Understanding common fluid-filled sacs on the ovaries, when they're concerning, and when they're part of normal ovulation
Understanding common fluid-filled sacs on the ovaries, when they're concerning, and when they're part of normal ovulation
Call 911 or go to the nearest emergency room immediately. Do not delay care.
Ovarian cysts are fluid-filled sacs that develop on or in the ovaries. They are extremely common in women of reproductive age. Most ovarian cysts are functional cysts related to the normal ovulatory process and are benign (not cancerous).
Every month during a normal menstrual cycle, follicles (small cysts) grow on the ovaries. Usually one follicle releases an egg (ovulation) and the others shrink away. Sometimes these follicles continue growing or fill with fluid, creating functional cysts. These typically resolve on their own within 1-3 menstrual cycles.
While most ovarian cysts are benign and resolve spontaneously, they can cause:
Understanding which cysts need monitoring and which require intervention helps reduce unnecessary anxiety and procedures.
Related to normal ovulatory process. Most common type.
Rare in premenopausal women. Risk increases with age, especially after menopause. Complex appearance on ultrasound (solid components, thick walls, septations) raises suspicion.
Important: Most functional cysts are asymptomatic.
Many cysts are discovered incidentally during pelvic exams or ultrasounds for other reasons. Having no symptoms is normal for functional cysts.
When symptomatic, cysts may cause:
A cyst can cause the ovary to twist on its blood supply (vascular pedicle), cutting off blood flow. Requires immediate surgery to save the ovary.
Symptoms: Sudden severe one-sided pelvic pain, nausea, vomiting
Cysts can rupture, releasing fluid into the pelvic cavity. Symptoms: Sudden sharp pelvic pain.
Hemorrhagic rupture: If cyst contains blood, rupture can cause internal bleeding with lightheadedness, fainting, rapid heart rate. Requires emergency evaluation.
Transvaginal ultrasound is the primary imaging modality. Differentiates simple vs. complex cysts and assesses size and characteristics.
Simple cysts: Thin-walled, fluid-filled, no solid components. Usually benign functional cysts.
Complex cysts: Thick walls, septations, solid components, or irregular appearance. Require further evaluation.
For simple functional cysts, repeat ultrasound in 4-12 weeks confirms resolution. Most functional cysts disappear within 1-3 menstrual cycles without treatment.
Tumor marker that can be elevated in ovarian cancer. However, also elevated in benign conditions (endometriosis, fibroids, PID). More useful in postmenopausal women. Not a reliable cancer screening test in premenopausal women.
For simple cysts less than 5 cm: Expectant management is appropriate. Most resolve spontaneously within 1-3 menstrual cycles.
Surgery may be recommended for:
This educational content cannot and does not:
Cyst management requires individualized assessment based on your age, symptoms, cyst characteristics, and personal health history.
Polycystic ovaries are a feature of PCOS (though not required for diagnosis)
Endometriomas (chocolate cysts) are a type of ovarian cyst caused by endometriosis
Scripts for discussing imaging and follow-up plans
Understanding pelvic ultrasound and CA-125 testing