Ovarian Cysts

An ovarian cyst is a small sac that forms on or in your ovaries. It’s filled with fluid or other semisolid material. Most don’t cause pain and aren’t cancer. You likely won’t know you have a cyst on your ovary unless a healthcare provider finds it during a pelvic exam or ultrasound. Ovarian cysts are extremely common, especially before menopause. They usually don’t cause serious problems.

Types of ovarian cysts

Most ovarian cysts are functional cysts. They form as a result of natural changes during your menstrual cycle. Less commonly, a cyst forms on your ovary for other reasons.

Functional ovarian cysts

Functional cysts are the most common type. They happen because of ovulation. These cysts generally shrink within a few months without treatment. Functional cysts are sometimes called simple cysts. They include:

• Follicular cysts: Each month, an egg grows inside a small sac called a follicle. During ovulation, the follicle releases the egg. A follicular cyst forms when the follicle doesn’t release the egg and keeps growing.
• Corpus luteum cysts: After the follicle releases an egg, it becomes a structure called the corpus luteum. If pregnancy doesn’t happen, the corpus luteum dissolves. But sometimes, it fills with fluid instead and forms a cyst.

Other ovarian cysts

Not all ovarian cysts are related to your menstrual cycle. They aren’t always signs of disease, but your provider may want to monitor them. Other types include:

• Cystadenomas: These cysts form on the surface of your ovary. They may contain a thin, watery fluid or a thicker, mucus-like fluid.
• Dermoid cysts (teratomas): These cysts contain cells like those found in your hair, teeth or skin. They’re smooth, rubbery and noncancerous.
• Endometriomas: These cysts can be filled with blood and are typically a sign of endometriosis.
• Ovarian cancer cysts: Unlike the conditions above, these growths may contain cancer cells.

Symptoms of ovarian cysts

Some smaller cysts don’t cause any symptoms. In these cases, you may not even know you have one. Larger cysts may cause:

• Pelvic pain or a dull ache in your back
• A feeling of fullness in your lower belly (it may be focused on just one side)
• Pain during sex
• Painful periods and/or irregular periods
• Trouble pooping or needing to pee frequently

What does the pain feel like?

Having a cyst on your ovary feels different for everyone. You may feel:

• No pain at all
• Mild discomfort or a feeling of fullness
• Pain that could be described as sharp or like a dull ache
• Discomfort or pain that comes and goes without explanation
• Pain during certain parts of your menstrual cycle

Ovarian cyst causes

Ovulation is the main reason you may get a cyst on your ovary. It’s a natural process that happens during your menstrual cycle. Other causes include:

• Abnormal cell reproduction: Unusual cell reproduction can cause dermoid cysts or cystadenomas to form.
• Endometriosis: Endometriomas (or chocolate cysts) often form on your ovary if you have severe endometriosis.
• Polyendocrine metabolic ovarian syndrome (PMOS): PMOS can cause multiple small cysts to form on your ovaries. This was formerly known as PCOS.
• Pelvic inflammatory disease (PID): Severe pelvic infections can spread to your ovaries, causing cysts.

Risk factors

Anyone with ovaries can get an ovarian cyst. Your chances increase based on your:

• Age: Ovarian cysts are more common if you haven’t gone through menopause.
• Pregnancy status: Cysts are more likely to form and remain during pregnancy.
• History of ovarian cysts: You’re more likely to have an ovarian cyst if you’ve had one before.
• Current medical conditions: You’re more likely to get an ovarian cyst if you have endometriosis, PMOS or another hormone disorder.
• Fertility medication: You’re more likely to get a cyst if you’re taking medications like clomiphene (Clomid­­®) to help with ovulation.

Complications of ovarian cysts

Most ovarian cysts don’t cause problems. Your provider can tell you if they think a cyst may cause issues. Some possible complications include:

• Cancer: Ovarian cysts that develop after menopause are more likely to be cancerous than cysts that form before menopause.
• Ruptured ovarian cyst: Some cysts can break open. Many don’t cause symptoms, but a ruptured cyst can sometimes cause severe pain, dizziness or weakness. Larger cysts are more likely to break open.
• Ovarian torsion: A large cyst can make an ovary twist. This can cut off blood flow to the ovary. Symptoms include sudden, severe pain, nausea and vomiting.

