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Ovarian cyst

Ovarian cysts are a common gynecological problem that can affect women of all ages. While most of them are mild and do not cause serious health problems, some may require medical intervention. Understanding the nature of ovarian cysts, their potential symptoms, causes, diagnostic methods, and available treatment options is crucial for every woman’s health.

What is an ovarian cyst? Definition and anatomy

An ovarian cyst (Latin: cystis ovarii) is a pathological space, a type of follicle or sac filled with fluid (serous, bloody, mucous or other content) that develops inside or on the surface of the ovary. The ovaries are the paired reproductive glands of a woman, located on both sides of the uterus in the pelvis minor. They are responsible for the production of eggs (oocytes) and sex hormones such as estrogen and progesterone, which regulate the menstrual cycle and play a key role in the reproductive process.

The size of the cyst can vary greatly – from a few millimeters (often undetectable without specialized tests) to a dozen or even several dozen centimeters, occupying a significant part of the abdominal cavity. Most ovarian cysts are benign (non-cancerous), but each lesion requires thorough diagnostics to exclude the malignant process.

Types of ovarian cysts – learn about the most common types

Ovarian cysts can be divided into several main categories, depending on their origin, structure and nature. Understanding this classification is important because different types of cysts may have different symptoms, prognosis, and require different therapeutic approaches.

Functional cysts – the most common group

Functional cysts are the most common type of ovarian cyst and are directly related to a woman’s physiological menstrual cycle. They are usually mild and often disappear on their own within a few menstrual cycles (usually 1-3 months) without the need for treatment.

• Follicular cyst (Latin: cystis follicularis): It is formed when the Graafian follicle (in which the egg matures) does not rupture during ovulation and does not release an egg, but continues to grow, filling with fluid. It usually reaches a small size (up to a few centimeters) and rarely gives symptoms.
• Cyst corpus lutei (Latin: cystis corporis lutei): It forms after ovulation, when the corpus luteum (a structure formed from a ruptured Graafian follicle that produces progesterone) does not disappear properly, but fills with fluid or blood. These cysts may be slightly larger and cause pain more often. They can also rupture, leading to bleeding into the peritoneal cavity, which can result in symptoms of cysts on the ovaries.

Pathological cysts (organic, non-functional) – requiring attention

Pathological cysts are not directly related to the ovulatory cycleand do not disappear on their own. They can grow and potentially lead to complications. This group includes both benign and (rarely) malignant lesions.

• Dermoid cysts (lat. cystis dermoidalis, teratoma adultum cysticum): These are benign germline tumors that originate from multipotent germ cells. They can contain various tissues, such as hair, teeth, bone fragments, fat or nerve tissue. They are most common in young women. Although they are usually benign, they can twist or break.
• Glandular cysts (adenocarcinocysts, Latin cystadenoma): They arise from the cells of the epithelium that covers the ovary. They are divided into:
  • Serous (Latin: cystadenoma serosum): They are filled with a watery, serous fluid. They can reach considerable sizes.
  • Mucinous (lat. cystadenoma mucinosum): They contain thick, sticky mucus. They can also grow to large sizes, sometimes filling the entire abdominal cavity. Most adenocarcinocysts are benign, but some may have malignant potential (so-called borderline tumors or carcinomas, including dermoid cysts, may require further diagnosis.
• Endometrial cysts (chocolate, Latin: endometrioma ovarii): They are the result of endometriosis, a disease that involves the presence of the lining of the uterus (endometrium) outside the uterine cavity, including the ovaries. The blood that accumulates inside these cysts during the menstrual cycle darkens and thickens, resembling liquid chocolate (hence the name). They are often accompanied by severe pelvic pain and fertility problems.

Polycystic ovary syndrome (PCOS) cysts

Polycystic ovary syndrome (PCOS) is a hormonal disorder characterized, m.in , by the presence of numerous, small follicles (often incorrectly called cysts) around the periphery of the ovaries, visible on ultrasound. These are rather immature follicles that have not gone through the full cycle of development, rather than classic cysts. PCOS requires comprehensive endocrine and gynecological treatment.

Neoplastic cysts (malignant)

Although most ovarian cysts are benign, each lesion requires an assessment for the risk of malignancy (ovarian cancer). This risk increases with age, especially after menopause. Ovarian cancer is often difficult to detect at an early stage, so regular gynecological examinations are extremely important. A suspicion of a malignant lesion is raised by certain features in the ultrasound image (e.g. solid components, thick walls, septa, vascularization) and elevated tumor markers (e.g. CA-125, although its specificity is limited).

