Ovarian Cysts Home A-Z Health Information Health Library A-Z Ovarian Cysts Overview Ovarian cysts are pouch-like structures filled with liquid or semi-solid material that form in your ovaries. They can either form either within the ovary or on the ovarian surface. Rarely, some ovarian cysts become malignant (cancerous) and/or cause serious complications; less than 1% of ovarian cysts are cancerous. Most ovarian cysts are benign (harmless) and are cleared on their own. However, very heavy cysts can cause ovarian torsion, a condition in which the ovary turns over on itself one or more times, leading to reduced or zero blood flow to the ovary, necessitating surgery. Types Based on their development, ovarian cysts can be broadly categorised into two classes:Functional cysts: These cysts develop as a part of the ovulation cycle (the release of an egg from the ovary) and are a sign of properly functioning ovaries; these cysts generally shrink over time.Pathological cysts: These cysts are formed as a result of abnormalities and are much less common than functional cysts. Pathological cysts include:Cystadenomas: Fluid-filled cysts that form on the ovarian surface.Dermoid cysts (teratomas): Cysts containing cells from all types of tissues (hair, teeth, skin, and even brain tissues).Endometriomas: Cysts filled with endometrial tissue, i.e., the same tissue that lines your uterus and bleeds during the menstrual cycle.Ovarian cancer cysts: Ovarian tumours (solid masses of cancer cells). Causes Hormonal changes during ovulation are the main cause of ovarian cysts. Other causative factors include:Endometriosis: Ovarian cysts can form in advanced stages of endometriosis, a condition in which tissue similar to the uterine lining (womb lining) grows in places outside the womb.Pelvic inflammatory disease (PID): Severe PID—an infection of the female reproductive system, usually caused by bacteria from sexually transmitted infections—can cause scarring and cyst formation in the ovaries. Women with PID are more likely to develop ovarian cysts that are infected with bacteria. Rupture of such cysts can lead to sepsis.Genetics: Some women may be at a high risk of developing ovarian cysts owing to their genetic background.Obesity: The underlying hormonal imbalances associated with obesity have been reported to increase the risk of ovarian cyst formation. Symptoms Most women with ovarian cysts may not exhibit any noticeable symptoms, especially if the cysts are small. However, large cysts or cyst rupture can result in various symptoms, including: Pelvic pain: You might experience pain on one side of the pelvis (the region below your bellybutton). The pain levels vary, ranging from a dull, persistent heavy sensation to an unexpected, severe, and sharp pain.Bloating: You may have a feeling of fullness or heaviness in your belly.Changes in the menstrual cycle: You might suffer from irregular periods, abnormal bleeding, or painful periods. Pain during intercourse: You might feel discomfort during sex.Urinary symptoms: You might experience difficulty in emptying the bladder or there might be an increased urgency to urinate.Difficulty in bowel movement: You might face bowel movement problems, such as constipation or pain during bowel movements. Diagnosis Pelvic examination: In this examination, a doctor physically checks for any abnormal masses (lumps) or tenderness in the pelvic region.Ultrasound: This sound wave-based imaging procedure can help determine the size, type (cystic, solid, or both), location, contents, and appearance of the cyst, in addition to providing details regarding the vascular content, i.e., blood vessels penetrating the cyst. Patients undergoing ultrasound for ovarian cysts must drink a lot of water at least one hour before the appointment and avoid emptying their bladder before the procedure.Blood tests: As hormonal imbalance can cause ovarian cysts, the serum levels of reproductive hormones (luteinising hormone (LH), follicle-stimulating hormone (FSH), oestradiol, and testosterone) are measured to determine the cause of ovarian cysts.Cancer antigen 125 (CA 125) test: As CA 125 levels can increase when a person has ovarian cancer, the CA 125 test is suggested for women with ovarian cysts, especially if they are postmenopausal, have a high risk of developing ovarian cancer, or if the cyst is suspected to be cancerous.Magnetic resonance imaging (MRI): In rare cases, more advanced imaging methods are required to diagnose ovarian cysts. MRI can accurately differentiate between harmless and cancerous ovarian masses with 88‒93% accuracy. They can identify different types of material in ovarian cysts, including fat, fluid, solid, and haemorrhage.Computed tomography (CT): Though CT is not typically used to evaluate ovarian cysts, it is the best technique for imaging haemorrhagic ovarian cysts (ovarian cysts filled with blood). Treatment Generally, if the cyst is small and is not causing too much difficulty to the patient, doctors usually recommend monitoring the cyst over a few menstrual cycles as most cysts tend to get cleared on their own. For cysts that persist and are associated with complications, the treatment depends on several factors, including cyst type and size and patient age. Here are some common treatment options:Medications: Hormonal contraceptives or birth control pills—that help regulate the menstrual cycle—can prevent the development of new ovarian cysts, but they cannot resolve the existing ones. Over-the-counter painkillers (e.g., acetaminophen (Tylenol), ibuprofen (Advil), naproxen (Aleve)) and can temporarily relieve ovarian cyst‒related pain. Narcotic medications like oxycodone and morphine sulphate are recommended for moderate to severe pain.Laparoscopic ovarian cystectomy: Laparoscopy may be recommended for noncancerous cysts that are less than 3 inches in size. In this procedure, a camera is inserted through a cut in the abdomen and the pelvis is inflated with gas to create extra space for accessing the ovaries. Then, a few more small cuts are made to insert the surgical tools and remove the cyst. Patients undergoing this surgical procedure can go home the same day.Ovarian cystectomy (Laparotomy): Laparotomy may be recommended for cysts that are particularly large or potentially cancerous. In this surgery, a single, large cut is made in the abdomen to access and remove the cyst. Patients need to stay in the hospital for a few days after surgery and avoid heavy physical work for some days. When to see a doctor You experience severe pelvic pain or abdominal pain.You exhibit symptoms of a ruptured cyst, e.g., sudden, sharp pain, nausea, vomiting, or faintness.You notice changes in your menstrual cycle or unusual bleeding.When your urinary or bowel symptoms persist.