Ovarian Cysts

Introduction

Being told you have an ovarian cyst can feel unsettling, especially if your doctor has mentioned the possibility of surgery. You may be wondering what kind of cyst you have, whether it is dangerous, whether it will affect your ability to have children, and what your real options are.

This guide is written for women who have already had an ovarian cyst found — on an ultrasound done for pelvic pain, during a routine check-up, or while being investigated for something else. The goal is to explain what ovarian cysts are, why they form, how doctors decide whether they need treatment, what each treatment involves, and what life and follow-up usually look like afterwards. Most ovarian cysts are harmless. A smaller number need careful monitoring or treatment, and a few need surgery. Knowing where your cyst sits in that range is the first step in making an informed decision with your gynaecologist.

What Are Ovarian Cysts?

An ovarian cyst is a sac filled with fluid, or sometimes with solid or mixed material, that forms on or inside an ovary. Cysts are very common. Most women who have menstrual cycles develop small cysts at some point, often without ever knowing it. The vast majority are not cancer and do not cause any harm.

Cysts vary widely. Some are only a centimetre or two across and disappear within a few weeks. Others grow larger, persist for months, or have features on imaging that need closer attention. The way a cyst looks on ultrasound, your age, your symptoms, and your menopausal status all influence what your doctor recommends.

Types of Ovarian Cysts

Ovarian cysts are usually grouped into two broad categories: functional cysts, which are part of the normal menstrual cycle, and non-functional cysts, which arise from other causes.

Functional Cysts

These are the most common type and almost always benign (non-cancerous). They form as part of ovulation and usually resolve on their own within one to three menstrual cycles.

• Follicular cysts form when a follicle that was preparing to release an egg does not rupture and instead keeps filling with fluid.
• Corpus luteum cysts form after ovulation when the empty follicle (the corpus luteum) seals over and fills with fluid or a small amount of blood.

Functional cysts usually cause no symptoms. When they do, they may cause a dull ache on one side of the lower abdomen or a change in the menstrual cycle.

Non-Functional Cysts

These do not arise from the normal ovulation process. Most are still benign, but they are less likely to disappear on their own and are more likely to need treatment.

• Dermoid cysts (mature cystic teratomas) are benign growths that can contain a mix of tissues such as skin, hair, or fat. They are most often found in younger women and rarely become cancerous, but they tend to grow over time and can twist the ovary.
• Endometriomas are cysts that form when tissue similar to the lining of the uterus grows on the ovary. They are linked to endometriosis and often contain old, dark blood, which is why they are sometimes called “chocolate cysts.”
• Cystadenomas are benign growths that develop from cells on the outer surface of the ovary. They can be filled with watery fluid (serous) or thicker, mucus-like fluid (mucinous) and can grow quite large.
• Polycystic ovaries are a separate condition (polycystic ovary syndrome, or PCOS) in which the ovaries contain many small follicles. PCOS is a hormonal disorder, not a single cyst that needs removal.
• Borderline and malignant ovarian tumours are uncommon but important to identify. Borderline tumours have some abnormal features but do not invade surrounding tissue in the way cancer does. Malignant tumours are ovarian cancer. Both are far more likely after menopause than in younger women.

Causes and Risk Factors

Most ovarian cysts develop as a normal part of the menstrual cycle and have no clear “cause” in the way that, for example, an infection causes a fever. Several factors can make cysts more likely or more likely to need treatment.

Factors that increase the chance of developing cysts

• Hormonal cycles. Ovulation itself produces functional cysts, so women in their reproductive years develop them most often.
• Endometriosis. Women with endometriosis are more likely to develop endometriomas.
• Pregnancy. A corpus luteum cyst that formed at ovulation may persist into early pregnancy.
• Pelvic infections. Severe pelvic infections can occasionally cause cyst-like collections on or around the ovaries.
• Previous ovarian cysts. Having had a cyst before makes another one more likely, although not inevitable.