Causes and risk factors for ovarian cysts

The etiology of ovarian cyst formation is complex and not fully understood. Different types of cysts may have different causes and predisposing factors.

• Hormonal disorders: They are the main cause of the formation of functional cysts, which can occur singly or multiple. Fluctuations in the levels of sex hormones (estrogens, progesterone, gonadotropins) can interfere with the proper course of the ovulation cycle.
• Endometriosis: A direct cause of endometrial cysts.
• Pregnancy: Early pregnancy is often associated with the presence of a corpus luteum cyst that sustains progesterone production until the placenta takes over this function. It usually disappears spontaneously.
• A history of pelvic inflammatory disease (PID): Infections can lead to the formation of fallopian tube abscesses, which can resemble cysts, including an ovarian dermoid cyst.
• History of previous ovarian cysts: Women who have previously been diagnosed with cysts have a higher risk of developing them again.
• The use of ovulation-stimulating drugs can lead to the formation of cysts, including ovarian dermoid cysts.: Medicines used to treat infertility (e.g. clomiphene, gonadotropins) may increase the risk of functional cysts, including ovarian hyperstimulation syndrome (OHSS).
• Genetic factors: Family predisposition may play a role in certain types of cysts, as well as in the risk of ovarian cancer (e.g., BRCA1/BRCA2 gene mutations).
• Smoking: Some studies suggest a link between smoking and a higher risk of certain types of cysts.
• Early first menstruation (menarche): May be associated with a slightly higher risk.
• Hypothyroidism: It can affect hormonal balance and promote the formation of cysts.

Symptoms of ovarian cysts – when to see a doctor?

Many ovarian cysts, especially small and functional ones, do not cause any symptoms and are detected accidentally during a routine gynecological examination or ultrasound. However, when the cyst grows, compresses adjacent organs, twists, ruptures or is associated with hormonal disorders, the following symptoms may appear: symptoms of a cyst on the ovaries.

• Pain in the lower abdomen or pelvis: It can be sharp, stinging, dull, continuous or appear periodically. It is often unilateral, on the side where the cyst is located. The pain can intensify during physical exertion, sexual intercourse, or during certain phases of the cycle.
• Bloating, feeling of fullness or heaviness in the abdomen: Especially with larger cysts.
• Painful sexual intercourse (dyspareunia).
• Irregular periods: These may include delays, more frequent bleeding, spotting between periods, or heavier bleeding.
• Pain when urinating or stooling: If the cyst compresses the bladder or rectum.
• Pollakiuria or bladder urgency: Resulting from pressure on the bladder.
• Feeling of quick satiety after a small meal.
• Nausea or vomiting can be symptoms of a cyst on the ovaries, including a hemorrhagic cyst.: Less common, they may indicate complications such as cyst torsion.
• Back pain in the lumbar region can be one of the symptoms of a cyst on the ovaries.
• Weight gain or abdominal circumference (with very large cysts).
• Problems with getting pregnant In the case of endometrial or PCOS-related cysts, special attention should be paid to the symptoms of ovarian cysts.

You should see a doctor urgently if you experience:

• Sudden, severe pain in the abdomen or pelvis.
• Abdominal pain accompanied by fever and vomiting.
• Symptoms of shock: pale skin, cold sweats, increased heart rate, dizziness, fainting (may indicate rupture of the cyst with hemorrhage or ovarian torsion).

Ovarian cyst diagnosis – what tests to perform?

Diagnosis of ovarian cysts is aimed at confirming its presence, determining its type, size, nature (benign or potentially malignant) and deciding on further treatment.

