What You Should Know About Ovarian Cysts
Key takeaways:
Ovarian cysts are common and occur in women of all ages.
There are several types of ovarian cysts, and most are not cancerous.
They often do not cause any symptoms and may go away on their own without treatment.
Having an ovarian cyst may seem like a worrisome problem. But you might be surprised to hear that ovarian cysts are very common. Many women get them at some point in their lives. But most are not cancerous, and most will go away on their own without treatment.
Here, we will discuss more about what causes ovarian cysts and what can be done about them.
What are ovarian cysts?
Ovarian cysts are sacs or pouches filled with fluid that can grow in or on your ovary (the organ that stores the eggs that can later form a pregnancy). Ovarian cysts are very common and can affect people with female anatomy at any age.
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What are the symptoms of an ovarian cyst?
Most ovarian cysts don’t cause any symptoms at all. You may only find out you have one because your provider found it on your routine physical exam. Occasionally though, for various reasons, some ovarian cysts can cause symptoms.
A cyst that has gotten very large may cause a dull ache. Or, you may get a feeling of heaviness or bloating in the lower part of your belly. A large cyst can also cause the ovary to twist on itself. If this happens, you may have a sudden, sharp, or stabbing pain on the side where the cyst is. If twisting occurs, the pain can be severe enough to make you nauseated or vomit.
Sometimes a cyst can also bleed or rupture. When this happens, it may also cause sharp or sudden pain. When an ovarian cyst bleeds, the blood stays inside your belly. You would not have abnormal vaginal bleeding from a cyst bleeding or bursting.
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What causes ovarian cysts?
Believe it or not, most ovarian cysts form as part of a natural process during your menstrual cycle. In a typical cycle, one egg is released from your ovary. The egg is in a tiny, fluid-filled sac — called a follicle — inside your ovary. This follicle grows for a couple weeks, then bursts to release the egg. This process is called ovulation.
Sometimes, the follicle that grew in preparation for ovulation does not release its egg. This follicle can continue to grow for a few more menstrual cycles, forming a follicular cyst. This is known as a simple cyst, because it has thin smooth walls and contains only fluid. This type of cyst usually does not cause symptoms.
Are there other types of ovarian cysts?
Yes, there are other types of ovarian cysts. These cysts have nothing to do with your menstrual cycle or ovulation. These include:
Dermoid cysts: These are also called teratomas and are usually found in women between the ages of 20 and 40. A dermoid cyst is very recognizable because it can contain teeth, hair, or fat. Most dermoid cysts are not cancerous. But because a small percentage can lead to cancer, identifying them is important.
Endometriomas: These cysts can sometimes be found in women who have endometriosis. Endometriosis is a condition in which tissue that normally grows on the inside of the uterus now grows on the outside of the uterus. It can affect your tubes or ovaries as well as other organs inside your belly. When it grows on your ovaries, it can form a cyst called an endometrioma.
Tubo-ovarian abscess: This is a pus-filled (infected) cyst that can form around your tubes and ovaries. It can develop in cases of severe pelvic infection which spreads to the tubes or ovaries. Because it is an infected area, it can be painful.
Corpus luteal cyst: This is a cyst that normally develops in early pregnancy. It produces hormones that help to support the early stages of a pregnancy.
Cystadenoma: This is a cyst that can form on the outer surface of the ovary. These cysts often grow very large, so they can cause symptoms of bloating or heaviness. They are noncancerous, but they still need to be removed, because they will not go away on their own.
Cancer: The majority of ovarian cysts are not cancerous. This is especially true if you have a simple (follicular) cyst and are still having regular periods. Less than 1% of simple ovarian cysts are due to cancer. But if you no longer have menstrual periods (after menopause), a new ovarian cyst may have a higher likelihood of being cancerous.
How are ovarian cysts usually found?
Because most ovarian cysts don’t cause any symptoms, you may not be aware you have one. Most are found during a routine pelvic exam by your provider.
If your provider suspects an ovarian cyst, they will recommend a transvaginal ultrasound. This is an imaging test performed by placing a small ultrasound probe into your vagina. The ovaries are deep in the pelvis, so they are difficult to see with the usual abdominal ultrasound.
A transvaginal ultrasound can detect an ovarian cyst and give details about the cyst’s shape, size, and location. It can also identify any features of the cyst that might be suspicious for cancer. Suspicious ultrasound findings may include having:
Multiple fluid-filled areas, or solid areas within the cyst
Irregular shape and size of the cyst
Nodules on the surface of the cyst
Fluid in your belly
How do you treat ovarian cysts?
Treatment depends on several factors. These may include your age, if you have a history of cancer, and what the cyst looks like on ultrasound.
If a simple cyst is suspected, then it may require only close monitoring or watchful waiting. This means your provider will repeat an ultrasound once per menstrual cycle to see if the cyst changes in size or appearance.
In some cases, hormone treatment with birth control pills, shots, or the patch may help. Hormone treatment works by preventing ovulation and slowing down the growth of follicular cysts. So, if you tend to get cysts often, hormone treatment may lessen how often you get them.
But if your provider suspects another type of cyst, they may recommend additional testing before deciding on treatment. Other tests may include:
A pregnancy test, since ovarian cysts are common during pregnancy.
A blood test called CA 125 (cancer antigen 125), which may be recommended if there are other reasons to be suspicious of cancer.
Imaging tests, such as CT scan or MRI, may be used in rare cases if cancer is suspected.
Based on your test results, your provider may recommend surgery. This is also true if your provider suspects your cyst may be cancerous. They may also recommend surgery if you have:
A very large cyst, since they are more likely to rupture or twist.
Persistent pain or pressure from your cyst.
A dermoid cyst, since some may become cancerous.
So, some ovarian cysts can go away on their own?
Yes, some ovarian cysts will go away without treatment. A follicular cyst can be monitored with repeat ultrasounds. The majority of follicular cysts go away on their own within one to two menstrual cycles (6 to 8 weeks).
Can ovarian cysts lead to ovarian cancer?
Most ovarian cysts are not cancerous, nor do they typically lead to cancer. But because there is a small chance of cancer with some cysts, a cyst may still be a worrisome finding. Understanding which situations may be more suspicious for cancer is important. These may include:
Being postmenopausal with a new cyst
Having certain findings on ultrasound (mentioned above)
Having a family history of ovarian or breast cancer
Having a personal history of breast cancer or colon cancer
Having a genetic or inherited condition that increases your risk of ovarian cancer, such as the BRCA mutation or Lynch syndrome
If you are worried about your risk of ovarian cancer, it’s a good idea to discuss this with your healthcare provider. They can help you understand the risks and figure out next steps.
The bottom line
Ovarian cysts are very common and can affect women of all ages. Most do not cause any symptoms. Although having an ovarian cyst may be scary, most are not cancerous and will go away on their own without treatment.
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References
American Cancer Society. (2021). Ovarian cancer risk factors.
American College of Obstetricians and Gynecologists. (2016). Evaluation and management of adnexal masses.
American College of Obstetricians and Gynecologists. (2021). Ovarian cysts.
Centers for Disease Control and Prevention. (2020). Lynch syndrome.
Centers for Disease Control and Prevention. (2021). BRCA gene mutations.
MedlinePlus. (2020). Transvaginal ultrasound.
