Ovarian Cyst: Symptoms, Treatment & Common Doubts

An ovarian cyst is a fluid-filled pouch that forms in or around the ovary, which can cause pain in the pelvic region, delayed menstruation or difficulty in getting pregnant. Generally, the cyst in the ovary is benign and disappears after a few months without needing treatment. However, if you present symptoms, you may need medical treatment.

Ovarian cysts are usually not very serious, being common in women between the ages of 15 and 35, and they may arise several times throughout life.

Cyst in the left ovary
Cyst in the left ovary

Types of ovarian cysts

The main types of ovarian cysts include:

  • Follicular cyst: this is formed when there is no ovulation or when the ovum does not leave the ovary during your fertile phase. Usually you do not have any symptoms and it does not require treatment. Its size can vary from 2.5 cm to 10 cm and it usually decreases in size in 4 to 8 weeks, thus it is not considered to be a type of cancer.
  • Corpus luteum cyst: this may occur after the release of an ovum and usually disappears without treatment. Its size varies between 3 and 4 cm and it may rupture during intimate contact, but no specific treatment is necessary. However, if you experience severe pain, a drop in blood pressure and an accelerated heartbeat, it may be necessary to remove it through laparoscopic surgery.
  • Theca-lutein cyst: it occurs rarely, being more common in women who take medication to get pregnant;
  • Hemorrhagic cyst: it happens when there is bleeding in the cyst wall and can cause pelvic pain;
  • Dermoid cyst: also called mature cystic teratoma, which can be found in infants, containing hair, tooth or bone fragment, requiring laparoscopy;
  • Ovarian fibroma: it’s a more common neoplasm in menopause. It can range from microcysts to a total weight of up to 23 kg, and it should be removed with surgery.
  • Ovarian endometrioma: it arises in cases of endometriosis in the ovaries, needing to be treated with medication or surgery;
  • Cystadenoma: a benign ovarian cyst, which must be removed through laparoscopy.

These cysts are filled with fluid, so they are also known as anechoic cysts because they do not reflect the ultrasounds used in diagnostic tests. However, the term anechoic is not related to their severity.

The type of cyst can be evaluated by a gynecologist through examinations such as ultrasound, laparoscopy or blood tests. Painkillers such as Dipyrone can be used in cases of pain, oral contraceptives can be used to suppress ovulation, which usually decreases follicular cysts, that are the most common. Placing a warm compress over the painful region may also relieve the discomfort, but whenever the pain is very intense you should go to the doctor or emergency room to undergo a new ultrasound in order to observe if there was growth or if the cyst ruptured and if surgery is needed.

Symptoms of ovarian cysts

It is very rare for an ovarian cyst to cause symptoms, but when it is very large, more than 3 cm in diameter, you can experience symptoms such as:

  • Pain in the ovary, on the side where the cyst is;
  • Pain during ovulation;
  • Pain during intimate contact;
  • Menstrual delay;
  • Increased breast tenderness;
  • Vaginal bleeding outside your menstrual period;
  • Weight gain, due to the hormonal changes;
  • Difficulty getting pregnant.

To diagnose an ovarian cyst, various tests are necessary, such as palpation of the pelvic region, transvaginal ultrasonography, computed tomography and magnetic resonance imaging. 

The gynecologist can also ask for a pregnancy test because it gives the reference range of Beta HCG so he can exclude the possibility of an ectopic pregnancy, which presents the same symptoms, and can even help to identify the type of cyst that you have.

After identifying the ovarian cyst, the gynecologist may also request blood tests, such as CA 125, whose maximum value should be 35 mUL, to check if the cyst is malignant and is considered ovarian cancer.

Warning signs

Warning signs that may indicate a possible ovarian torsion, which needs urgent surgery are:

  • Intense pain on one side of the abdomen, which lessens when you put hot compresses on the region;
  • Symptoms usually arise such as nausea and vomiting, which can be confused with appendicitis or bowel obstruction.

If you experience these symptoms, you should go to the emergency room as soon as possible.

Cysts that are more likely to rupture or twist are those that measure more than 8 cm. In addition, for a woman who gets pregnant and has a large cyst, there is a greater chance of torsion between 10 and 12 weeks of pregnancy due to the growth of the uterus, because it pushes on the ovary, provoking torsion.

Ovarian Cyst: Symptoms, Treatment & Common Doubts

What are the treatment options

Having a cyst in the ovary is not always dangerous, and usually it is expected to decrease in size alone, without the need for treatment.

However, ovarian cysts can also be treated by taking the contraceptive pill appropriate to each case, and when it causes symptoms or hinders the functioning of the organ, surgery can be recommended to remove the cyst without removing the ovary. In more severe cases, where the cyst is very big, has signs of cancer or there is ovary torsion, it may be necessary to completely withdraw the ovary.

Is it possible to get pregnant?

A cyst in the ovary does not cause infertility, but it may make getting pregnant more difficult due to the hormonal changes that led to the cyst. However, with proper treatment, the cyst tends to diminish or disappear allowing the body to go back to its normal hormonal rhythm, facilitating fertilization.

If you have an ovarian cyst and become pregnant, you should make regular visits to your obstetrician because there is a greater risk of complications such as ectopic pregnancy.

Can a cyst be a sign of ovary cancer?

An ovarian cyst is usually not cancer, being only a benign lesion that can disappear on its own or be removed through surgery when it is too big, because there can be a risk of it rupturing or if it causes significant pain and discomfort. Ovarian cancer is more common in women over the age of 50, being very rare in women under 30.

The cysts that may be cancer are those large in size, with a thick septum and a solid area. If the doctor suspects anything, they should request the CA 125 blood test because that high value may indicate a carcinogenic lesion. However, women with ovarian endometrioma may have elevated CA 125, and not have cancer.

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  • McCartney C, Marshall J. Polycystic ovary syndrome. N Engk J Med. 1. 375; 54-64, 2016
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