Ovarian Cyst

An ovarian cyst is a fluid-filled sac on or in an ovary. In women who still have periods, most are functional cysts formed as part of the normal cycle, and they disappear on their own within two or three cycles. Other benign types include dermoid cysts, endometriomas and cystadenomas.

The great majority are harmless and need no more than a repeat scan. Treatment is needed when a cyst is large, persistent, painful, twisted or ruptured, or when its ultrasound appearance raises any concern about cancer, which becomes a more important consideration after menopause.

Symptoms

• No symptoms in most cases, found on a scan
• A dull ache or pressure low in the abdomen on one side
• Bloating or a feeling of fullness
• Pain during sex
• Needing to pass urine more often or difficulty emptying the bowels
• Irregular periods with some hormone-producing cysts
• Sudden sharp pain if a cyst bursts, bleeds or twists

Causes and risk factors

Follicular cysts form when the follicle fails to release its egg and continues to swell. Corpus luteum cysts form after ovulation and can bleed into themselves. Fertility drugs increase the number of functional cysts. Dermoid cysts arise from egg cells and contain hair, fat and sometimes teeth. Endometriomas come from endometriosis. Cystadenomas grow from the surface of the ovary and can become very large. Polycystic ovaries are a different matter: many tiny follicles related to a hormonal condition, not true cysts. Ovarian cancer risk rises with age, family history and BRCA gene mutations.

How it is diagnosed

• Pelvic examination: May detect a larger cyst, but most are too small to feel.
• Transvaginal ultrasound: The central test. Size, walls, internal divisions, solid areas and blood flow are described using systems such as the IOTA rules or O-RADS, which sort cysts into benign, indeterminate and suspicious.
• Pregnancy test: Done in anyone of reproductive age with pelvic pain to exclude ectopic pregnancy.
• CA-125 and other tumour markers: Helpful after menopause or when the scan is worrying. In younger women CA-125 is often raised by endometriosis, fibroids or periods, so it is used selectively.
• MRI: Clarifies indeterminate cysts and distinguishes dermoids, endometriomas and fibroids.

Treatment options

• Watchful waiting: Simple cysts under about 5 cm in premenopausal women need no follow-up. Those of 5 to 7 cm are rescanned, often yearly, and most resolve.
• Pain relief: Simple analgesia while a functional or haemorrhagic cyst settles over a few weeks.
• Hormonal contraception: Prevents new functional cysts from forming but does not shrink one that already exists.
• Laparoscopic cystectomy: Keyhole removal of the cyst while preserving the ovary, for persistent, large, symptomatic, dermoid or endometriotic cysts. Usually a day case or one night.
• Oophorectomy: Removal of the ovary, with the tube, when the cyst has replaced the ovary, after menopause, or when cancer is suspected.
• Referral to gynaecological oncology: For suspicious cysts, so that a proper staging operation can be done in one sitting without spilling the contents.

When it is urgent

Go to a local emergency department for sudden severe pain low on one side, particularly with nausea and vomiting, which can mean the ovary has twisted and needs surgery within hours to save it. Also for pelvic pain with fainting, dizziness, shoulder-tip pain or a positive pregnancy test, or for pain with fever.

Travelling to Türkiye for treatment

A planned laparoscopic cystectomy for a persistent benign cyst fits a visit of about 5 to 7 days, with ultrasound and blood tests first and pathology results following within a week or so. Bring previous scan reports, as a cyst that has already shrunk may not need surgery at all. Cysts suspicious for cancer need a specialist cancer team and continuity of care, which is better arranged in one place, usually at home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions