This article has been fact-checked by Dr Timothy Lim Yong Kuei, gynecologist at Timothy Lim Clinic for Women & Cancer Surgery, Mount Alvernia Hospital, Singapore.
About the Doctor
Ovarian cysts are one of the most common gynaecological disorders and occur in women of all ages. Most ovarian cysts are harmless, don’t cause any symptoms, and go away without treatment. But some cysts can grow, cause pain, affect fertility or, in rare cases, be a sign of ovarian cancer. It is important to know when an ovarian cyst is just one to watch, and when it needs to be seen by a doctor right away.
What Is an Ovarian Cyst?
An ovarian cyst is a sac filled with fluid that develops either on the surface or inside an ovary. Many cysts are normal and a part of the menstrual cycle, and they go away on their own within a few weeks or months.
Most cysts of the ovary are benign but some features such as continued growth, complex appearance on imaging or post-menopausal occurrence may merit further evaluation.
What Types of Ovarian Cysts Exist?
Several different types of ovarian cysts can develop, each with distinct characteristics:
- Functional cysts: The most common type, formed during ovulation and usually resolving spontaneously.
- Corpus luteum cyst: Develops after ovulation and may occasionally bleed or cause discomfort.
- Dermoid cyst: Contains tissues such as hair, skin, or fat. These benign cysts often require surgical removal if large.
- Endometrioma: Also known as a “chocolate cyst,” caused by endometriosis and associated with pelvic pain and infertility.
- Cystadenoma: Benign cysts arising from the ovarian surface that may become quite large.
- Hemorrhagic cyst: Occurs when bleeding develops within a cyst, sometimes causing sudden pelvic pain.
- Polycystic ovaries: Multiple small follicles seen in polycystic ovary syndrome (PCOS). These are not true ovarian cysts.
What Symptoms Can Ovarian Cysts Cause?
Many ovarian cysts produce no symptoms and are discovered during routine pelvic examinations or imaging performed for unrelated reasons.
When symptoms occur, they may include:
- Pelvic pain or pressure.
- Abdominal bloating or fullness.
- Pain during sexual intercourse (dyspareunia).
- Changes in menstrual patterns.
- Frequent urination if the cyst presses on the bladder.
Sudden, severe pelvic pain accompanied by nausea or vomiting may indicate ovarian torsion (twisting of the ovary) or cyst rupture. These are medical emergencies requiring immediate assessment.
How Are Ovarian Cysts Diagnosed?
Evaluation begins with a thorough medical history and pelvic examination.
Diagnostic tests may include:
- Pelvic ultrasound: The primary imaging test used to determine the cyst’s size, appearance, and internal characteristics.
- MRI: Helpful when ultrasound findings are unclear or complex.
- Tumor markers: Blood tests such as CA-125 may be recommended in selected women, particularly those who are postmenopausal or have suspicious imaging findings.
These investigations help determine whether a cyst is likely benign or requires further treatment.
When Can We Simply Observe?
Many ovarian cysts do not require immediate treatment.
Observation is appropriate for:
- Simple, fluid-filled cysts with a benign appearance.
- Small cysts causing minimal or no symptoms.
- Functional cysts that are expected to resolve naturally.
Your doctor may recommend repeat ultrasound examinations after several weeks or months to confirm that the cyst has disappeared or remained stable.
When Should We Be Concerned?
Certain findings increase the likelihood that a cyst requires specialist evaluation:
- Large ovarian cysts.
- Complex ultrasound features such as solid components or multiple septations.
- Persistent growth on follow-up scans.
- Ovarian cysts occurring after menopause.
- Elevated tumour marker levels.
- A strong family history of ovarian or breast cancer.
- Imaging findings suspicious for malignancy.
These situations do not necessarily mean cancer is present, but they warrant prompt assessment by a gynaecologist.
When Is Surgery Needed?
Surgery may be recommended if the cyst:
- Causes persistent pain or significant symptoms.
- Continues to enlarge over time.
- Causes ovarian torsion.
- Ruptures and leads to significant bleeding or complications.
- Appears suspicious for ovarian cancer.
The decision to operate depends on the patient’s age, symptoms, cyst characteristics, and reproductive plans.
Surgical Options
The choice of surgery depends on the nature of the cyst.
- Laparoscopic cystectomy: Minimally invasive removal of the cyst while preserving healthy ovarian tissue whenever possible.
- Oophorectomy: Removal of the affected ovary when necessary, particularly if malignancy is suspected or the ovary cannot be preserved.
- Fertility preservation: In younger women, surgeons aim to preserve ovarian function whenever it is safe.
- Referral to a gynaecological oncologist: Recommended whenever ovarian cancer is suspected, as specialist surgery improves outcomes.
Most ovarian cysts are harmless and require only observation. Regular follow-up, appropriate imaging, and timely specialist assessment help identify the small number of cysts that need treatment. Seeking medical advice for persistent pelvic pain, increasing abdominal swelling, or sudden severe pain allows prompt diagnosis and ensures the best possible outcome.
References
- Mobeen, Sadia, and Radu Apostol. “Ovarian cyst.” (2020).
- Farghaly, S. A. “Current diagnosis and management of ovarian cysts.” Clin Exp Obstet Gynecol 41.6 (2014): 609-12.
- Knudsen, Ulla Breth, et al. “Management of ovarian cysts.” Acta obstetricia et gynecologica Scandinavica 83.11 (2004): 1012-1021.
- Cheng, Yvonne, and Society for Maternal-Fetal Medicine (SMFM. “Ovarian cysts.” American journal of obstetrics and gynecology 225.5 (2021): B23-B25.
- Zahidy, Al, and Zina Abdulkareem. “Causes and management of ovarian cysts.” The Egyptian Journal of Hospital Medicine 70.10 (2018): 1818-1822.
