Ovarian Cysts: Symptoms, Treatment, & Diagnosis

What Is an Ovarian Cyst?

An ovarian cyst is a sac filled with fluid located either in or on an ovary. These cysts are extremely common and often do not cause any pain or harm. A normal cyst can range in size from half an inch to four inches.

Types and Causes of Ovarian Cysts

There are several different types of ovarian cysts, each with their own specific causes. Each type of cyst falls into one of two categories—functional (also called physiologic) or pathologic.

Functional Cysts

Functional cysts are the most common type of ovarian cysts and develop as part of the menstrual cycle. Every month, the ovaries produce follicles, which are small sacs that produce estrogen and progesterone and release an egg during ovulation. When the egg is released, the follicle should disintegrate. If it doesn’t, it can fill with fluid and become a cyst.

The two main types of functional cysts are:

• Follicular cyst: In the middle of your menstrual cycle, an egg should be released from its follicle as it begins to travel down the fallopian tubes. If the follicle fails to rupture or release an egg, and continues to grow, a follicular cyst is formed.

• Corpus luteum cyst: After the follicle releases the egg, it then produces the hormones estrogen and progesterone to prepare for possible conception. Once this happens, the follicle is then called a “corpus luteum.” If it does not disintegrate after the egg is released and fluid accumulates inside it, it turns into a corpus luteum cyst.

While it is possible for a functional cyst to fill with blood and cause discomfort, usually both types of functional cysts are painless and harmless. They tend to resolve on their own after two or three menstrual cycles.

Pathologic Cysts

While functional cysts are very common, and often go away on their own, pathologic cysts are caused by the abnormal reproduction of cells. They generally require medical treatment.

Types of pathologic cysts include:

• Endometriomas: This type of cyst appears in women who suffer from endometriosis. Endometriosis is a condition characterized by uterine tissue growing outside of the uterus. When this tissue grows on an ovary, it will grow quickly and create large ovarian cysts that are very painful, especially during sex. Left untreated, endometriomas can also lead to infertility. They are sometimes referred to as “chocolate cysts” because of the dark color of the fluid inside them.

• Cystadenomas: These are cysts made up of cells from the outer surface of the ovary. They are usually filled with a watery fluid or a sticky gel, and can grow very large. Cystadenomas do not usually cause pain unless they rupture.

• Dermoid cysts: Dermoid cysts are made up of many types of cells and may contain hair, teeth, and other tissues. They are usually painless and if they grow large enough they can show up in a pelvic exam or ultrasound. Dermoid cysts need to be removed surgically.

• Cancerous cysts: Cysts that are cancerous are extremely rare—the risk of ovarian cancer is only about 1.5% for the general population and 5% for those with a first-degree family member with ovarian cancer. In addition, women who are carriers of the BRCA1 or BRCA2 gene mutations (these are specific gene mutations in which the carriers are more likely to get breast cancer) should get any ovarian cysts evaluated.

In addition to the types of cysts described above, it is also possible to develop cysts as a result of one of the following:

• Polycystic ovary syndrome (PCOS)
• Pregnancy
• Severe pelvic infections such as chlamydia or pelvic inflammatory disease.

Symptoms of Ovarian Cysts

Fortunately, most cysts are completely asymptomatic and do not cause any trouble at all. It is only when a cyst grows larger that it can cause issues, such as the following symptoms:

• Feeling of pain or pressure in lower abdomen
• Bloating
• Pain during sexual intercourse
• Changes in bowel movements or urination
• Unexplained weight loss or gain
• Feeling full very quickly when eating
• Painful periods

The symptoms are unlikely to be severe and may be easy to ignore. You may find that they go away relatively quickly. If you have a few of these symptoms, or if they start to worsen, check with a doctor. You can also download the K Health app and chat to a doctor about your symptoms to help you determine what your next steps should be.

Ruptured Ovarian Cysts

If you’re feeling sharp and sudden pain, it’s possible your ovarian cyst has burst. When an ovarian cyst ruptures or bursts, it can cause severe pain and sometimes bleeding. As cysts grow larger they are at greater risk of rupture, and vigorous activity or sexual intercourse can also increase the risk.

The pain caused by a ruptured cyst will vary depending on cyst size and contents of the cyst. The pain associated with cyst rupture is thought to be due to the fluid released from the cyst irritating the peritoneum. If the cyst was full of blood, you may experience vaginal bleeding as a result of the rupture along with nausea, vomiting, dizziness, and weakness.

