Ovarian cyst

An ovarian cyst is a fluid-filled sac that develops in or on an ovary. Most are harmless, cause no symptoms, and resolve on their own without treatment. They are very common, especially during the reproductive years, and are often found incidentally on ultrasound.

Types of ovarian cysts

• Functional cysts — by far the most common. Related to the normal menstrual cycle — follicular cysts (when a follicle doesn't release the egg) or corpus luteum cysts (form after ovulation). Usually resolve within 1-3 cycles.
• Dermoid cysts (teratomas) — contain different tissue types, usually benign
• Endometriomas ("chocolate cysts") — a complication of endometriosis
• Cystadenomas — from the ovary's surface tissue; usually benign
• Polycystic ovary syndrome (PCOS) — multiple small cysts; a separate hormonal condition
• Rarely, ovarian cancer — more likely after menopause

Symptoms

Most cysts cause no symptoms. When they do, they can cause:

• Pelvic or lower abdominal pain — dull ache or pressure, or sharp pain with cyst rupture or torsion
• Bloating
• Irregular periods
• Pain during sex
• Frequent urination (if the cyst presses on the bladder)
• Difficulty conceiving (for some types)

Seek urgent medical care for sudden severe pelvic pain, with or without fever or vomiting — could indicate ovarian torsion (the ovary twisting on its blood supply) or cyst rupture with bleeding. Dial 112.

Diagnosis

Pelvic examination + transvaginal or abdominal ultrasound is the usual starting point. Additional tests depending on the cyst:

• Blood tests (including tumour markers like CA-125 in certain situations)
• MRI for detailed imaging of complex cysts
• Laparoscopy — both diagnostic and potentially therapeutic

Treatment

Depends on the cyst type, size, symptoms, and your age:

• Watchful waiting — most functional cysts resolve on their own within a few months. Follow-up ultrasound confirms.
• Hormonal contraception — may reduce the chance of new functional cysts forming
• Pain relief for symptoms
• Surgery (usually laparoscopic cystectomy) — for large, persistent, complex, or suspicious cysts. The ovary itself is preserved when possible.

Any ovarian cyst in a postmenopausal woman should be investigated thoroughly. Regular pelvic check-ups are a reasonable part of women's health care.