Ovarian Cysts: Types, Symptoms and When to Treat

An ovarian cyst is a fluid-filled sac that forms in or on an ovary. Most are harmless, cause no symptoms and disappear by themselves within a few months.

A small number can cause trouble, and sudden severe pain with vomiting is an emergency. This guide explains the common types, the signs to watch for, and how doctors decide between waiting and treating.

What Is an Ovarian Cyst?

Many women develop a cyst at some point, often during the normal monthly cycle. MedlinePlus notes that most are found during a routine pelvic examination or scan, and most go away without treatment. Cysts are usually not linked to fertility problems, according to the NHS, although some underlying conditions that cause cysts can affect fertility.

Types of Ovarian Cysts

Functional cysts

These are the most common and are part of the menstrual cycle. Cleveland Clinic names two kinds: a follicular cyst, when the follicle keeps growing instead of releasing the egg, and a corpus luteum cyst, when the sac left behind after ovulation fills with fluid. They usually shrink within a few months.

Other cysts

• Dermoid cysts: contain tissue such as hair or skin; usually non-cancerous
• Cystadenomas: grow on the ovary surface and hold watery or mucus-like fluid
• Endometriomas: blood-filled cysts linked to endometriosis (see our guide to painful periods and endometriosis)
• Cysts that need checking for cancer: uncommon, and the chance rises after menopause

Women with PCOS often have many small follicles on the ovaries, which people loosely call cysts. That is a different situation, explained in our article on understanding PCOS.

Symptoms

Small cysts often cause nothing. The NHS says symptoms usually appear when a cyst bursts, grows large or twists. They can include:

• A dull, heavy ache or sharp pain in the lower tummy, sometimes on one side
• Pain during sex
• Bloating, a swollen tummy or feeling full quickly
• Needing to pass urine more often, or difficulty emptying the bowels
• Changes in periods: heavier, lighter or irregular
• Pain in the lower back

Ovarian Torsion and Rupture: The Emergencies

A large cyst can make the ovary twist, cutting off its blood supply. This is called torsion. Cleveland Clinic describes sudden, severe pain with nausea and vomiting, and calls it a medical emergency. A cyst can also burst. MedlinePlus advises getting medical help right away if a cyst bursts or causes bleeding.

When to be cautious: Sudden severe tummy or pelvic pain, especially with vomiting, fever, dizziness, fainting, fast breathing or cold clammy skin needs care straight away. Do not wait for it to pass. Go to the nearest hospital or see our emergency page.

How Cysts Are Diagnosed

1. Pregnancy test. Pregnancy, including an ectopic pregnancy, can cause similar pain, so this is checked first. See our guide to ectopic pregnancy signs.
2. Pelvic examination. To feel for lumps or tenderness.
3. Ultrasound. Shows the size, position and whether the cyst is fluid-filled or has solid parts.
4. Further tests or laparoscopy. Used if the cyst looks unusual, and sometimes the cyst can be removed through the same keyhole procedure.

Watching, Medicine or Surgery?

The NHS says treatment depends on the cyst's size and look, your symptoms and whether you have been through menopause. Typical approaches are:

• Watchful waiting: for likely functional cysts, a repeat ultrasound after some weeks or months to see whether it has gone
• Hormonal birth control: your doctor may prescribe it to stop ovulation and help prevent new functional cysts, and to stop cysts growing or coming back
• Surgery: considered for cysts that are large (Cleveland Clinic mentions about 10 cm), keep growing, cause symptoms or look suspicious. Surgeons try to protect the ovary and fertility where possible.

After menopause, doctors usually follow cysts more closely with scans and sometimes blood tests, because the chance of a cancerous cyst is higher.

Tip: If you are told to wait and rescan, note the date and keep the appointment. Missing the follow-up scan is the most common way a changing cyst gets overlooked.

Cysts, Fertility and Pregnancy

Most cysts do not affect fertility. If a cyst is found during early pregnancy, it is usually followed with scans; your doctor decides whether anything is needed. Discuss any known cyst at your first antenatal visit. If you are having trouble conceiving, the infertility and reproductive care team can review your ovaries and cycle.

Myths and Facts

• Myth: Every ovarian cyst is a tumour. Fact: Most cysts are fluid-filled sacs linked to ovulation and go away on their own.
• Myth: A cyst means you cannot have a baby. Fact: Fertility is usually unaffected, and surgeons try to protect the ovary when a cyst must be removed.
• Myth: A cyst you cannot feel is not worth checking. Fact: Small cysts are often silent, which is why scans and follow-up matter.

What to Expect at the Hospital

You will be asked about your periods, the pain, and whether you could be pregnant. An ultrasound is the main test, and it is usually quick and painless. If the cyst looks simple and you feel well, your doctor may suggest a repeat scan later. If you arrive with sudden severe pain, doctors will check for bleeding or torsion and decide whether urgent surgery is needed.

Ask the doctor what the scan showed in plain words, how big the cyst is, and exactly when to come back. Keep a copy of the report for the next visit.

When to See a Doctor

• Pelvic or abdominal pain that does not go away
• A swollen or enlarging tummy, or constant bloating or pressure
• Periods that are late, irregular or painful
• Pain during sex
• Trouble getting pregnant
• Any new symptoms after menopause

Talk to a doctor

Book an appointment at Chaitanya Hospital, Kadapa (near RTC Bus Stand, Simhapuri Colony), or call +91 944 103 0587. Teleconsultation is also available if you would like to start with a conversation from home. This article is for general awareness and is not a substitute for a doctor's advice.