Factors that raise the chance a cyst will need treatment

• Large cyst size, particularly above about 5 cm, and especially above 10 cm
• A cyst that grows over time rather than shrinking
• A cyst that persists beyond two or three menstrual cycles
• Severe or worsening pelvic symptoms
• Features on ultrasound suggesting it is not a simple fluid-filled sac — for example, solid areas, thick walls, internal divisions, or increased blood flow
• Cysts found after menopause, when functional cysts no longer form
• A personal or family history of ovarian, breast, or bowel cancer, or a known genetic risk such as a BRCA gene change

Symptoms Ovarian Cysts Can Cause

Many ovarian cysts cause no symptoms at all and are found by chance during a scan done for another reason. When cysts do cause symptoms, the most common ones include:

• A dull ache, pressure, or heaviness in the lower abdomen or pelvis, often on one side
• Bloating or a feeling of fullness
• Pain during or after sex
• Pain around the time of periods, or changes to your menstrual cycle
• Needing to pass urine more often, or difficulty emptying the bladder if a large cyst is pressing on it
• Discomfort with bowel movements

Urgent warning signs

Two complications of ovarian cysts can become medical emergencies. You should seek urgent medical care if you develop:

• Sudden, severe pelvic or abdominal pain, especially on one side, sometimes with nausea or vomiting. This can be a sign of ovarian torsion — the ovary twisting on its blood supply — or of a cyst rupture.
• Severe pain with fever, dizziness, fast heartbeat, or fainting. This may suggest significant internal bleeding or infection.

Ovarian cysts are diagnosed using a combination of history, physical examination, imaging, and sometimes blood tests. The aim is not only to confirm that a cyst is present, but also to estimate whether it is likely to be benign, whether it is causing symptoms, and how it is likely to behave over time.

Medical history and examination

Your doctor will ask about your menstrual cycles, any pain, your reproductive history and plans, prior surgeries, and family history of ovarian or breast cancer. A pelvic examination may detect a mass or tenderness, but small or even moderately sized cysts can easily be missed on examination alone.

Ultrasound

Ultrasound is the main test for ovarian cysts. A transvaginal ultrasound, where a small probe is placed in the vagina, gives the clearest view of the ovaries. A transabdominal ultrasound may be used in addition, particularly for very large cysts. The ultrasound report will describe the cyst's size, whether it is “simple” (a thin-walled sac of clear fluid) or “complex” (containing solid parts, divisions, or unusual features), and whether there is any free fluid in the pelvis.

Many radiologists now use a structured reporting system called O-RADS, developed under the Society of Radiologists in Ultrasound, which categorises cysts by their likelihood of being benign or malignant. This helps standardise decisions about whether to observe, repeat scanning, or refer for specialist opinion.

MRI and CT scans

If the ultrasound is unclear, or if the cyst is large or has suspicious features, an MRI scan can give more detailed information about the tissue inside the cyst. CT scans are used less often for the ovaries themselves but may be ordered if there is concern about cancer spread elsewhere in the abdomen.

Blood tests

Blood tests can help in selected situations. The most commonly used is CA-125, a protein that can be raised in ovarian cancer but also in many benign conditions such as endometriosis, fibroids, pelvic infection, and even normal menstruation. For this reason, CA-125 is interpreted carefully, particularly in women before menopause, where false elevations are common. In younger women with certain cyst types, other markers such as AFP, hCG, and LDH may be checked because some rare ovarian tumours of younger women produce these.

Professional bodies including ACOG (the American College of Obstetricians and Gynecologists) and the RCOG (Royal College of Obstetricians and Gynaecologists) recommend that women with cysts showing suspicious features — particularly after menopause — be referred to a gynaecologic oncologist (a specialist in cancers of the female reproductive organs) for assessment.

Treatment Options

Treatment depends on the type of cyst, its size and appearance, your symptoms, your age, your menopausal status, and your wishes about future fertility. The main approaches are watchful waiting, medical management, and surgery.

Watchful Waiting (Observation)

Many cysts do not need any treatment at all. For a simple, small cyst in a woman who is still having periods, doctors typically recommend a repeat ultrasound after a few weeks or months to see whether it has resolved. Functional cysts usually disappear within one to three cycles. If the cyst goes away or stays small and unchanged, no further action is usually needed.

Observation may also be used for small, simple cysts found after menopause, with periodic scans to check for any change.

Medical Management

Medication does not make an existing cyst shrink quickly, but hormonal contraceptives (such as the combined pill) can prevent new functional cysts from forming by suppressing ovulation. This may be suggested for women who have repeated functional cysts. Pain relief, such as paracetamol or anti-inflammatory medication, can help manage cyst-related discomfort while a cyst is being observed.

For endometriomas linked to endometriosis, hormonal treatments may be used to manage the underlying disease, though they will not remove the cyst itself.

Surgical Treatment

Surgery is considered when a cyst is:

• Large (commonly above 5–10 cm, depending on type and features)
• Causing significant or persistent symptoms
• Not resolving after a period of observation
• Complex or suspicious on imaging
• Causing complications such as torsion or rupture
• Found in a woman after menopause, in many cases

Two main surgical operations are used:

• Ovarian cystectomy — removal of the cyst while preserving the ovary. This is preferred when fertility and hormone function need to be protected.
• Oophorectomy — removal of the whole ovary on the affected side. Sometimes the fallopian tube is removed at the same time (salpingo-oophorectomy). Both ovaries may be removed (bilateral oophorectomy) when there are cysts on both sides or when the risk of cancer is significant.

The choice between cystectomy and oophorectomy depends on the cyst type, the appearance of the ovary, age, fertility goals, and the operating surgeon's findings during the procedure.

Surgical Approaches

Once surgery is planned, the next decision is which approach to use. Most ovarian cyst operations today are done using minimally invasive surgery, but open surgery still has an important role in certain situations.

Laparoscopic surgery (keyhole surgery)

Laparoscopy is the most common approach for ovarian cyst surgery in women without features suggesting cancer. The surgeon makes a few small cuts in the abdomen, usually less than a centimetre each. A thin tube with a camera (the laparoscope) is inserted through one cut, and fine instruments through the others. The abdomen is gently inflated with carbon dioxide gas to create space to work.

Compared with open surgery, laparoscopy is associated with:

• Less pain after the operation
• Shorter hospital stay (often one to two nights, sometimes day-case)
• Faster return to normal activities
• Smaller scars
• Lower rates of wound infection and adhesion formation

Robotic-assisted laparoscopy

Robotic-assisted surgery is a form of minimally invasive surgery in which the surgeon operates the laparoscopic instruments through a console connected to a robotic system. It offers a magnified, three-dimensional view and very precise movement. For ovarian cysts, robotic surgery is used in selected complex cases and where the technology is available; outcomes for routine cyst surgery are generally similar to standard laparoscopy.

Open surgery (laparotomy)

Open surgery involves a single, larger cut in the lower abdomen, either horizontal (along the bikini line) or vertical. It is used when:

• The cyst is very large
• There is significant suspicion of cancer, where keeping the cyst intact during removal is especially important
• There are extensive adhesions from previous surgery or infection
• An emergency situation makes laparoscopy unsafe

Open surgery has a longer recovery time but allows the surgeon a wider working space and a clearer view of the entire abdomen and pelvis, which can be important in suspected ovarian cancer.

If cancer is suspected or found

If imaging or blood tests suggest a cyst may be cancer, professional guidelines recommend that surgery be performed by a gynaecologic oncologist when possible, often in a centre that manages ovarian cancer regularly. Treatment may then involve a more extensive operation (called staging surgery) and, in some cases, chemotherapy afterwards. These decisions are made by a multidisciplinary team after looking at all the findings together.

Preparing for Surgery

If surgery is planned, the days and weeks beforehand usually include several steps:

• Pre-operative tests such as blood tests, an ECG (heart tracing), and sometimes a chest X-ray, depending on your age and health.
• Anaesthetic review to discuss any health conditions, allergies, and medications. Some medications, such as blood thinners, may need to be stopped or adjusted in advance.
• Fasting instructions for the hours before surgery.
• Discussion of fertility if you are of reproductive age. If both ovaries are likely to be affected, options such as egg or embryo freezing before surgery may be discussed.
• Consent, where the surgeon explains the planned operation, alternatives, benefits, and risks, and what may need to happen if unexpected findings occur during surgery (for example, removing an ovary if a cystectomy is not safely possible).

Recovery and Aftercare

After laparoscopic surgery

• Hospital stay is usually one to two nights, sometimes shorter.
• Mild shoulder-tip discomfort is common for a day or two, caused by the gas used during surgery.
• Light activities and walking can usually be resumed within a few days.
• Most women return to office work and normal routines within two to three weeks.
• Strenuous exercise and heavy lifting are typically avoided for four to six weeks.

After open surgery

• Hospital stay is usually three to five days.
• Pain is more pronounced and is managed with regular medication.
• Recovery is slower; most women return to normal activities over six to eight weeks.
• Driving, lifting, and exercise restrictions last longer; your surgical team will give specific guidance.

General aftercare

• Keep wounds clean and dry as advised; minor bruising and tenderness around incision sites are normal.
• Some vaginal bleeding or spotting in the first one to two weeks is common.
• Constipation is common after abdominal surgery; fluids, fibre, and gentle activity help.
• Follow-up usually includes a review of pathology results from the removed cyst and a check on healing.

