Ovarian cysts

What are Ovarian Cysts?
Ovarian cysts are common fluid-filled sacs or pockets that develop within or on the surface of an ovary.

The vast majority of women will experience them at some point during their reproductive years. Most cysts present are entirely harmless, cause no discomfort whatsoever, and naturally disappear without medical treatment within a few months.

Symptoms

Most cysts go completely unnoticed and are only discovered during routine pelvic exams. However, if a cyst grows unusually large or ruptures, symptoms may include:

• Pelvic Pain: A dull, heavy ache or a sudden, sharp pain in the lower abdomen on the side of the cyst. Pain may also radiate to the lower back or thighs.
• Menstrual Irregularities: Severe pain shortly before your period begins or just after it ends.
• Dyspareunia: Pain experienced during sexual intercourse.
• Bowel/Bladder Issues: Pain during bowel movements or a frequent, urgent need to urinate (caused if a large cyst presses physically against the bladder).
• Fullness: A persistent feeling of fullness, pressure, or heaviness in the abdomen.

⚠️ EMERGENCY WARNING
Seek immediate emergency medical help if you experience sudden, severe abdominal or pelvic pain accompanied by:

• Fever and recurrent vomiting.
• Cold, clammy skin.
• Rapid breathing, dizziness, or weakness.

This could indicate Ovarian Torsion (a dangerous twisting of the ovary) or a severely Ruptured Cyst causing internal bleeding.

When to See a Doctor

If you experience persistent pelvic pain, bloating, or unusual changes in your menstrual cycle, you should schedule an appointment with your gynecologist. It is especially critical for postmenopausal women to seek prompt medical evaluation for any new pelvic symptoms, as the risk of a cyst being cancerous increases significantly after menopause.

Types & Causes

Most cysts naturally develop as a normal, functional result of your monthly menstrual cycle (Functional Cysts). Others are abnormal and unrelated to normal reproductive function.

1. Functional Cysts (Normal)

• Follicular Cyst: Occurs when the follicle (the tiny sac holding the maturing egg) fails to break open and release the egg during ovulation. Instead, it continues to grow and fill with fluid.
• Corpus Luteum Cyst: Occurs when the follicle successfully releases the egg, but the opening accidentally reseals itself, causing fluid to rapidly accumulate inside.

These functional cysts are almost always harmless, rarely cause pain, and usually disappear on their own within two to three menstrual cycles.

2. Other Cysts (Pathological)

• Dermoid Cysts (Teratomas): Form from embryonic cells and can bizarrely contain tissue such as hair, skin, or even teeth. They are rarely cancerous but can grow quite large.
• Cystadenomas: These develop on the surface of the ovary and are typically filled with a watery or mucous-like material.
• Endometriomas: Caused by a condition called endometriosis, where uterine-lining tissue grows outside the uterus and attaches to the ovary, forming a painful cyst.

Complications

• Ovarian Torsion: Very large cysts can cause the ovary to shift out of its usual position and twist. This painful complication cuts off the blood supply to the ovary, leading to tissue death if not treated surgically right away.
• Rupture: A cyst that bursts open can cause sudden, agonizing pain and dangerous internal bleeding in the pelvis.

Diagnosis

If a cyst is suspected during a routine bimanual pelvic exam, doctors will use specific diagnostic tools to investigate further:

• Transvaginal Ultrasound: The primary tool used to determine the cyst's exact size, location, shape, and composition (whether it is fluid-filled, solid, or mixed).
• Pregnancy Test: Used to immediately rule out pregnancy (as a corpus luteum cyst is a normal and common occurrence in early pregnancy).
• CA 125 Blood Test: Measures blood levels of a protein often elevated in ovarian cancer. This is typically only ordered if the cyst appears solid on an ultrasound or if the patient is past menopause.

Treatment

Treatment is highly individualized and depends heavily on your age, the severity of your symptoms, and the physical characteristics of the cyst.

1. Watchful Waiting

If you have no symptoms, are premenopausal, and the ultrasound shows a small, simple, fluid-filled cyst, doctors almost always recommend "watchful waiting." You will likely have a follow-up ultrasound in 1 to 3 months to see if the cyst has resolved on its own.

2. Medications

Birth Control Pills: Hormonal contraceptives prevent ovulation, which effectively stops new functional cysts from forming. Note: While they prevent future cysts, birth control pills will not shrink existing cysts.

3. Surgery

Surgical intervention is usually recommended if the cyst is:

• Unusually large or continuing to grow.
• Causing severe, persistent pain.
• Appears solid or complex on an ultrasound (not just simple fluid).
• Persisting through 2 to 3 menstrual cycles without shrinking.

Cystectomy: A minimally invasive procedure (laparoscopy) to carefully remove only the cyst, leaving the healthy ovary completely intact.
Oophorectomy: If the ovary is severely damaged or the cyst is too large, the surgeon may need to remove the entire affected ovary.

Frequently Asked Questions (FAQs)

Can ovarian cysts make it harder to get pregnant?

Most common functional cysts do not affect your fertility. However, if your cysts are caused by an underlying condition like Polycystic Ovary Syndrome (PCOS) or Endometriosis, those specific conditions can make it more difficult to become pregnant.

Are ovarian cysts a sign of cancer?

The vast majority of ovarian cysts are completely benign (non-cancerous), especially in premenopausal women. Cysts that develop after menopause carry a higher risk of being cancerous, which is why regular monitoring is crucial for older women.

References

• American College of Obstetricians and Gynecologists (ACOG)
• Office on Women's Health (OWH) - Ovarian Cysts
• Mayo Clinic - Ovarian Cysts Overview