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Ovarian Cysts: Symptoms, Diagnosis, Treatment and Surgical Options



Ovarian Cysts: Symptoms, Diagnosis, Treatment and Surgical Options

By Dr. Alpana Gupta Khare
Consultant Obstetrician & Gynaecologist, Navi Mumbai

What is an Ovarian Cyst?

An ovarian cyst is a fluid-filled sac that develops in or on an ovary. Ovarian cysts are very common among women of reproductive age and, in most cases, are harmless and disappear on their own without treatment. However, some cysts can cause pain, menstrual irregularities, infertility issues, or complications requiring medical or surgical treatment. 

Types of Ovarian Cysts

1. Functional Cysts

These are the most common ovarian cysts and are related to the normal menstrual cycle.

* Follicular cyst
* Corpus luteum cyst

Most functional cysts resolve naturally within a few weeks to months. 

2. Endometrioma (Chocolate Cyst)

These cysts develop in women suffering from endometriosis and may be associated with pelvic pain and infertility.

3. Dermoid Cyst (Teratoma)

These cysts may contain hair, skin, fat, or other tissues and usually require surgical removal.

4. Cystadenoma

These cysts arise from the surface of the ovary and can grow quite large.

5. Polycystic Ovaries (PCOS)

Multiple small cysts may be seen in women with Polycystic Ovary Syndrome, a hormonal disorder affecting ovulation.

Symptoms of Ovarian Cysts

Many women have no symptoms and the cyst is discovered during a routine ultrasound examination. When symptoms occur, they may include:

* Lower abdominal or pelvic pain
* Bloating or abdominal fullness
* Irregular menstrual cycles
* Pain during intercourse
* Frequent urination
* Difficulty conceiving
* Sudden severe pain if the cyst ruptures or twists (ovarian torsion) 

When Should You See a Doctor?

Consult a gynaecologist if you experience:

* Persistent pelvic pain
* Increasing abdominal swelling
* Irregular or heavy periods
* Severe pain with nausea or vomiting
* Difficulty becoming pregnant
* Pain after menopause

Emergency medical attention is needed if there is sudden severe pelvic pain, dizziness, fainting, or signs of internal bleeding. 

Diagnosis of Ovarian Cysts

Your doctor may recommend:

Pelvic Examination
To detect any pelvic mass.
 Ultrasound Scan
The most important investigation to determine:

* Size of the cyst
* Location
* Whether it is simple or complex
* Presence of solid components

Blood Tests

* CA-125 (in selected cases)
* Hormonal profile
* Pregnancy test when indicated

MRI or CT Scan

Used for complex or suspicious cysts. 

Treatment Options

Treatment depends on:

* Age of the patient
* Symptoms
* Size of the cyst
* Type of cyst
* Menopausal status
* Risk of malignancy

1. Observation (Watchful Waiting)

Small simple cysts often disappear naturally.

Your doctor may advise:

* Repeat ultrasound after 6–12 weeks
* Regular follow-up visits

Many cysts resolve without any intervention. 
2. Medical Treatment
Pain Relief

Pain medications may be prescribed for symptomatic relief.

Hormonal Treatment

Oral contraceptive pills may be recommended in selected patients to reduce the formation of new functional cysts, although they do not shrink existing cysts. 

When is Surgery Required?

Surgery may be advised when:

* The cyst is large
* Persistent despite observation
* Causes significant pain
* Suspicion of cancer exists
* Ovarian torsion occurs
* Cyst rupture with complications
* Infertility-related cysts such as endometriomas
* Complex ovarian masses are present 

Surgical Options for Ovarian Cysts

 1. Laparoscopic Ovarian Cystectomy (Keyhole Surgery)

This is the preferred treatment for most benign ovarian cysts.

Procedure

* Performed through small incisions
* A camera and specialized instruments are inserted
* Only the cyst is removed while preserving the ovary whenever possible

Advantages

* Minimal pain
* Smaller scars
* Less blood loss
* Faster recovery
* Short hospital stay
* Early return to work and normal activities

Most women return home within 24 hours. 

 2. Laparotomy (Open Surgery)

Open surgery may be necessary when:

* The cyst is very large
* Cancer is suspected
* There are extensive adhesions
* Safe removal through laparoscopy is not feasible

Advantages

* Better access for complex cases
* Safer removal of suspicious masses

 Disadvantages

* Larger incision
* Longer hospital stay
* Slower recovery period 

3. Oophorectomy (Removal of Ovary)

In some cases, the entire ovary may need to be removed if:

* The cyst cannot be separated from the ovary
* Severe ovarian damage exists
* Cancer is suspected

Whenever possible, fertility-preserving surgery is preferred, especially in younger women. 

Recovery After Surgery

After Laparoscopy

* Discharge within 24 hours
* Mild discomfort for a few days
* Return to work within 1–2 weeks

 After Open Surgery

* Hospital stay of 2–5 days
* Recovery may take 4–6 weeks

Your doctor will advise follow-up visits and review the pathology report if tissue has been sent for examination. 

Can Ovarian Cysts Affect Fertility?

Most ovarian cysts do not affect fertility. However:

* Endometriomas may reduce fertility
* Large cysts can interfere with ovarian function
* Timely treatment can improve reproductive outcomes

Women planning pregnancy should seek specialist evaluation if an ovarian cyst is detected.

Prevention and Regular Check-ups

Although not all ovarian cysts can be prevented, regular gynaecological check-ups help detect problems early. Women should not ignore persistent pelvic pain, bloating, or menstrual irregularities.

Final Thoughts

Most ovarian cysts are benign and can be managed with observation and regular monitoring. However, some cysts require medical treatment or surgery to prevent complications and preserve reproductive health. Early diagnosis and appropriate management are key to achieving the best outcomes.

If you are experiencing pelvic pain, irregular periods, infertility, or have been diagnosed with an ovarian cyst, consult an experienced gynaecologist for personalized evaluation and treatment.

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