You should contact your care team if you develop a fever, increasing wound redness or discharge, heavy vaginal bleeding, severe abdominal pain, swelling or pain in a leg, or breathlessness after surgery.

Risks and Complications

Ovarian cyst surgery is generally safe, but no operation is risk-free. Potential complications include:

• Bleeding during or after surgery
• Wound or pelvic infection
• Injury to nearby organs such as the bladder, bowel, ureters, or blood vessels
• Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism)
• Adhesions (internal scar tissue) forming after surgery, which can occasionally cause later pain or bowel problems
• Anaesthetic reactions
• Loss of some ovarian reserve if ovarian tissue is removed or disturbed, even when the ovary itself is preserved — this is particularly relevant for women planning future pregnancy
• Recurrence of cysts on the same or other ovary
• For endometriomas, a small risk of recurrence and of reduced ovarian reserve from the surgery itself

Worries about fertility and hormones are among the most common concerns women have when surgery is suggested. The impact varies with the type of surgery.

• Cystectomy preserves the ovary. Fertility is usually maintained, although surgery on an ovary can slightly reduce its reserve of eggs, especially in conditions such as endometriosis.
• Removal of one ovary still allows natural conception and normal hormone production, because the remaining ovary takes over.
• Removal of both ovaries before menopause causes immediate “surgical menopause” with symptoms such as hot flushes, sleep disturbance, vaginal dryness, and longer-term effects on bone and heart health. Hormone replacement therapy may be discussed for women who have both ovaries removed before the natural age of menopause, unless there is a specific reason to avoid it.
• Removal of both ovaries ends natural fertility. Women who wish to have children in future may discuss fertility preservation, such as egg or embryo freezing, with a fertility specialist before surgery whenever this is possible.

If fertility is important to you, raising this clearly at the consultation lets your surgeon plan the operation with fertility preservation in mind wherever it is medically possible.

Ovarian Cysts in Pregnancy

Cysts are sometimes found during a pregnancy ultrasound. Most are simple cysts of the corpus luteum and resolve by the second trimester. Larger or persistent cysts may need monitoring during pregnancy. Surgery during pregnancy is reserved for cysts that cause complications such as torsion, rupture, or strong suspicion of cancer. When surgery is needed, the second trimester is usually considered the safest time. Decisions in pregnancy are individualised and made together with an obstetrician.

Ovarian Cysts After Menopause

After menopause, the ovaries stop producing eggs and functional cysts no longer form. Any new cyst found after menopause is therefore assessed more carefully. Many postmenopausal cysts are still benign, particularly small simple cysts. However, the risk of malignancy is higher than in younger women, so guidelines from RCOG and ACOG recommend a careful combination of ultrasound features and CA-125 to estimate risk, with referral to a gynaecologic oncologist when the risk is raised.

Small, simple, low-risk cysts after menopause may be safely observed with periodic scans. Cysts with any concerning features are usually removed surgically.

Ovarian Cysts in Children and Adolescents

Ovarian cysts can occur in girls before puberty and during adolescence. In newborns and very young children, small cysts are sometimes seen on scans done for other reasons and usually resolve on their own. In adolescents, most cysts are functional, related to the hormonal changes of puberty and early menstruation.

Two situations need careful attention in younger patients. The first is ovarian torsion, which can present as sudden severe abdominal pain and needs urgent surgery to try to save the ovary. The second is the small but important group of ovarian tumours specific to younger women (such as germ cell tumours), which can produce particular blood markers. For these reasons, ovarian cysts in children and adolescents are usually managed by paediatric surgeons or gynaecologists with experience in this age group, with a strong emphasis on preserving the ovary whenever possible.

Long-Term Outlook and Follow-Up

For most women, the long-term outlook after an ovarian cyst is reassuring. Functional cysts come and go. Benign cysts that have been removed do not return in the same place, although new cysts can form, particularly in conditions such as endometriosis or in women who have repeated functional cysts.

Follow-up depends on the cyst type and what was done:

• Observed cysts usually need one or more repeat scans to confirm resolution or stability.
• After cystectomy for a benign cyst, follow-up is usually limited to a single review with the pathology report, unless there is an underlying condition such as endometriosis that needs ongoing care.
• After surgery for a borderline or malignant cyst, longer-term follow-up under a gynaecologic oncology team is needed, sometimes including scans, blood tests, and clinical reviews over several years.
• After both ovaries are removed before natural menopause, follow-up includes discussion of menopausal symptom management and long-term bone and cardiovascular health.

