Ovarian cysts are common fluid-filled sacs that can develop on or within an ovary. Most are harmless and frequently resolve without intervention. Many individuals with ovaries will experience at least one cyst during their reproductive years, often without even realizing it. These growths are not typically associated with serious health issues.
What Are Ovarian Cysts?
An ovarian cyst is a sac, usually filled with fluid, that forms in an ovary or on its surface. The ovaries are two small, almond-shaped organs located in the pelvis, responsible for producing eggs and hormones. Cysts often arise as a normal part of the menstrual cycle, reflecting the ovaries’ regular function. Each month, small structures called follicles grow on the ovaries, each containing an immature egg. These follicles produce hormones and release an egg during ovulation. If a follicle does not rupture to release its egg, it can continue to grow and fill with fluid, forming a cyst.
Different Kinds of Ovarian Cysts
Ovarian cysts broadly fall into two categories: functional cysts, the most common, and other less frequent types. Functional cysts are a direct result of the normal menstrual cycle, including follicular and corpus luteum cysts. Follicular cysts form when a follicle does not rupture to release an egg, continuing to grow instead. Corpus luteum cysts develop after an egg has been released, but the follicle opening seals, causing fluid to accumulate. These functional cysts are usually benign and often resolve on their own within a few menstrual cycles.
Beyond functional cysts, other types can develop. Dermoid cysts, also known as teratomas, originate from reproductive cells and can contain various tissues such as hair, skin, or teeth. While they can grow large and potentially twist the ovary, they are rarely cancerous. Endometriomas, often called “chocolate cysts,” occur in individuals with endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus. These cysts are filled with old, dark blood and can indicate a more severe stage of endometriosis. Cystadenomas are cysts that arise from cells on the surface of the ovary and can be filled with watery or mucous material, sometimes growing to a considerable size.
While most ovarian cysts are non-cancerous, a small number can be malignant, with a slightly higher risk after menopause. Concerns about malignancy are evaluated through specific diagnostic methods.
Recognizing Symptoms and When to Seek Medical Advice
Many ovarian cysts do not cause any symptoms and are discovered incidentally during a pelvic examination or imaging for another reason. However, when symptoms do occur, they can include:
Pelvic pain (dull ache or sharp)
Feeling of fullness, pressure, or bloating in the abdomen
Irregular periods
Pain during intercourse
Pain in the lower back or thighs
Difficulty emptying bladder or bowels
Frequent need to urinate
Seek immediate medical attention if symptoms are sudden or severe, such as sudden, severe abdominal or pelvic pain accompanied by fever, vomiting, dizziness, or rapid breathing. These signs could indicate a ruptured cyst, which can cause internal bleeding, or ovarian torsion, where the ovary twists, potentially cutting off its blood supply. Prompt evaluation is required to prevent serious complications.
How Ovarian Cysts are Diagnosed and Managed
Diagnosis often begins with a physical examination, where a healthcare provider might feel swelling on an ovary. Imaging tests are then used to confirm the presence of a cyst and assess its characteristics. A pelvic ultrasound is the most common diagnostic tool, using sound waves to create images of the pelvic organs and determine the cyst’s size, location, and whether it is fluid-filled or solid. For more detailed evaluation, an MRI or CT scan may be recommended if a cyst is large or complex. Blood tests, such as a CA-125 test, might be performed if there is a concern about malignancy, though elevated CA-125 levels can also occur in non-cancerous conditions.
Management of ovarian cysts varies widely, depending on the cyst’s type, size, symptoms, and the individual’s age and health status. For many functional cysts, a “watchful waiting” approach is common, involving monitoring the cyst with follow-up ultrasounds to see if it resolves on its own. This is often the first step. Hormonal contraceptives, like birth control pills, may be prescribed to prevent the formation of new cysts, although they do not shrink existing ones.
Surgical removal of a cyst may be necessary if it is large, causing persistent symptoms, growing, or if there are concerns about malignancy. Surgery can be performed using minimally invasive laparoscopy, involving small incisions, or a laparotomy, which requires a larger incision for bigger or suspicious cysts. In some cases, only the cyst is removed (cystectomy), while in others, the entire ovary might need to be removed (oophorectomy). The decision for surgery is individualized, aiming to balance symptom relief with preserving ovarian function.