Most ovarian cysts cause no symptoms at all and are discovered by accident during an ultrasound or pelvic exam for something else entirely. Around 7% of women experience a symptomatic cyst at some point, but the actual prevalence is much higher: roughly 8% of premenopausal women have a significant cyst at any given time, and the rate in postmenopausal women is surprisingly even higher, between 14% and 18%. So the short answer is that you often don’t know you have one unless it grows large enough to cause problems or shows up on imaging.
That said, there are specific signs your body gives you when a cyst is making its presence felt, and knowing what to look for can help you figure out whether that pelvic discomfort is worth bringing up with your doctor.
The Most Common Symptoms
The hallmark sign of an ovarian cyst is pelvic pain on one side, typically below your bellybutton and slightly left or right. It can feel like a dull ache that lingers for days or a sharper pain that comes and goes. Some people notice the pain more around ovulation or just before their period, since that’s when functional cysts (the most common type) are most active.
Beyond the one-sided pain, you might experience bloating or a feeling of fullness in your lower abdomen, especially if the cyst has grown. Pressure on your bladder can make you feel like you need to pee more often. Some women notice pain during sex, particularly with deep penetration. Irregular periods or unusually heavy bleeding can also be a clue, though these symptoms overlap with many other conditions.
The tricky part is that most functional cysts are completely painless. They form as a normal part of your menstrual cycle, either when a follicle doesn’t release its egg or after ovulation when the empty follicle fills with fluid. These typically disappear on their own within two to three menstrual cycles without you ever knowing they were there.
Types of Cysts and How They Feel Different
Not all ovarian cysts behave the same way, and the type you have affects what you’re likely to feel.
Follicular cysts are the most common. They’re filled with clear fluid, have a thin wall, and very little blood supply. Because of this, they rarely cause significant pain and tend to resolve quietly on their own.
Corpus luteum cysts form after ovulation, when the follicle transforms into a structure that pumps out progesterone to prepare for pregnancy. These cysts have a rich blood supply, which means they’re more likely to cause trouble. If one gets bumped or jostled, it can bleed internally, grow rapidly, and hurt.
Dermoid cysts are made from egg cell tissue and can contain unexpected material like hair, teeth, or other body tissues. They look distinctive on ultrasound and don’t resolve on their own.
Endometriomas are cysts that form as part of endometriosis. They’re filled with old, dark blood (sometimes called “chocolate cysts”) and tend to cause more persistent symptoms: pelvic pain that happens at any time and not just during your period, painful sex, pain while urinating or having a bowel movement, and back pain. If your pelvic pain is constant rather than cyclical, and especially if it comes with painful periods and pain during sex, an endometrioma is worth considering.
Warning Signs That Need Immediate Attention
Two complications turn an ovarian cyst into an emergency: rupture and torsion.
A ruptured cyst bursts open and can cause sudden, severe pelvic pain along with internal bleeding. The pain often hits all at once and feels very different from the gradual ache of a growing cyst. You might feel dizzy, lightheaded, or faint if the bleeding is significant.
Ovarian torsion happens when a large cyst causes the ovary to twist on itself, cutting off its blood supply. This produces sudden, intense pelvic pain along with nausea and vomiting. Torsion is a surgical emergency because the ovary can be permanently damaged if blood flow isn’t restored quickly.
If you experience sudden, severe abdominal or pelvic pain, especially with vomiting, dizziness, or feeling faint, get emergency medical care.
How Ovarian Cysts Are Diagnosed
You can’t diagnose an ovarian cyst based on symptoms alone. The symptoms overlap too much with other conditions like endometriosis, fibroids, ectopic pregnancy, and even appendicitis. Imaging is what confirms the diagnosis.
A pelvic ultrasound is the primary tool. A small wand-shaped device uses sound waves to create an image of your uterus and ovaries. The ultrasound reveals whether a cyst is present, where exactly it sits, how large it is, and, critically, whether it’s filled with fluid or solid. Fluid-filled cysts are almost always benign. Solid masses raise more concern, particularly after menopause.
Your doctor uses the ultrasound appearance and your age to decide next steps. For premenopausal women, cysts 5 centimeters or smaller (about the size of a golf ball) with a simple, fluid-filled appearance generally need no further testing. Cysts between 5 and 7 centimeters are usually monitored with yearly follow-up imaging. Anything larger than 7 centimeters may require an MRI or surgical evaluation.
The thresholds shift after menopause. Cysts smaller than 1 centimeter can be left alone. Simple cysts up to 7 centimeters get yearly re-imaging. Larger ones call for further workup.
When Blood Tests Come Into Play
If a cyst looks solid on ultrasound or you have risk factors for ovarian cancer, your doctor may order a CA-125 blood test. This measures a protein that’s sometimes elevated in ovarian cancer. But the test has real limitations. CA-125 levels can be raised by endometriosis, pelvic inflammatory disease, uterine fibroids, liver disease, your menstrual period, or pregnancy. A high result doesn’t mean cancer, and a normal result doesn’t rule it out, since levels can be low in early-stage cancer. CA-125 is most useful for monitoring known ovarian cancer or evaluating a suspicious-looking mass, not as a general screening tool.
In rare cases when imaging is inconclusive, a laparoscopy may be performed. A thin, lighted camera is inserted through a small incision in your abdomen, giving your doctor a direct view of your ovaries and any cyst. This is both a diagnostic and a treatment tool, since a cyst can be removed during the same procedure.
Why Many Cysts Go Unnoticed
If you’re reading this because you’re wondering whether vague pelvic discomfort might be a cyst, know that the most common outcome is reassuring. The majority of ovarian cysts are functional, meaning they formed as a normal byproduct of ovulation. They appear, hang around for a cycle or two, and dissolve. Many women develop these cysts regularly throughout their reproductive years without ever having symptoms.
Cysts are often discovered during imaging ordered for completely unrelated reasons, like an abdominal CT scan after an injury or an ultrasound during early pregnancy. These incidental findings can be alarming, but a simple, fluid-filled cyst in a premenopausal woman is almost never dangerous. Your doctor will base any follow-up plan on the cyst’s size, appearance, and whether you’ve gone through menopause, not just the fact that it exists.