Returning to your gynaecologist for any new pelvic symptoms, even years after a cyst has been treated, is sensible — both because cysts can recur and because other gynaecological conditions can cause similar symptoms.

Preventing Complications

Ovarian cysts themselves cannot always be prevented, but a few steps can reduce the chance of problems:

• Attending recommended follow-up scans when your doctor has asked for them.
• Reporting new or worsening pelvic pain rather than waiting, particularly if it is sudden or severe.
• Hormonal contraception, where appropriate, can reduce the formation of new functional cysts in women prone to them.
• Treating underlying conditions such as endometriosis can reduce the chance of further endometriomas.
• Knowing your family history. If close relatives have had ovarian, breast, or bowel cancer, this is worth telling your doctor; it may change your screening and follow-up.

When to Seek Urgent Care

You should seek urgent medical attention if you experience:

• Sudden severe pelvic or abdominal pain, particularly with nausea or vomiting
• Fainting, dizziness, or a fast heartbeat together with abdominal pain
• Fever with worsening pelvic pain
• Heavy vaginal bleeding after recent ovarian surgery
• Increasing pain, redness, swelling, or discharge at a surgical wound
• New chest pain, breathlessness, or leg swelling after surgery, which can suggest a blood clot

Frequently Asked Questions

Do all ovarian cysts need to be removed?

No. Most ovarian cysts do not need surgery. Many resolve on their own and only require a follow-up scan. Surgery is generally considered for cysts that are large, persistent, symptomatic, complex on imaging, or found after menopause.

Can an ovarian cyst be cancer?

Most ovarian cysts are not cancer, particularly in women before menopause. The risk of cancer is higher in postmenopausal women and in cysts with certain features on imaging or with raised tumour markers. Your doctor will use a combination of ultrasound findings, blood tests where appropriate, and your overall risk profile to estimate this and to decide whether referral to a gynaecologic oncologist is needed.

Will I still have periods after ovarian cyst surgery?

If at least part of one ovary remains, you will usually continue to have periods and natural hormonal cycles. If both ovaries are removed before menopause, periods stop and menopause begins immediately.

Can I get pregnant after ovarian cyst surgery?

In most cases, yes. Cystectomy preserves the ovary and usually preserves fertility. Even after removal of one ovary, pregnancy is usually possible from the remaining side. If fertility is a priority, discussing this clearly with your surgeon before the operation lets the team plan with that goal in mind.

Will the cyst come back after surgery?

A cyst that has been completely removed does not grow back in that exact location, but new cysts can form on the same or other ovary. Recurrence is more common in conditions such as endometriosis. Your follow-up plan will be tailored to your situation.

How is the choice between keyhole and open surgery made?

The choice depends on the cyst's size and features, suspicion of cancer, prior surgeries, and the surgeon's assessment. Keyhole (laparoscopic) surgery is generally preferred for cysts that appear benign and are not very large, because recovery is faster. Open surgery is used when a large or potentially malignant cyst needs to be removed safely and intact, or when the abdomen is difficult to access laparoscopically.

How soon can I travel after ovarian cyst surgery?

This depends on the type of surgery and your recovery. After uncomplicated laparoscopic surgery, short trips are often possible within one to two weeks, with longer-distance travel typically considered safe after two to four weeks. After open surgery, longer travel is usually delayed for four to six weeks or more. Your surgical team can give specific advice based on your operation, including precautions to reduce the risk of blood clots during longer journeys.

Is it safe to delay surgery if I am not ready?

For some cysts, a period of observation is medically reasonable and is part of the standard plan. For others — particularly cysts with suspicious features, severe symptoms, or complications — delay can carry risk. Whether delay is safe is a clinical decision that should be discussed openly with your gynaecologist.

Conclusion

Ovarian cysts cover a wide range of conditions, from harmless fluid sacs that disappear on their own to growths that need careful surgical management. The right course of action depends on the specific kind of cyst, your symptoms, your age and menopausal status, your fertility plans, and how the cyst looks on imaging and behaves over time.

Modern care for ovarian cysts has moved firmly towards a personalised approach: observation where it is safe, medical management where it helps, and surgery — usually minimally invasive — where it is needed, with strong attention to preserving the ovaries and fertility whenever possible. Understanding what kind of cyst you have, what the options are, and what each one means for your body is the foundation for a confident decision with your gynaecologist.