Ovarian Cysts: Symptoms, Types & Treatment Guide

What Are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that develop on or within the ovaries. They are extremely common during the reproductive years and most are harmless functional cysts that form as part of normal ovulation. The vast majority resolve spontaneously without treatment.

A cyst is simply a fluid-filled sac or pocket of tissue. Cysts can form in various parts of the body, but ovarian cysts specifically develop in or on the ovaries—the two small, almond-shaped organs located on either side of the uterus. The ovaries are responsible for producing eggs (ova) and the female hormones estrogen and progesterone.

Ovarian cysts are remarkably common, affecting approximately 7-12% of women worldwide at some point during their reproductive years. Many women develop ovarian cysts during their lifetime without ever knowing, as these cysts often cause no symptoms and are discovered incidentally during routine pelvic examinations or imaging studies performed for other reasons.

The term "ovarian cyst" can sometimes cause unnecessary worry, as many people immediately associate cysts with cancer. However, it's important to understand that the overwhelming majority of ovarian cysts are benign (non-cancerous). Ovarian cancer arising from cysts is rare, particularly in premenopausal women, where the malignancy rate is less than 1%.

Understanding the different types of ovarian cysts, their causes, symptoms, and treatment options can help alleviate anxiety and ensure you seek appropriate medical care when necessary. This comprehensive guide covers everything you need to know about ovarian cysts, from diagnosis to treatment and prevention.

What Are the Different Types of Ovarian Cysts?

There are several types of ovarian cysts, including functional cysts (follicular and corpus luteum), endometriomas (chocolate cysts), dermoid cysts, and cystadenomas. Functional cysts related to ovulation are by far the most common and typically resolve without treatment.

Ovarian cysts are classified into different categories based on their origin, composition, and characteristics. Understanding these different types is important because each type has different implications for treatment and prognosis. The most common types of ovarian cysts include functional cysts, endometriomas, dermoid cysts, and cystadenomas.

Functional Cysts (Ovulation Cysts)

Functional cysts are the most common type of ovarian cyst and are a normal part of the menstrual cycle. These cysts form when the normal process of ovulation doesn't proceed as expected. There are two main types of functional cysts:

Follicular cysts develop when the follicle—the small sac containing the developing egg—doesn't rupture to release the egg during ovulation. Instead, the follicle continues to grow, filling with fluid and forming a cyst. Follicular cysts are typically small (usually less than 5 centimeters) and usually resolve on their own within one to three menstrual cycles.

Corpus luteum cysts form after ovulation has occurred. Normally, after the egg is released, the empty follicle shrinks and transforms into a structure called the corpus luteum, which produces hormones to support a potential pregnancy. Sometimes, instead of shrinking, the corpus luteum seals off and fills with fluid or blood, forming a cyst. Corpus luteum cysts can grow larger than follicular cysts and may cause symptoms such as pelvic pain, but they typically resolve within a few weeks.

Functional cysts are most common during the reproductive years when women are menstruating regularly, but they can persist after menopause in some cases. These cysts rarely require treatment and are usually monitored with follow-up ultrasounds to confirm resolution.

Endometriomas (Chocolate Cysts)

Endometriomas are cysts that develop as a result of endometriosis, a condition where tissue similar to the uterine lining (endometrium) grows outside the uterus. When this endometrial tissue attaches to the ovary, it can form a cyst.

These cysts are often called "chocolate cysts" because they contain old, dark blood that resembles chocolate. Endometriomas can vary in size from very small to quite large (over 10 centimeters) and often affect both ovaries. Unlike functional cysts, endometriomas typically don't resolve on their own and may require surgical treatment, especially if they cause significant pain or affect fertility.

Women with endometriomas often experience symptoms related to endometriosis, including painful periods, chronic pelvic pain, pain during intercourse, and fertility problems. Treatment may involve hormonal therapy to manage symptoms or surgery to remove the cysts while preserving ovarian function.

Dermoid Cysts (Mature Cystic Teratomas)

Dermoid cysts, also known as mature cystic teratomas, are a fascinating type of benign tumor that can contain a variety of tissue types, including skin, hair, teeth, and even thyroid tissue. These cysts develop from germ cells—the cells that eventually become eggs—and are present from birth, though they may not be discovered until adulthood.

Despite their unusual contents, dermoid cysts are almost always benign. They tend to grow slowly and are usually found on only one ovary, though in about 10% of cases they occur on both sides. Dermoid cysts can range in size from tiny to quite large and may cause symptoms if they become large enough to press on surrounding structures.

