Ovarian cysts are common, especially in women of reproductive age. Most cause no symptoms and will go away without treatment.
However, if you have a recurrent or persistent ovarian cyst that causes pain, pressure or other symptoms, the obstetrics and gynecology team at The Ohio State University Wexner Medical Center in Columbus, Ohio, can help. Our gynecology experts identify possible causes and provide advanced care for both common and complex ovarian cysts that may affect the ovaries, nearby organs or your fertility, with a focus on preventing painful ovarian cysts in the future.
What are ovarian cysts?
Ovarian cysts are fluid-filled sacs that form inside your ovary or on its surface. Some cysts contain blood or mucus. A growth containing solid tissue may be called a complex cyst or ovarian mass rather than a simple cyst.
The most common ovarian cyst is a functional or follicular cyst, which forms during the normal menstrual cycle and is found only during an ultrasound or pelvic exam. Other ovarian cysts can cause pain or other symptoms, especially if they become too large, twist or rupture.
Most ovarian cysts go away on their own. The majority of ovarian cysts are noncancerous. Ovarian cancer risk is higher after menopause or when an imaging test shows concerning features.
Types of ovarian cysts
The type of ovarian cyst can affect whether it causes symptoms, goes away on its own or requires treatment. Common types include:
- Functional cysts, which develop as part of ovulation and are the most common type of ovarian cyst. Most are benign and go away on their own, although some can bleed and form a hemorrhagic cyst.
- Endometriomas, or chocolate cysts, which form when tissue similar to uterine lining grows inside the ovary. That tissue bleeds during menstrual cycles, creating a sac filled with old, dark blood. They usually do not go away on their own.
- Dermoid cysts, also called mature cystic teratomas, develop from embryonic cells and can contain bits of skin, hair or fatty tissue. Most are benign, but larger dermoid cysts can increase the risk of ovarian torsion.
- Cystadenomas, which grow from cells on the surface of the ovary. These cysts are usually benign, may contain clear, watery fluid or thick mucus and can cause pressure, bloating or discomfort if they become large.
What causes ovarian cysts?
During a normal menstrual cycle, a follicle grows and releases an egg. A functional cyst can persist if this process does not happen as expected. In some cases, we don’t know why this happens nor why an ovarian cyst develops.
Other possible causes of a cyst on the ovary include:
- Endometriosis
- Pregnancy-related hormonal changes
- Fertility medications that stimulate ovulation
- Pelvic infections that spread to the ovary
- Bleeding into an existing cyst
Ovarian cysts are more common before menopause because the ovaries are still releasing eggs. It is also more likely for people to get ovarian cysts if they've had one before.
Does polyendocrine metabolic ovarian syndrome cause ovarian cysts?
No. Polyendocrine metabolic ovarian syndrome (PMOS), which used to be called polycystic ovary syndrome (PCOS), does not cause ovarian cysts.
PMOS is a hormonal and metabolic condition. An ultrasound may show many small, underdeveloped follicles in the ovaries that do not release eggs. Follicles are sacs where eggs develop and are not the same thing as ovarian cysts.
What to avoid if you have an ovarian cyst
Ohio State experts explain what to know about ovarian cysts and when to be concerned. Watch videos about managing ovarian cyst pain, how ovarian cysts are diagnosed and more.
Symptoms of ovarian cysts
Many ovarian cysts cause no symptoms. When symptoms do occur, they could include:
- Pelvic pain or pressure
- Aching in the lower abdomen or back
- Bloating or abdominal swelling
- Pain during sex, exercise or certain movements
- Painful periods or changes in menstrual bleeding
- Frequent urination or trouble fully emptying your bladder
- Constipation or pressure during bowel movements
Ovarian cyst symptoms can overlap with endometriosis, fibroids, pelvic infections, digestive problems and other conditions. Talk with your healthcare provider if symptoms continue, become more painful or interfere with daily life.
What do ovarian cysts feel like?
Some cysts cannot be felt at all, while others can be painful.
Ovarian cyst pain may feel like a dull ache, pressure or heaviness on one side of the pelvis. It may also feel sharp and come and go, depending on its size, type and location.
Simple functional cysts are often painless unless they reach about 8 centimeters or larger. Other types, like endometriomas, can cause pain even when they are smaller.
