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What are ovarian cysts?
Cysts are fluid-filled sacs that can appear on or in any area of the body. Follicles are normal fluid-filled cysts that the ovary makes every month.
Follicles grow during every menstrual cycle. One of them survives and releases an egg. The others shrink and disappear. Having a cyst can be a normal part of the menstrual cycle.
Most ovarian cysts do not cause any symptoms and eventually go away on their own. Often a doctor first notices them while doing an ultrasound or CT scan for a different issue. Your doctor may decide to monitor the cyst to see if it goes away or changes over time.
What does it feel like when you have a cyst on your ovary?
Symptoms vary from no signs to very severe ones. Many patients do not even know they have a cyst. Others may notice pelvic pressure or pain (especially if the cyst is large).
When someone has an ovarian cyst, there is a higher risk for ovarian torsion. So they should make sure to seek emergency care if they develop severe sudden onset, lower abdominal, or pelvic pain. Untwisting the ovary can restore the blood flow to the ovary. However, it has to happen as soon as possible. Ideally, within hours of the onset of pain. Waiting days before seeking care can lead to minimal or no blood flow for a long period. It can result in the death of that ovary. —Dr. Eduardo Hariton
Ovarian cyst symptoms
If you are experiencing any of the following, make an appointment with your primary doctor or gynecologist to check whether you may have an ovarian cyst.
- Mild pain in the lower abdomen on the side of the cyst
- Lower abdominal or pelvic pressure
Sometimes the cysts rupture, releasing clear fluid or blood into the abdomen. It can cause mild to severe lower abdominal pain.
At times, the cyst causes the ovary to twist, reducing or cutting off blood flow to the ovary. This is called ovarian torsion. It is a surgical emergency.
If you are experiencing any of the following, go to the ER or call 911.
- Severe lower abdominal/pelvic pain that starts suddenly. You may also have nausea and vomiting. This may be a sign of ovarian torsion or internal bleeding from a ruptured hemorrhagic cyst. (A cyst that is bleeding into the abdomen.)
- Very heavy vaginal bleeding—needing more than one sanitary pad per hour. It's not usually caused by cysts. You need immediate medical attention.
What causes ovarian cysts?
Ovarian cysts often form as part of the menstrual cycle. Though it is not known why some people are more likely to have cysts than others.
Functional ovarian cysts develop when a follicle grows and releases an egg. The first is a follicular cyst. The other is a corpus luteum cyst. They generally disappear on their own with no or little pain.
Many other types of ovarian cysts form on the ovary. Some examples: An endometrioma is associated with endometriosis. A dermoid cyst is a benign ovarian growth. It can contain different types of cells, such as hair, teeth, and fat.
These cysts do not have anything to do with your period. In some cases, depending on the size of the cysts, your doctor may want to remove them.
When should I be concerned about ovarian cysts?
When a doctor suspects an ovarian cyst, they will usually do a pelvic exam and an ultrasound. In some cases, they'll suggest a CT scan or an MRI.
For postmenopausal women, a doctor may order some blood tests, such as a CA-125 (a marker of ovarian cancer). Imaging studies and labs help determine the size of the cyst, what kind of cyst it is, and the best treatment.
Being diagnosed with an ovarian cyst can be scary. You may not know if you have cancer until after the cyst—and often, the whole ovary—is removed and examined under the microscope. It is normal to be scared, but make sure you talk to your doctor about how you feel as these cysts are almost always benign. Just discussing your concerns with your doctor may put you at ease. —Dr. Hariton
Ovarian cyst treatment
An important question to ask your doctor about this illness is What type of cyst do I have, and do you recommend watching it or removing it? What are the reasons why you would choose to remove it, and what are the risks of damage to the rest of the ovary? You always want to understand why your physician is recommending a specific option to make sure his or her values and decision is aligned with your values and goals. —Dr. Hariton
The treatment of ovarian cysts depends on many factors. It includes whether the patient is premenopausal or postmenopausal, the size of the cyst, the type of cyst, and any other medical issues.
For some patients, the doctor monitors the cysts. Another imaging study will be done anywhere from 6 weeks to 6 months to evaluate for change. In other patients, the cyst or the entire ovary will be removed and examined under a microscope.
For cysts that are causing only mild pain, your doctor may recommend over-the-counter pain relievers or placing a warm pack on the abdomen.
Your doctor may prescribe hormonal medication to lessen cyst formation, such as birth control pills or a Nexplanon implant. These hormonal medications help prevent ovulation, lowering the risk of cyst formation.
Sometimes, doctors recommend removing the cyst surgically. It can be through small incisions (laparoscopically) or one large incision (abdominal).
Abdominal surgery is usually for large cysts. Or for other reasons like causing constant pain, possibly cancerous, or growing quickly. Also, if infertility is an issue and there's an endometrioma.
You cannot prevent ovarian cysts if you ovulate. Some birth control pills lessen or stop cysts from recurring.
Questions your doctor may ask to determine ovarian cyst
- When was your last menstrual period?
- Have you ever had any surgeries?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Do you currently smoke?
- Is your abdominal pain getting better or worse?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Hariton currently is a fellow physician of reproductive endocrinology and infertiltity at University of Calfornia San Francisco. He's knowledgable in a wide range of OBGYN and fertility topics. Dr. Hariton graduated from Harvard Medical School and Harvard Business School and received awards during his time at Massachusetts General Hospital in Boston.
- SG McNeeley. Benign Ovarian Masses. Merck Manual Professional Version. Revised March 2017. Merck Manuals Professional Version Link
- Levine D, Brown DL, Andreotti RF, Benacerraf B, et al. Management of Asymptomatic Ovarian and Other Adnexal Cysts Imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2006;256(3). Radiology Link
- Pinkerton JV. Polycystic Ovary Syndrome (PCOS). Merck Manual Professional Version. Revised September 2017. Merck Manuals Professional Version Link
- What is Ovarian Cancer? American Cancer Society. Revised April 11, 2018. American Cancer Society Link