Because dermoid cysts don't resolve on their own and carry a small risk of ovarian torsion (twisting) due to their weight, surgical removal is often recommended, especially for larger cysts. The good news is that the transformation of a dermoid cyst into cancer is extremely rare, occurring in less than 2% of cases.

Cystadenomas

Cystadenomas are benign tumors that develop from the outer surface of the ovary. There are two main types: serous cystadenomas, which are filled with a thin, watery fluid, and mucinous cystadenomas, which contain a thicker, sticky fluid.

These cysts can grow quite large—mucinous cystadenomas in particular can become very sizable, sometimes filling a significant portion of the abdominal cavity. Despite their potential for large size, cystadenomas are typically benign, though they usually require surgical removal to prevent complications and rule out the small possibility of malignancy.

Borderline Tumors

Borderline ovarian tumors occupy a middle ground between clearly benign cysts and malignant ovarian cancer. They have some features of cancer cells but typically don't invade surrounding tissues or spread to other parts of the body like true cancers do.

Treatment for borderline tumors is similar to that for ovarian cancer, usually involving surgical removal. However, in women who wish to preserve fertility, more conservative surgery may be possible, removing only the affected ovary while leaving the other ovary and uterus intact. Borderline tumors generally have an excellent prognosis, with very high survival rates.

What Are the Symptoms of Ovarian Cysts?

Many ovarian cysts cause no symptoms and are discovered incidentally. When symptoms occur, they may include pelvic pain, bloating, pressure sensation, frequent urination, pain during intercourse, and feeling a lump in the lower abdomen. Sudden severe pain may indicate a complication requiring emergency care.

One of the challenging aspects of ovarian cysts is that many cause no symptoms at all. Small functional cysts, in particular, often go completely unnoticed and are only discovered during routine pelvic examinations or imaging studies performed for unrelated reasons. This is why regular gynecological check-ups are important—they can help detect cysts and other conditions that might otherwise remain undiagnosed.

However, when ovarian cysts do cause symptoms, the nature and severity of those symptoms can vary depending on the size of the cyst, whether it has ruptured, and whether any complications have developed. Understanding the potential symptoms of ovarian cysts can help you recognize when to seek medical attention.

Common Symptoms of Ovarian Cysts

When symptoms are present, they may include one or more of the following:

• Pelvic pain: This is the most common symptom of symptomatic ovarian cysts. The pain may be dull and aching, or it may come and go in waves. Some women describe it as a heavy feeling or pressure in the lower abdomen. The pain is typically felt on the side where the cyst is located.
• Bloating or abdominal swelling: Larger cysts can cause the abdomen to feel full or bloated. Some women notice their clothes fitting more tightly around the waist.
• Pressure sensation: As a cyst grows, it may press on nearby organs, causing a feeling of fullness or pressure in the pelvis or lower abdomen.
• Frequent urination: If a cyst presses on the bladder, you may feel the need to urinate more frequently or may have difficulty emptying your bladder completely.
• Pain during intercourse: Deep pelvic pain during vaginal or anal intercourse can occur, particularly with larger cysts or endometriomas.
• Feeling a lump: Very large cysts may be felt as a noticeable mass in the lower abdomen.
• Menstrual irregularities: Some ovarian cysts can affect hormone levels, leading to irregular periods, spotting between periods, or changes in menstrual flow.

Symptoms of Cyst Rupture

When an ovarian cyst ruptures (breaks open), it can cause sudden, sharp pain on one side of the pelvis. The fluid or blood released from the cyst can irritate the lining of the abdomen (peritoneum), causing more widespread abdominal pain. While a ruptured cyst can be quite painful, the pain usually improves within a few hours to a day as the body absorbs the fluid.

In some cases, particularly with larger cysts or those containing blood, rupture can cause significant internal bleeding that requires emergency medical treatment. Signs of severe bleeding may include dizziness, weakness, rapid heartbeat, and cold, clammy skin.

When Should You See a Doctor for Ovarian Cysts?

Contact your healthcare provider if you experience persistent pelvic pain, bloating, or changes in your menstrual cycle. Seek immediate emergency care for sudden severe pain, fever with vomiting, dizziness, or signs of shock, as these may indicate serious complications requiring urgent treatment.

Knowing when to seek medical care for symptoms that might be related to an ovarian cyst is important for your health and peace of mind. While many ovarian cysts resolve on their own and cause minimal concern, certain symptoms warrant prompt medical evaluation.