A sudden sharp or severe pain could indicate that a cyst has ruptured or that the ovary has twisted. A ruptured cyst or a twisted ovary both can be urgent medical conditions that require emergency care.
How to know if your ovarian cyst has burst
When an ovarian cyst ruptures, it can release fluid or blood into the pelvis. Some ruptures cause no symptoms while others cause sudden pain. Signs that an ovarian cyst may have burst include:
- Sudden, sharp pelvic pain, often on one side
- Abdominal pressure, bloating or tenderness
- Light vaginal bleeding or spotting
- Nausea
A small, ruptured cyst can be painful without being dangerous. The pain may improve with rest, a heating pad and over-the-counter pain medicine.
A hemorrhagic cyst can release a larger amount of blood into the abdomen. This may require a hospital visit to monitor the cyst or, in some cases, surgery.
Get emergency care if you have:
- Severe or worsening pelvic or abdominal pain
- Dizziness or fainting
- Heavy breathing
- Cold or clammy skin
- Heavy vaginal bleeding
- Fever
- Severe pain with nausea or vomiting
Severe pain with nausea and vomiting may also be a sign of ovarian torsion (twisting) rather than a ruptured ovarian cyst. That requires prompt evaluation, and often, emergency surgery.
How are ovarian cysts diagnosed?
Your healthcare provider will ask about your symptoms, menstrual cycle, medical history and any chance of pregnancy. You may also have a pelvic exam.
An ultrasound is the main test used to diagnose an ovarian cyst. It uses sound waves to create images of the ovaries and nearby organs.
A transvaginal ultrasound often gives the clearest view of the ovaries. During this exam, a thin ultrasound device is gently placed in the vagina. An abdominal ultrasound may also be used.
You could also receive other tests that give your provider more insight, including:
- Blood tests: Check for blood loss, hormone changes or signs that a cyst needs closer evaluation.
- Pregnancy test: Rules out pregnancy-related causes of pelvic pain, including an ectopic pregnancy.
- Tumor marker tests: Help evaluate a cyst that looks concerning or develops after menopause. An abnormal result does not always mean cancer.
- MRI: Provides more detail when ultrasound results are unclear.
Your provider may recommend another ultrasound in six to 12 weeks to see whether the cyst has changed.
Treatment for ovarian cysts
Many functional ovarian cysts go away without treatment within six to 12 weeks. If a cyst is small, looks benign and causes few to no symptoms, your provider may suggest monitoring it for changes.
Medications and pain management
Ibuprofen, acetaminophen, rest and a heating pad may help with mild ovarian cyst pain. Hormonal birth control can help prevent new functional cysts by stopping ovulation. It does not treat all types of cysts or make existing cysts go away faster. Your provider will consider your health history and pregnancy plans before recommending hormonal medication.
Ovarian cyst surgery
You may need surgery if a cyst:
- Causes ongoing or severe symptoms
- Keeps growing or does not go away
- Looks concerning on imaging
- Causes ovarian torsion or serious internal bleeding
- May affect fertility
- Develops after menopause and needs further evaluation
Whenever medically appropriate, surgeons can remove the cyst while preserving healthy ovarian tissue. This procedure is called an ovarian cystectomy.
Many cysts can be removed through laparoscopic or robotic surgery, using a camera and small instruments placed through small abdominal incisions. This approach often causes less pain and allows for a faster recovery than open surgery.
A larger incision, called a laparotomy, may be needed for a large cyst or when cancer is a concern. In some cases, the affected ovary must be removed. A gynecologic oncologist may help plan or perform the surgery if cancer is suspected.
Why choose Ohio State for gynecologic care and minimally invasive surgery?
Our providers have advanced training in gynecologic and minimally invasive surgery. We’re experienced in treating both common ovarian cysts and complex conditions such as endometriosis or uterine fibroids that can occur alongside ovarian cysts. When surgery is needed, we look for the least invasive option that can safely treat the cyst while preserving healthy ovarian tissue, when possible.
We understand that an ovarian cyst diagnosis can elicit a range of emotions. Most cysts are benign, but you deserve a clear explanation of what your test results mean. We're dedicated to helping you fully understand your test results, reviewing your options with empathy and respect and including you in treatment decisions.