Ovarian cysts

What are ovarian cysts?

Ovarian cysts are fluid-filled formations that develop in or on the ovaries. Most women will have at least one ovarian cyst during their lifetime. In the majority of cases, cysts are painless, cause no symptoms, and are discovered incidentally during a routine gynecological examination.

The ovaries are part of the female reproductive system — they are located in the lower abdomen on either side of the uterus and produce eggs as well as the hormones estrogen and progesterone.

Types of ovarian cysts

There are several types of ovarian cysts. Functional cysts are the most common and arise during the normal menstrual cycle:

• Follicular cysts — form when the follicle does not rupture during ovulation, causing fluid to accumulate and form a cyst
• Corpus luteum cysts — form when the follicle seals after releasing the egg and fills with fluid; if a blood vessel ruptures, blood may leak into the cyst forming a hemorrhagic cyst

Other types of ovarian cysts:

• Dermoid cyst (teratoma) — may contain hair, fatty tissue, and other types of tissue
• Cystadenoma — an encapsulated cyst that may develop on the outer surface of the ovary
• Endometriotic cyst (chocolate cyst) — forms when endometrial tissue grows outside the uterus and attaches to the ovary
• Polycystic ovary syndrome (PCOS) — a condition in which the ovaries contain numerous small cysts and may become enlarged

Symptoms of ovarian cysts

Most cysts cause no symptoms. However, as a cyst grows, the following signs may appear:

• Abdominal bloating and a feeling of pressure
• Pelvic pain before or during the menstrual cycle
• Painful sexual intercourse
• Lower back or thigh pain
• Painful bowel movements
• Breast tenderness
• Nausea and vomiting

Emergency symptoms requiring immediate medical attention:

• Severe or sharp pelvic pain
• Fever
• Weakness or dizziness
• Rapid breathing

These symptoms may indicate a ruptured cyst or ovarian torsion — both complications require emergency intervention.

Complications of ovarian cysts

Most cysts are benign and resolve spontaneously without treatment. In rare cases, serious complications may arise:

• Ovarian torsion — a large cyst may cause the ovary to twist, disrupting blood flow and potentially damaging the tissue. Torsion surgery accounts for approximately 3% of all emergency gynecological procedures
• Cyst rupture — a ruptured cyst can cause severe pain, internal bleeding, and an increased risk of infection
• Malignant transformation — extremely rare; the gynecologist may detect a cystic formation requiring additional oncological evaluation

Diagnosing ovarian cysts

A gynecologist may detect a cyst during a routine pelvic examination. The following methods are used for an accurate diagnosis:

• Ultrasound examination — determines the cyst's size, location, shape, and composition (solid or fluid-filled)
• CT scan — produces cross-sectional images of internal organs
• MRI (Magnetic Resonance Imaging) — provides detailed images of internal organs

Additional tests that may be requested:

• Pregnancy test — to rule out pregnancy as a cause
• Hormone panel — to check estrogen and progesterone levels
• Tumor markers — screening to rule out malignancy

Treatment of ovarian cysts

The treatment approach depends on the cyst's size, symptoms, and the patient's age:

• Watchful waiting — most functional cysts resolve spontaneously within weeks to months; the doctor may recommend a follow-up ultrasound
• Oral contraceptive pills — suppress ovulation and prevent the development of new cysts; they also reduce the risk of ovarian cancer
• Laparoscopic cystectomy — a minimally invasive surgical method in which the gynecologist removes the cyst through a small incision near the navel
• Laparotomy — a conventional abdominal surgery for removing large cysts that cannot be excised laparoscopically; allows on-site biopsy

Prevention and long-term prognosis

Complete prevention of ovarian cysts is not possible, but routine gynecological examinations allow early detection. Pay attention to the following symptoms:

• Changes in your menstrual cycle
• Persistent pelvic pain
• Unexplained loss of appetite or weight
• Increase in abdominal girth

The prognosis is excellent in the vast majority of cases. In premenopausal women, most cysts disappear within a few months. Functional cysts do not affect fertility. Endometriotic cysts and PCOS may require treatment to preserve fertility. In postmenopausal women, every newly discovered cyst should be carefully evaluated due to the increased risk of malignant transformation.