• Medical history and gynecological examination: The doctor collects information about symptoms, medical history, menstrual cycle, medications used. During a two-handed examination, he can feel an enlarged ovary or the presence of a lumpy lesion in the pelvis.
• Ultrasound examination: This is the basic and most important test in the diagnosis of ovarian cysts.
  • Transvaginal (transvaginal) ultrasound: It allows for a very accurate assessment of the ovaries and uterus. The ultrasound head is inserted into the vagina.
  • Transabdominal ultrasound: Performed through the abdominal wall, often with a full bladder. It may be helpful in the evaluation of large cysts or in women who cannot have a transvaginal examination (e.g. virgins). During the ultrasound, the doctor assesses the size of the cyst, its structure (single-chamber, multi-chamber, the presence of solid elements, septa), wall thickness, echogenicity of the contents and vascularization (using the Doppler function). These features help to differentiate benign cysts from potentially malignant ones.
• Blood tests:
  • Tumor markers: CA-125 is most commonly determined. Its levels can be elevated in ovarian cancer, but also in other conditions such as endometriosis, uterine fibroids, inflammation of the appendages, pregnancy or even during menstruation. Therefore, its interpretation must be careful and combined with the results of other studies, especially in premenopausal women. Other markers (e.g. HE4, AFP, hCG, LDH) may be prescribed in specific situations. The Risk of Ovarian Malignancy Algorithm (ROMA), which links CA-125 and HE4 to the patient’s age, may be helpful in assessing the risk of malignancy.
  • Hormone levels: Hormone tests (e.g., FSH, LH, estradiol, testosterone) can be helpful in diagnosing PCOS or other hormonal disorders.
  • Pregnancy test: Performed to rule out ectopic pregnancy, which may have similar symptoms, and in the presence of corpus luteum cysts.
  • Complete blood count, CRP: These may indicate inflammation or bleeding.
• Computed tomography (CT) or magnetic resonance imaging (MRI): These are more advanced imaging tests, ordered in doubtful cases, when the ultrasound does not give a clear answer, when malignant lesions are suspected, to assess the extent of the process or before planned surgical treatment. MRI is particularly useful in assessing the nature of soft tissues.
• Diagnostic laparoscopy: This is a minimally invasive surgical procedure in which a camera (laparoscope) and surgical instruments are inserted through small incisions in the abdominal wall. It allows for direct assessment of pelvic organs, taking samples for histopathological examination, and often also for simultaneous removal of the cyst.

The final diagnosis of the type of cyst (especially distinguishing between benign and malignant lesion) is possible only after histopathological examination of the removed tissue.

Ovarian cyst treatment – methods and when is it necessary?

The choice of ovarian cyst treatment method depends on many factors, such as: the type and size of the cyst, the patient’s age, the severity of symptoms, reproductive plans and the risk of malignant lesion.

Watchful Waiting

Many small (usually less than 5-7 cm), simple, functional ovarian cysts that do not cause symptoms do not require immediate treatment. Regular gynaecological check-ups with an ultrasound examination (e.g. every 1-3 months) are then recommended to monitor whether the cyst is growing, changing its nature or disappearing on its own. This is especially true for premenopausal women.

Pharmacological treatment

• Oral contraceptives (birth control pills): These may be recommended to prevent the formation of new functional cysts by inhibiting ovulation. However, they do not treat existing cysts, but they can reduce the risk of their recurrence.
• Painkillers can be used for symptoms of cysts on the ovaries.Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be used to relieve pain associated with a simple cyst or hemorrhagic cyst.
• Hormonal treatment in endometriosis: In the case of endometrial cysts, various forms of hormone therapy (e.g. GnRH analogues, progestins, danazol) are used to reduce the symptoms and inhibit the growth of endometriosis foci.

There are no drugs that cause most types of organic cysts to “dissolve” or be absorbed.

Surgical treatment

Surgical intervention is necessary in the following situations:

• Suspected malignant lesion (ovarian cancer).
• Large cysts (usually more than 7-10 cm) that cause pressure symptoms or the risk of complications.
• Cysts that do not disappear or grow during follow-up.
• Symptomatic cysts, causing severe pain or other ailments.
• Occurrence of complications such as cyst torsion, rupture with hemorrhage.
• Cysts in postmenopausal women (they are at higher risk of malignancy).
• Certain types of cysts, e.g. leathery, endometrial (if they cause symptoms or fertility problems).

There are two main operating methods available:

• Laparoscopy: This is the preferred, minimally invasive method. The surgeon makes several small incisions (0.5-1 cm) in the abdominal wall, through which he inserts a laparoscope (camera) and specialized instruments. It allows the removal of the cyst (cystectomy) or the entire ovary (oophorectomy). The advantages of laparoscopy are less postoperative pain, shorter hospital stay, faster recovery and better cosmetic effect.
• Laparotomy may be necessary if cysts such as a hemorrhagic cyst are removed.: This is a traditional open surgery that requires a larger cut in the abdominal wall (transverse or longitudinal). It is used in the case of very large cysts, suspected ovarian cancer, massive adhesions or when laparoscopy is technically impossible or too risky.

The type of surgery depends on the clinical situation:

• Cyst enucleation (cystectomy): Removal of the cyst itself while leaving healthy ovarian tissue. It is the preferred method for young women who want to preserve their fertility.
• Removal of the ovary (oophorectomy): Removal of the entire ovary along with the cyst. It may be necessary in case of large lesions, suspected malignancy, or in postmenopausal women.
• Removal of the ovary along with the fallopian tube (adnexectomy).
• If ovarian cancer is suspected, the scope of surgery is much wider and may include removal of both ovaries, fallopian tubes, uterus, greater omentum and lymph nodes.

