Ovarian Cysts: Types, Symptoms, Diagnosis, and Management

Ovarian cysts are fluid-filled sacs on or within the ovary. Most are functional (physiological), benign, and self-resolving. Pathological cysts require evaluation.

Classification

Functional (Physiological)

• Follicular cyst: Follicle fails to rupture; >3 cm. Resolves 1–3 cycles.
• Corpus luteum cyst: Post-ovulation; may hemorrhage (hemorrhagic cyst). Resolves spontaneously.
• Theca lutein cysts: hCG-stimulated (molar pregnancy, ovulation induction); bilateral, multiple.

Neoplastic (Benign > Malignant)

• Mature cystic teratoma (dermoid): Germ cell; contains hair, teeth, sebaceous material. Most common benign neoplasm (20–40 yrs).
• Serous/mucinous cystadenoma: Epithelial; unilocular/multilocular.
• Endometrioma: Endometriosis implant; "chocolate cyst" (old blood).
• Borderline tumors: Low malignant potential.
• Ovarian carcinoma: Epithelial (90%), germ cell, sex cord-stromal. Risk ↑ with age, BRCA, family history.

Symptoms

• Asymptomatic (incidental finding)
• Pelvic pain (dull, sharp, intermittent; unilateral)
• Bloating, fullness, early satiety
• Dyspareunia
• Urinary frequency/retention (mass effect)
• Bowel changes
• Abnormal uterine bleeding (hormonally active tumors)
• Acute abdomen: Rupture, torsion (surgical emergency)

Diagnosis

• Transvaginal ultrasound: First-line; assesses size, morphology (simple vs. complex), vascularity (Doppler).
• IOTA simple rules / ADNEX model: Standardized malignancy risk stratification.
• CA-125: Elevated in endometriosis, PID, menstruation, malignancy; not specific.
• MRI: Problem-solving for indeterminate US.
• Diagnostic laparoscopy: Therapeutic + definitive histology.

Management

• Simple cyst <5 cm (premenopausal), <3 cm (postmenopausal): Follow-up US in 6–12 weeks.
• Persistent/complex/symptomatic: Laparoscopic cystectomy (ovarian preservation) or oophorectomy.
• Endometrioma >4 cm + pain/infertility: Surgery.
• Suspicious for malignancy: Refer to gyn-onc; staging surgery.

Pregnancy Considerations

Corpus luteum cysts common 1st trimester; support pregnancy until placental takeover (~10 wks). Most resolve. Surgery only for torsion, rupture, or suspicion of malignancy (delayed to 2nd trimester if possible).

Prevention

Combined oral contraceptives suppress ovulation → reduce functional cysts. No proven prevention for neoplastic cysts.