Understanding Ovarian Cysts, Symptoms, Diagnosis and Treatment Options
Being told you have an ovarian cyst can understandably cause worry. Many women immediately associate the word “cyst” with something serious, but the reality is that most ovarian cysts are benign and do not require treatment.
Ovarian cysts are very common, particularly during the reproductive years, and many disappear naturally without causing any long-term problems.
However, some cysts can cause symptoms, affect fertility, or require further investigation. Understanding the different types of ovarian cysts, the warning signs to look out for, and when to seek specialist advice can help you feel more informed and reassured.
What is an ovarian cyst?
An ovarian cyst is a fluid-filled sac that develops on or inside an ovary.
The ovaries naturally produce follicles every month as part of the menstrual cycle. These follicles contain eggs and usually disappear after ovulation. Occasionally, a follicle continues to grow and becomes a cyst.
There are several different types of ovarian cysts, and the significance of a cyst depends on factors such as:
- Its size
- Its appearance on ultrasound
- Whether it is causing symptoms
- Your age and stage of life
- Whether you have gone through menopause
What are the different types of ovarian cysts?
Functional ovarian cysts
Functional cysts are the most common type and develop as part of the normal menstrual cycle.
They include:
Follicular cysts
These occur when a follicle does not release an egg and continues to grow.
Corpus luteum cysts
These develop after ovulation when the follicle closes and fills with fluid.
Functional cysts often resolve naturally within a few months and may not require any treatment.
Endometriomas
An endometrioma is a cyst caused by endometriosis.
These cysts develop when endometrial-like tissue grows on the ovary and can sometimes affect fertility or cause pelvic pain.
Women with endometriomas may also experience symptoms such as:
- Painful periods
- Pain during sex
- Chronic pelvic pain
- Difficulty becoming pregnant
Dermoid cysts
Dermoid cysts develop from cells that can form different types of tissue. They are usually benign but may grow larger over time and sometimes require monitoring or removal.
Cystadenomas
These cysts develop from cells on the surface of the ovary. They are usually benign but can occasionally become large enough to cause discomfort or pressure symptoms.
What symptoms can ovarian cysts cause?
Many ovarian cysts cause no symptoms and are discovered incidentally during an ultrasound scan for another reason.
When symptoms do occur, they may include:
- Pelvic pain or lower abdominal discomfort
- A feeling of pressure or fullness
- Bloating
- Pain during sex
- Changes in menstrual bleeding
- Increased need to urinate
- Difficulty emptying the bowel
The symptoms can vary depending on the size and type of cyst.
When should you be concerned about an ovarian cyst?
Most ovarian cysts are not dangerous, but there are situations where further assessment is important.
You should seek medical advice if you experience:
Persistent or worsening pelvic pain
Pain that continues, becomes more severe, or interferes with daily activities should always be investigated.
Sudden severe abdominal pain
A sudden onset of severe pain may occasionally indicate complications such as:
- Ovarian cyst rupture
- Ovarian torsion (twisting of the ovary)
These situations require urgent medical assessment.
Symptoms after menopause
Ovarian cysts after menopause require careful assessment, as the risk profile is different compared with cysts found in younger women.
Increasing abdominal swelling or persistent bloating
Although often caused by benign conditions, ongoing abdominal symptoms should be reviewed by a specialist.
How are ovarian cysts diagnosed?
The first step in assessing an ovarian cyst is usually a consultation and pelvic ultrasound scan.
Ultrasound assessment
An ultrasound can provide information about:
- The size of the cyst
- Whether it is fluid-filled or solid
- The thickness of the cyst wall
- Whether there are any concerning features
A transvaginal ultrasound is often the most detailed way to assess the ovaries.
Blood tests
In some cases, blood tests may be recommended to provide additional information.
These may include tumour markers, particularly if the scan shows features that require further investigation.
It is important to remember that these tests are interpreted alongside your age, symptoms and scan findings. An abnormal result does not automatically mean cancer.
Do ovarian cysts always need treatment?
No. Many ovarian cysts simply need monitoring.
The recommended approach depends on:
- The type of cyst
- Its size
- Your symptoms
- Your age
- Whether the cyst changes over time
Treatment options for ovarian cysts
Monitoring and follow-up scans
For many women, particularly those with simple functional cysts, the best approach is observation.
A repeat ultrasound may be arranged to confirm that the cyst is reducing in size or has disappeared.
Medication
Medication does not usually make an existing cyst disappear, but it may help manage symptoms.
Treatment may include:
- Pain relief medication
- Hormonal contraception to reduce the chance of developing new functional cysts
Surgery for ovarian cysts
Surgery may be considered if:
- The cyst is large
- It is causing significant symptoms
- It has concerning features
- It does not resolve over time
- There is a risk of complications
The majority of ovarian cyst surgery is performed using minimally invasive laparoscopic (keyhole) surgery.
Depending on the situation, surgery may involve:
- Removing the cyst while preserving the ovary (cystectomy)
- Removing the affected ovary in selected cases
A specialist will always consider preserving ovarian function, particularly in women who wish to maintain fertility.
Can ovarian cysts affect fertility?
Most ovarian cysts do not affect fertility.
However, certain types, particularly endometriomas associated with endometriosis, may have an impact.
If you are trying to conceive and have been diagnosed with an ovarian cyst, it is important to discuss:
- Your fertility goals
- The type of cyst
- Whether treatment is recommended before pregnancy
A personalised approach is essential, as surgery on the ovary can sometimes affect ovarian reserve.
When should you see a London gynaecologist?
You should consider specialist advice if:
- You have persistent pelvic pain
- An ovarian cyst has been found on a scan
- You have symptoms that are affecting your quality of life
- You are concerned about fertility
- You have symptoms after menopause
A consultation can provide reassurance, explain your scan results clearly and help you understand whether monitoring or treatment is appropriate.
Final thoughts
Ovarian cysts are common, and in many cases they are harmless and resolve without treatment.
However, symptoms should never be ignored, particularly if pain is persistent, symptoms are worsening, or you have concerns about fertility or your long-term health.
The right assessment and advice can help you understand your diagnosis and make confident decisions about your care.
