are beneficial in improving their quality of life.

1. Abduljabbar HS, Bukhari YA, al Hachim EG, Ashour GS, Amer AA, Shaikhoon MM, & Khojah, M. I. Review of 244 cases of ovarian cysts. Saudi Medical s Journal, 2015; 36; 834-838.
2. Almas I, Nisar-Ur-Rehman, Azhar S, Ismail M, Murtaza G, & Hussain I. Perception and awareness of patients regarding ovarian cysts in Peshawar, Pakistan: a qualitative approach. Contemporary oncology (Poznan, Poland), 2015; 19: 487-490.
3. Bruthans T, Vránová J, & Yamamotová A. Objective Evaluation of Chronic Low-Back Pain Using Serum Lipids: The Role of the Doctor-Patient Relationship. Pain Research and Management, 2023.
4. Farghaly Current diagnosis and management of ovarian cysts. Clinical and Experimental Obstetrics & Gynecology, 2014; 41: 609-612.
5. Farheen A, Naveed W, Sultana S, Ali SA, Rasheed NMA, & Mahveen. CLINICAL STUDY On efficacy of dawae akgas in management of benign ovarian cyst: journal of Medical science and clinical research (08) 550. 2020.
6. Greenlee RT, Kessel B, Williams CR, Riley TL, Ragard LR, Hartge P, Buys SS, Partridge EE, & Reding DJ. Prevalence, incidence, and natural history of simple ovarian cysts among women >55 years old in a large cancer screening trial. American journal of obstetrics and gynecology, 2010; 202: 373:e1-e9.
7. Hepsen S, Cakal E, Karakose M, Eyerci N, Saat H, Beysel S. Melanocortin 3 receptor gene polymorphism is associated with polycystic ovary syndrome in. Turkish population; 2019; 1-6.
8. Jiji V, Sreedhar A. AYURVEDIC MANAGEMENT OF OVARIAN CYST: A CASE International Journal of Ayurveda and Pharma Research, 2021; 74-77.
9. Lee MS, Moon MH, Woo H, Sung CK, Jeon HW & Lee TS, et al. Ruptured Corpus Luteal Cyst: Prediction of Clinical Outcomes with CT. Korean journal of radiology, 2017; 18: 607-614.
10. Mobeen S, Apostol Ovarian Cyst. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
11. Pakhomov SP, Orlova VS, Verzilina IN, Sukhih NV, Nagorniy AV & Matrosova AV. Risk Factors and Methods for Predicting Ovarian Hyperstimulation Syndrome (OHSS) in the in vitro Fertilization. Archives of Razi Institute, 2021; 76: 1461-1468.
12. Panzini RG, Paz Mosqueiro B, Zimpel RR, Bandeira NS, Rocha DR, Fleck Quality-of-life and spirituality. Int Rev Psychiatry 2017; 9: 1
13. Park S, Park J, Lee E, Eom H, Shin MY, Kim J, Kang D, & Lee S, et al. Ovarian cancer in a former asbestos textile factory worker: a case report. Annals of occupational and environmental medicine, 2018; 30: 65.
14. Rofe G, Auslend R, Dirnfeld M. Benign ovarian cysts in reproductive-age women undergoing assisted reproductive technology treatment. Open J Obstet Gynecol. 2013; 3:17-22.
15. Rzo?ca E, Bie? A, Wdowiak A, Szyma?ski R, & Iwanowicz-Palus Determinants of Quality of Life and Satisfaction with Life in Women with Polycystic Ovary Syndrome. International journal of environmental research and public health, 2018; 15: 376.
16. Shi XY, Huang AP, Xie DW, & Yu XL. Association of vitamin D receptor gene variants with polycystic ovary syndrome: a meta-analysis. BMC medical genetics, 2019; 20: 1-11.
17. Solanki KG, Choudhary NV. Role of ultrasonography and colour doppler imaging in evaluation of adnexal masses. International Journal of Medical and Biomedical Studies, 2020; 4: 187-191
18. Suh-Burgmann E, Flanagan T, Osinski T, Alavi M, & Herrinton L. Prospective validation of a standardized ultrasonography-based ovarian Cancer risk assessment Obstetrics & Gynecology, 2018; 132: 1101-1111.
19. Tabassum F, Jyoti C, Sinha HH, Dhar K, & Akhtar MS. Impact of polycystic ovary syndrome on quality of life of women in correlation to age, basal metabolic index, education and PloS one, 2021; 16: e0247486.
20. Tresa A, Rema P, Suchetha S, Dinesh D, Sivaranjith J, & Nath AG. Hypothyroidism Presenting as Ovarian Cysts-a Case Series. Indian journal of surgical oncology, 2021; 12: 343-347.
21. Trudel-Fitzgerald C, Poole EM, Idahl A, Lundin E, Sood AK, Kawachi I, Kubzansky LD, & Tworoger The Association of Work Characteristics with Ovarian Cancer Risk and Mortality. Psychosomatic medicine, 2017; 79: 1059-1067.
22. Wazir H, Jain MS, Luvsannyam E, Rayalu M, & Alston C. Massive Leiomyomata and Severe Endometriosis Resulting in a Frozen Pelvis in an Asymptomatic Cureus, 2020; 12.
23. Zahra F. Pattern of benign ovarian cysts in Qatari women. Qatar medical journal, 2017; 2016: 17.