Schedule an appointment with your healthcare provider if you experience:

• Persistent pelvic pain that doesn't resolve within a few days
• Unusual bloating or a feeling of fullness in your abdomen
• Pain during intercourse that is new or worsening
• Changes in your menstrual cycle, such as irregular periods or unusual bleeding
• Difficulty urinating or frequent need to urinate
• A palpable mass or lump in your lower abdomen

Seek immediate emergency care if you experience:

• Sudden, severe pelvic or abdominal pain that comes on quickly
• Pain with fever or vomiting
• Dizziness, fainting, or feeling like you might pass out
• Rapid breathing or rapid heartbeat
• Cold, clammy skin or signs of shock

These emergency symptoms may indicate serious complications such as ovarian torsion (where the cyst causes the ovary to twist, cutting off its blood supply) or significant internal bleeding from a ruptured cyst. Both conditions require prompt surgical intervention to prevent permanent damage to the ovary or other serious health consequences.

How Are Ovarian Cysts Diagnosed?

Ovarian cysts are primarily diagnosed using transvaginal ultrasound, which provides detailed images of the ovaries. Additional tests may include pelvic examination, blood tests (including CA-125 tumor marker), and in some cases CT or MRI scans to further characterize complex cysts.

The diagnosis of ovarian cysts typically involves a combination of clinical evaluation and imaging studies. Your healthcare provider will use information from your medical history, physical examination, and diagnostic tests to determine whether you have an ovarian cyst, what type it might be, and whether treatment is necessary.

Pelvic Examination

A pelvic examination is often the first step in evaluating symptoms that might be related to an ovarian cyst. During this examination, your healthcare provider will manually feel (palpate) your lower abdomen and pelvis to check for any masses, tenderness, or abnormalities. Larger cysts may be felt during a pelvic examination, though smaller cysts often cannot be detected this way.

Transvaginal Ultrasound

Transvaginal ultrasound is the primary imaging method for diagnosing and evaluating ovarian cysts. During this procedure, a small ultrasound probe is gently inserted into the vagina, allowing the technician or doctor to obtain detailed images of the ovaries and surrounding structures.

Ultrasound can reveal important information about a cyst, including its size, location, whether it is filled with fluid (simple cyst) or has solid components (complex cyst), and whether it appears suspicious for malignancy. The ultrasound can also detect other conditions that might be causing your symptoms, such as fibroids or ectopic pregnancy.

In some cases, an abdominal ultrasound (performed on the outside of the abdomen) or a transrectal ultrasound may be used instead of or in addition to transvaginal ultrasound.

Blood Tests

Blood tests may be ordered to help characterize an ovarian cyst and rule out certain conditions. Common blood tests include:

• CA-125: This is a tumor marker that can be elevated in ovarian cancer. However, CA-125 can also be elevated in many benign conditions, including endometriosis, pelvic inflammatory disease, and even pregnancy. CA-125 is most useful in postmenopausal women, where elevated levels are more likely to indicate malignancy.
• Pregnancy test: A pregnancy test is important to rule out ectopic pregnancy, which can present with symptoms similar to ovarian cysts.
• Complete blood count (CBC): This test can help identify signs of infection or significant blood loss.
• Hormone levels: In some cases, hormone tests may be ordered to evaluate for conditions like polycystic ovary syndrome (PCOS).

Advanced Imaging

For complex cysts or when ultrasound findings are unclear, additional imaging studies may be recommended:

• MRI (Magnetic Resonance Imaging): MRI provides more detailed images than ultrasound and can help characterize complex cysts, particularly when trying to distinguish between different types of benign cysts or evaluating for malignancy.
• CT scan (Computed Tomography): CT scans may be used in emergency situations to evaluate for complications like cyst rupture with bleeding, or to assess cysts that might be cancerous.

The entire diagnostic process, including the ultrasound examination, typically takes about 15-30 minutes. Your healthcare provider will discuss the findings with you and recommend appropriate follow-up or treatment based on the results.

How Are Ovarian Cysts Treated?

Treatment for ovarian cysts depends on the type, size, and symptoms. Most functional cysts require only watchful waiting with follow-up ultrasound. Hormonal contraceptives can prevent new functional cysts. Surgery (usually laparoscopic) may be needed for large, persistent, or symptomatic cysts.

The treatment approach for ovarian cysts varies depending on several factors, including the type and size of the cyst, whether it's causing symptoms, your age, and whether you wish to preserve fertility. Many ovarian cysts, particularly functional cysts, don't require any treatment at all and will resolve on their own.

Watchful Waiting

For most functional cysts, the recommended approach is watchful waiting, also called expectant management. This means monitoring the cyst with follow-up ultrasounds to see if it resolves on its own, which most functional cysts do within one to three menstrual cycles.