Get medical care right away if you have symptoms of a ruptured ovarian cyst or ovarian torsion.

How doctors diagnose an ovarian cyst

Your healthcare provider may first do a pregnancy test to see if pregnancy is causing your symptoms. They may also use the following tests to find an ovarian cyst:

• A pelvic exam: Your provider will feel inside your pelvis for any lumps or changes.
• Ultrasound: This imaging procedure can detect cysts on your ovaries, including where they are and if they’re filled with fluid.
• Laparoscopy: Your provider makes a small cut in your abdomen and inserts a tiny camera. This lets them look at your ovaries and other organs in your pelvis. They may remove the cyst during the procedure.

How is it treated?

Treatment depends on your symptoms, the type of cyst and what’s causing it. Your age and whether you’ve reached menopause also play a role.

Watchful waiting

Many functional ovarian cysts go away on their own. If your cyst is likely functional, your provider may recommend monitoring it. You may have another ultrasound a few weeks or months later to see if the cyst has changed. This is often the first treatment used because most ovarian cysts are small and aren't cancer.

Ovarian cyst medications

Your provider may prescribe hormone medications like birth control pills. These medicines will stop ovulation. Once ovulation stops, some cysts won’t grow or come back.

Ovarian cyst surgery

If a cyst is causing symptoms and getting bigger, you may need surgery to remove it. The type of surgery depends on the size of the cyst and how it looks on the ultrasound. Options may include:

• Ovarian cystectomy: This surgery removes the cyst through small cuts in your belly.
• Laparotomy: This surgery involves making a larger cut in your belly. Your provider may recommend this when the cyst is very large or if there are other concerns.

When does an ovarian cyst need to be removed?

Your provider may want to remove a cyst based on a few factors:

• Size of the cyst: Larger cysts are more likely to cause pain or discomfort. Your doctor may recommend removing a cyst larger than 10 centimeters.
• Symptoms: Your provider may recommend removal if the cyst causes you pain or makes it hard to get pregnant.
• Risk of cancer: Your provider may want to remove a cyst if there’s any concern that it’s cancerous, especially if you’re at a higher risk for ovarian cancer.
• Type of cyst: Functional cysts tend to stay small and go away after a few menstrual cycles. Other types of cysts get larger and don’t go away on their own. This means your provider is more likely to recommend removing them.

Your provider will also consider factors, like your age, health history and if you wish to get pregnant. Ask your provider any questions you have about removing an ovarian cyst.

What can happen if a cyst is left untreated?

It depends on the type and the cause. Some ovarian cysts don’t need treatment and go away on their own. Others need treatment or immediate removal. You should discuss all the treatment options with your healthcare provider and see what they recommend.

When should I see my healthcare provider?

Call your healthcare provider if any of the following occur:

• Your periods are late, irregular or painful.
• Your abdominal pain doesn’t go away.
• Your belly becomes enlarged or swollen.
• You have pain during sex.
• You have feelings of fullness (bloating), pressure or discomfort in your belly.

Get help immediately if you notice signs of ovarian torsion or ovarian cyst rupture:

• Severe abdominal pain that comes on suddenly, accompanied by vomiting or fever
• Feeling light-headed or faint and breathing rapidly
• Cold, clammy skin

What can I expect if I have an ovarian cyst?

Most ovarian cysts are harmless, and often eventually go away on their own within a few months. You may need follow-up appointments with your provider to make sure a cyst isn’t growing or causing symptoms. Cysts that cause symptoms or that keep growing bigger require closer monitoring than others. Your provider may suggest watchful waiting, prescribe medications or recommend a mixture of both. For more concerning cysts, you may need surgery. Some types of cysts are more likely to become cancerous or cause complications, but this is rare.