Each removed tissue is sent for histopathological examination for a final diagnosis.

Possible complications of ovarian cysts

Untreated or growing ovarian cysts can lead to serious complications that often require immediate medical intervention, especially in the course of endometriosis.

• Torsion of the ovarian cyst (torsio ovarii): This occurs when the ovary and the cyst rotate around their axis (pedicle), which leads to compression of the blood vessels and ischemia of the ovary. It manifests itself as sudden, very severe abdominal pain, nausea, vomiting. It requires urgent surgery to “unscrew” the ovary and restore circulation; otherwise, ovarian necrosis may occur.
• Rupture of the ovarian cyst (ruptura cystis ovarii): It can occur spontaneously or as a result of trauma. The contents of the cyst spill into the peritoneal cavity, which can cause pain, peritoneal irritation, and in the case of a ruptured blood vessel – internal bleeding. Symptoms depend on the size of the cyst and the amount of fluid poured out. Small ruptures of functional cysts often do not require treatment, but larger ones or those with bleeding can be dangerous.
• Cyst infection: A rarer complication, it can lead to the formation of an ovarian abscess. It manifests itself with pain, fever, symptoms of peritonitis.
• Bleeding inside the cyst or into the peritoneal cavity: It may be associated with rupture of the cyst or damage to its wall.
• Fertility problems: Some cysts (e.g., endometrial, PCOS-related) can make it difficult to get pregnant. Large cysts can press on the fallopian tubes.
• Malignant transformationAlthough rare, benign cysts can (in some cases) become malignant, or cancerous from the beginning, and can also occur individually or in multiple cases.

Ovarian cyst and pregnancy – what do you need to know?

Detection of ovarian cysts in a pregnant woman is not uncommon. Most often these are benign functional cysts (mainly of the corpus luteum), which disappear spontaneously in the second trimester of pregnancy.

• BehaviorMost cysts detected during pregnancy only require observation with regular ultrasound examinations, especially simple cysts, which rarely lead to serious problems.
• Risk: Large cysts can pose a risk of complications such as torsion (more common in pregnancy due to anatomical changes in the pelvis) or rupture. They can also be an obstacle to childbirth if they are located in the pelvis and block the birth canal.
• Surgical treatment in pregnancy: It is considered only in situations of absolute necessity, e.g. when a torsion is suspected, ruptured with hemorrhage, a malignant lesion or very rapid cyst growth is suspected. If surgery is unavoidable, the safest period is the second trimester of pregnancy.

It is important that any cyst detected during pregnancy is carefully monitored by a gynecologist.

Ovarian cyst and fertility – what is the impact?

The impact of ovarian cysts on fertility depends on its type, size and possible complications.

• Functional cysts: They usually have no negative effect on fertility and often disappear on their own.
• Endometrial (chocolate) cysts: These are strongly associated with endometriosis, which is itself a common cause of infertility. These cysts can damage ovarian tissue, reduce the ovarian reserve, cause adhesions and interfere with ovulation. Treatment (often surgery) may be necessary to improve the chances of getting pregnant.
• Polycystic ovary syndrome (PCOS): It is characterized by ovulation disorders, which is the main cause of fertility problems in women with PCOS.
• Large organic cysts: They can mechanically compress the fallopian tubes or distort the pelvic anatomy, making fertilization more difficult.
• Surgical treatment: Cyst enucleation (cystectomy) is done to preserve as much healthy ovarian tissue and fertility as possible. However, any surgical intervention on the ovary carries some risk of reducing the ovarian reserve. Removal of the entire ovary (oophorectomy) significantly affects fertility if the other ovary is not functioning properly.

Women with ovarian cysts planning pregnancy should discuss their situation with their gynecologist, who will assess the potential impact of the cyst on fertility and suggest appropriate management of the ovarian dermoid cyst.

Ovarian cyst prevention – can they be prevented?

There are no fully effective methods to prevent all types of ovarian cysts, as their causes are diverse. However, there are some steps you can take to reduce risk or detect early:

• Regular gynecological examinations: Annual check-ups with the gynecologist, including a gynecological examination and a transvaginal ultrasound, allow for early detection of possible changes in the ovaries, before they give symptoms.
• Use of oral hormonal contraception: In women who are not planning pregnancy, birth control pills may reduce the risk of functional cysts by inhibiting ovulation. They can also reduce the risk of ovarian cancer.
• Healthy lifestyle: Although the direct impact of diet or physical activity on the formation of most cysts is not conclusively proven, taking care of your overall health, maintaining a healthy body weight and avoiding stimulants (e.g. smoking) is always beneficial.
• Awareness of symptoms: Knowing the potential symptoms of ovarian cysts and seeing a doctor immediately if they occur can speed up diagnosis and treatment.
• Treatment of underlying conditions: Effective treatment of endometriosis or hormonal disorders can reduce the risk of cysts associated with them.