During this time, your healthcare provider may recommend over-the-counter pain relievers like acetaminophen or ibuprofen to manage any discomfort. You'll likely be scheduled for a repeat ultrasound in 6-8 weeks to check whether the cyst has resolved or changed in size.

Watchful waiting is typically appropriate when:

• The cyst appears simple (fluid-filled without solid components) on ultrasound
• The cyst is relatively small (usually less than 5-7 cm)
• You are premenopausal
• Symptoms are minimal or easily managed

Hormonal Contraceptives

If you experience recurrent functional cysts, your healthcare provider may recommend hormonal contraceptives such as birth control pills, hormonal patches, vaginal rings, hormonal IUDs, or hormonal injections. These medications work by suppressing ovulation, which prevents new functional cysts from forming.

It's important to note that hormonal contraceptives don't shrink existing cysts—they only prevent new ones from developing. They are particularly useful for women who have had multiple episodes of symptomatic functional cysts.

Surgical Treatment

Surgery may be recommended in certain situations, including:

• The cyst is large (typically greater than 5-7 cm) and causing symptoms
• The cyst doesn't resolve after several months of monitoring
• The cyst has suspicious features on imaging that suggest it might be cancerous
• You are postmenopausal (cysts are more likely to be problematic after menopause)
• A complication has occurred, such as ovarian torsion or significant cyst rupture with bleeding

Laparoscopic Surgery (Keyhole Surgery)

Most ovarian cyst surgeries are performed laparoscopically, which is a minimally invasive technique. During laparoscopic surgery, the surgeon makes several small incisions (usually 0.5-1 cm) in the abdomen and inserts a thin, lighted camera (laparoscope) and specialized surgical instruments.

The surgery typically takes about one hour, and most patients can go home the same day or the following day. Recovery is generally quicker than with open surgery, with most women returning to normal activities within 1-2 weeks.

During surgery, the surgeon will try to remove only the cyst while preserving as much healthy ovarian tissue as possible (cystectomy). This approach helps maintain fertility and hormone production.

Open Abdominal Surgery (Laparotomy)

In some cases, open abdominal surgery through a larger incision may be necessary. This approach might be used for:

• Very large cysts that cannot be safely removed laparoscopically
• Cysts that appear potentially cancerous on imaging
• Emergency situations such as significant internal bleeding

Recovery from open surgery typically requires a hospital stay of 1-2 days and a longer recovery period of 4-6 weeks before returning to normal activities.

Removal of the Ovary

In most cases, surgeons aim to remove only the cyst while preserving the ovary (cystectomy). However, sometimes it may be necessary to remove the entire ovary (oophorectomy), particularly if the ovary has been damaged by the cyst, in cases of ovarian torsion where the ovary cannot be saved, or when there is concern about cancer.

If only one ovary is removed, the remaining ovary can usually maintain normal hormone production and fertility. In some cases, particularly in postmenopausal women or those at high risk for ovarian cancer, both ovaries and sometimes the fallopian tubes may be removed to reduce future risk.

Can You Prevent Ovarian Cysts?

Functional ovarian cysts cannot be completely prevented as they are a normal part of the menstrual cycle. However, hormonal contraceptives can prevent new functional cysts by suppressing ovulation. Regular gynecological check-ups help detect cysts early, even if they cannot be prevented.

Since most ovarian cysts are functional cysts that form as a natural part of the ovulation process, they cannot be entirely prevented. Some women are simply more prone to developing cysts than others, and there's no known reason why this occurs.

However, there are some strategies that may help reduce your risk of developing ovarian cysts or their complications:

Hormonal Contraceptives

If you experience recurrent functional cysts, using hormonal contraceptives that suppress ovulation can prevent new cysts from forming. Options include:

• Combined oral contraceptives (birth control pills)
• Hormonal patches or vaginal rings
• Hormonal IUDs (though these may not completely suppress ovulation)
• Hormonal injections
• Contraceptive implants

These methods work by preventing ovulation, so no follicle develops that could potentially become a cyst. Discuss with your healthcare provider whether hormonal contraceptives are appropriate for you.

Regular Gynecological Examinations

While regular check-ups won't prevent cysts from forming, they can help detect cysts early, before they cause problems. Your healthcare provider can monitor any cysts and recommend treatment if necessary. Regular examinations also help ensure that any changes in your ovaries are caught early.

Know Your Body

Being aware of your body and any changes can help you seek medical attention promptly if something seems wrong. Pay attention to:

• Your menstrual cycle and any changes in regularity or flow
• Any new pelvic pain or discomfort
• Changes in urination or bowel habits
• Bloating that doesn't resolve or seems unusual

What Complications Can Occur with Ovarian Cysts?