However, ruptured cysts do not necessarily require any sort of treatment, particularly if the pain subsides and you don’t experience other symptoms. If the pain continues, you should see a doctor as you may need stronger pain medication or, in very rare cases, surgery to stop internal bleeding.

Risk Factors for Ovarian Cysts

As stated above, the vast majority of women will experience ovarian cysts at some point in their lives. In general terms, only 8% of premenopausal women develop cysts that need treatment, and cysts are uncommon after menopause.

There are a few situations that put you more at risk:

• Hormonal imbalances (including those caused by taking fertility drugs that induce ovulation)
• Pregnancy
• Endometriosis
• A severe pelvic infection
• Previous ovarian cysts

Ovarian Cyst Prevention

During regular pelvic examinations, your doctor can check for irregularities and identify them early. Take note of any changes in your menstrual cycle or unusual symptoms that last for more than a few cycles.

If you have known hormonal imbalances, your doctor may recommend taking birth control pills, which can help prevent the formation of ovarian cysts. If you are diagnosed with a pelvic infection, take your antibiotics as prescribed.

How Are Ovarian Cysts Diagnosed?

If you suspect you have an ovarian cyst, there are several ways your doctor can confirm the presence of a cyst:

• Pelvic exam: Your doctor will use his/her hands to feel for the presence of a mass.

• Imaging tests: Ultrasounds, MRIs, and CT scans can all be used to see inside the body and determine whether or not there is an ovarian cyst.

• Laparoscopy: If an ultrasound reveals a cyst that is unlikely to resolve on its own, the doctor may perform a laparoscopy. This a minimally invasive surgical procedure done with the assistance of a camera. It is typically an outpatient procedure where you can go home the same day at the surgery.

• Blood tests: Blood tests can provide information about what type of cyst you have. For post-menopausal women in particular, your doctor may order a CA-125 test to check the levels of cancer-antigen in your blood, which will be higher if you have ovarian cancer. Even for post-menopausal women, however, the chances of a cyst being cancerous are relatively low.

Treatment Options for Ovarian Cysts

Once you have been officially diagnosed with an ovarian cyst, there are a number of possible ovarian cyst treatment options depending on your specific situation:

• Wait and watch: Because most cysts resolve on their own, if yours is not causing discomfort your doctor may decide to wait a couple of months before recommending any treatment. In this case, you will have another examination and ultrasound after one or two menstrual cycles.

• Pain relief: If you are in pain, you can take over-the-counter pain medication such as acetaminophen (Tylenol), ibuprofen (Motrin or Advil), or naproxen (Aleve). A heating pad or a warm bath can also provide comfort.

• Refrain from vigorous activity: If your cyst is large, you may be told to avoid exercise or any vigorous activity until the cyst resolves. This will help prevent ovarian torsion (explained below).

• Birth control pills: While taking birth control pills won’t make an existing cyst go away, they can stop ovulation and thereby prevent new cysts from forming.

• Cystectomy: In this surgical procedure, the cyst is surgically removed. This does not prevent new cysts from developing in the future. Surgery is advised if the cyst is causing a lot of painful symptoms, if it’s bigger than 10 centimeters, or if it looks abnormal on the ultrasound.

• Oophorectomy: This is another surgical procedure in which the entire ovary and cyst are removed.

Complications and Related Conditions

The main complication that can arise from ovarian cysts is ovarian torsion.

Ovarian Torsion

The ovaries are held in place alongside the uterus by ligaments. Ovarian torsion occurs when an ovary gets twisted around the ligament. This happens when a cyst grows very large and causes the ovary to move and twist painfully. Symptoms of ovarian torsion include a sudden onset of severe pain in the pelvis, nausea, and vomiting.

The treatment for ovarian torsion is emergency surgery, which is necessary to untwist the ovary. If the blood supply to the ovary has been cut off due to the torsion, it may be necessary to remove the entire ovary.

If there is no blood flow to the ovary for long enough, it will impact its ability to function, which could lead to infertility. Luckily, if ovarian torsion is treated quickly, women can make a full recovery.

When to See a Doctor

An ovarian cyst is unlikely to be a medical emergency, but if you are concerned, it is a good idea to have a physician evaluation. You should seek immediate medical attention if you have any of the following symptoms:

• Sudden severe abdominal or pelvic pain
• Pain accompanied by fever or vomiting
• Cold and clammy skin
• Lightheadedness
• Weakness

If you suspect that you have ovarian torsion you should see a doctor emergently.