When to urgently see a doctor with an ovarian cyst?

There are situations in which the symptoms associated with an ovarian cyst require immediate medical consultation or even calling an ambulance. These are primarily symptoms suggesting acute complications:

• Sudden, very severe, sharp pain in the lower abdomen or pelvis that does not go away with painkillers.
• Abdominal pain accompanied by fever, chills, nausea and vomiting.
• Symptoms of shock: pale skin, cold sweats, increased heart rate, drop in blood pressure, dizziness, feeling weak, fainting.
• Sudden enlargement of the abdominal circumference.
• Bleeding from the genital tract not related to menstruation, especially heavy or in postmenopausal women.

These symptoms may indicate cyst torsion, rupture with hemorrhage, infection, or other serious condition that requires urgent intervention.

Living with an ovarian cyst – what should you know?

The diagnosis of ovarian cysts can be alarming, but most cases have a good prognosis.

• Regular check-ups: If follow-up is recommended, adherence to follow-up appointments and ultrasound examinations is crucial.
• Mental well-being: The uncertainty of diagnosis and waiting for the results or resolution of cysts, such as a hemorrhagic cyst, can be stressful. It is worth talking about your concerns with your doctor, partner or loved ones. If necessary, you can use the support of a psychologist, especially in the context of problems related to ovarian cysts in reproductive age.
• Physical activity: With small, asymptomatic cysts, there are usually no contraindications to moderate physical activity. However, if you have larger cysts or are at risk of twisting, your doctor may recommend avoiding sudden movements, jumps or intense exercise.
• Diet: There is no specific diet to treat ovarian cysts. General principles of healthy eating are recommended. In the case of PCOS or endometriosis, your doctor or dietitian may recommend some dietary modifications.
• Informing your doctors: If you need to treat other conditions, always tell your doctors if you have an ovarian cyst.

Myths and facts about ovarian cysts

Many myths have arisen around ovarian cysts. It is worth dispelling them:

• MYTH: Every ovarian cyst is cancer. FACT: Some cysts, such as a dermoid cyst, can occur in the course of endometriosis: The vast majority of ovarian cysts (over 90-95%) are benign, especially in premenopausal women. However, each cyst requires diagnostics to rule out cancer.
• MYTH: Ovarian cysts always cause pain. FACT: Many cysts, especially small ones, are asymptomatic and detected accidentally.
• MYTH: Ovarian cysts, such as a simple cyst, can be “dissolved” with herbs or diet. FACT: There is no scientific evidence that herbs or special diets are effective in treating most types of organic cysts. Functional cysts can disappear spontaneously, which is sometimes mistakenly attributed to alternative methods.
• MYTH: If I have an ovarian cyst, I will definitely have problems getting pregnant. FACT: The effect on fertility depends on the type and size of the cyst. Many women with cysts get pregnant without problems. Problems can mainly affect endometrial cysts and PCOS.
• MYTH: Removal of an ovarian cyst always means removal of the entire ovary. FACT: The aim of surgery, especially in young women, is to enucleate the cyst itself while preserving healthy ovarian tissue (cystectomy). Oophorectomy (removal of the ovary) is considered in specific cases.
• MYTH: Hormonal contraception treats existing cysts. FACT: Birth control pills can prevent the formation of new functional cysts, but they do not cause the disappearance of existing organic cysts.

The key to health is awareness and regular examinations

Ovarian cysts are a common gynecological phenomenon that can affect women of all ages. It is crucial to understand that most of them are benign and do not pose an immediate threat to life. Nevertheless, due to the potential risk of complications and the possibility of (albeit rare) malignant transformation, each detected lesion on the ovary requires careful diagnosis and appropriate management under the supervision of a gynecologist.

Regular preventive examinations, awareness of your own body and not ignoring worrying symptoms, such as symptoms of cysts on the ovaries, are the best strategy for taking care of your intimate health. Early detection of ovarian cysts allows for the implementation of optimal treatment, minimization of the risk of complications and maintenance of a good quality of life. Please note that this article is for informational purposes only and is not a substitute for professional medical advice. If you have any doubts or symptoms, consult your gynecologist.