The main complications of ovarian cysts are ovarian torsion (twisting of the ovary) and cyst rupture. Ovarian torsion is a medical emergency requiring immediate surgery. Cyst rupture usually causes temporary pain but can occasionally cause significant bleeding requiring treatment.

While most ovarian cysts are harmless and resolve without causing any problems, complications can occasionally occur. Understanding these potential complications can help you recognize warning signs and seek appropriate medical care.

Ovarian Torsion

Ovarian torsion occurs when a cyst causes the ovary to twist on its blood supply, cutting off blood flow to the ovary. This is a medical emergency because without blood flow, the ovary can become damaged or die.

Ovarian torsion is more common with larger cysts (typically greater than 5 cm) and with certain types of cysts, such as dermoid cysts, which may be heavier due to their contents. Symptoms of ovarian torsion include:

• Sudden, severe pelvic pain on one side
• Pain that may come and go (as the ovary twists and untwists)
• Nausea and vomiting
• Fever (in some cases)

If ovarian torsion is suspected, emergency surgery is needed to untwist the ovary and restore blood flow. If treated promptly, the ovary can often be saved. However, if blood flow has been cut off for too long, the ovary may need to be removed.

Cyst Rupture

When an ovarian cyst ruptures (bursts), fluid or blood from inside the cyst spills into the pelvis. This can cause sudden, sharp pain that may be quite severe initially but typically improves over several hours.

Most ruptured cysts can be managed with pain medication and rest, and the body will naturally absorb the fluid. However, in some cases—particularly with larger cysts or those that contain a lot of blood—rupture can cause significant internal bleeding that requires emergency treatment, potentially including surgery.

Signs that a ruptured cyst may be causing serious bleeding include:

• Severe pain that doesn't improve
• Dizziness or fainting
• Rapid heartbeat
• Shortness of breath
• Cold, clammy skin

Do Ovarian Cysts Affect Fertility and Pregnancy?

Most ovarian cysts do not affect fertility. Functional cysts are part of normal ovulation and typically resolve without treatment. Endometriomas may impact fertility but can often be treated. Having one ovary removed usually doesn't prevent pregnancy if the other ovary is healthy.

Many women worry about whether ovarian cysts might affect their ability to become pregnant. The good news is that most ovarian cysts have no impact on fertility whatsoever.

Functional Cysts and Fertility

Functional cysts—the most common type—are actually a sign that your ovaries are working normally and producing eggs. These cysts form as part of the natural ovulation process and don't interfere with fertility. They typically resolve on their own and don't require treatment that would affect your reproductive organs.

Endometriomas and Fertility

Endometriomas (chocolate cysts) related to endometriosis can potentially impact fertility. Endometriosis can cause scarring and adhesions that may affect the fallopian tubes or interfere with egg release and fertilization. However, many women with endometriomas do conceive naturally, and treatments are available to help improve fertility in those who have difficulty.

If surgery is needed to remove an endometrioma, your surgeon will try to preserve as much healthy ovarian tissue as possible to maintain fertility. However, repeated surgeries on the same ovary can reduce the ovary's egg reserve.

Surgery and Fertility

When surgery is needed to remove an ovarian cyst, surgeons typically try to preserve the ovary by removing only the cyst (cystectomy) rather than the entire ovary. This approach helps maintain fertility and hormone production.

If an entire ovary needs to be removed, fertility is usually preserved as long as the other ovary is healthy. Women have two ovaries, and one functioning ovary is typically sufficient for normal fertility and hormone production. However, having only one ovary may slightly reduce the total number of eggs available, which could potentially affect fertility in some cases, particularly as a woman ages.

Ovarian Cysts During Pregnancy

Ovarian cysts are sometimes discovered during pregnancy, often during routine prenatal ultrasounds. Most cysts found during pregnancy are benign corpus luteum cysts that formed as part of early pregnancy and will resolve on their own during the second trimester.

If a larger or persistent cyst is discovered during pregnancy, it may need to be monitored more closely. Surgery during pregnancy is typically avoided unless necessary, but if the cyst poses a risk (such as potential torsion), it can be safely removed, usually during the second trimester when the risk to the pregnancy is lowest.

Cysts and Breastfeeding

Ovarian cysts are less common during breastfeeding because breastfeeding often suppresses ovulation. However, cysts can still occur. If you develop symptoms of an ovarian cyst while breastfeeding, consult your healthcare provider for evaluation and appropriate management.