Ovarian Cysts: Types, Symptoms, Diagnosis, and Treatment Options

Ovarian cysts are fluid-filled sacs that develop on or within the ovaries. They are extremely common—most women develop at least one during their reproductive years. The vast majority are benign, functional cysts that resolve spontaneously. However, some require monitoring or intervention.

Types of Ovarian Cysts

Functional Cysts (Most Common, Usually Benign)

• Follicular cyst: Forms when a follicle fails to rupture and release an egg; continues growing. Typically resolves in 1–3 cycles.
• Corpus luteum cyst: Forms after ovulation when the follicle reseals and accumulates fluid. May cause pain or bleeding; usually resolves spontaneously.

Pathologic Cysts (May Require Treatment)

• Dermoid cyst (mature cystic teratoma): Contains tissue like hair, skin, teeth; usually benign but can torsion.
• Endometrioma: "Chocolate cyst" from endometriosis; filled with old blood.
• Cystadenoma: Serous or mucinous epithelial tumors; can grow large.
• Malignant cysts: Ovarian cancer (rare, <1% of cysts); risk increases with age, complex features, solid components, elevated CA-125.

Symptoms

Many cysts are asymptomatic. When present, symptoms may include:

• Pelvic pain (dull/aching or sharp/sudden if rupture/torsion)
• Bloating, abdominal fullness/heaviness
• Pain during intercourse (dyspareunia)
• Irregular menstrual cycles, abnormal bleeding
• Urinary frequency/urgency or difficulty emptying bladder
• Bowel pressure, constipation
• Nausea/vomiting (especially with torsion)

Diagnosis

• Transvaginal ultrasound – first-line; assesses size, composition (simple vs. complex), vascularity
• CA-125 blood test – elevated in endometriosis, PID, malignancy; not specific
• MRI/CT – for complex or indeterminate ultrasound findings
• Pregnancy test – rule out ectopic pregnancy

Treatment

• Watchful waiting: Simple cysts <5 cm in premenopausal women—repeat ultrasound in 6–12 weeks
• Hormonal contraception: Combined OCPs prevent new functional cysts; don't shrink existing ones
• Surgery (laparoscopy preferred):
  • Cystectomy (cyst removal) for benign, symptomatic, or growing cysts
  • Oophorectomy (ovary removal) if malignancy suspected, torsion with necrosis, or in postmenopausal women with complex cysts
• Emergency surgery: Ovarian torsion (sudden severe pain, nausea) – time-sensitive to preserve ovary

When to Seek Care

Sudden severe pelvic pain, fever with vomiting, signs of shock (lightheadedness, rapid breathing)—possible rupture or torsion requiring emergency evaluation.