Ovarian Cysts: The Good, the Bad, and the Ugly
Hearing the phrase “ovarian cyst” can be unsettling. Many people imagine something dangerous or urgent - especially if the finding comes out of nowhere during an ultrasound.
The reality is much calmer. Most ovarian cysts are common, temporary, and benign, and many people have them without ever knowing it. The key is understanding what kind of cyst it is, whether it’s expected, and when it actually matters. This article breaks that down.
What Is an Ovarian Cyst?
An ovarian cyst is a fluid-filled structure that forms on or inside the ovary.
That’s it. A cyst is a description, not a diagnosis.
Many cysts are part of how the ovary normally functions. Others are benign growths that may need monitoring. Only a small fraction are dangerous. Having an ovarian cyst does not automatically mean something is wrong.
How Are Ovarian Cysts Diagnosed and Evaluated?
Most ovarian cysts are found on a pelvic ultrasound — often incidentally.
When clinicians look at a cyst on ultrasound, they’re paying attention to things like:
- Size
- What’s inside the cyst (clear fluid, thicker material, or a mix)
- Whether the cyst has smooth walls or internal structures
- Any features that look unusual or concerning
In some situations:
- An MRI may be used if ultrasound findings aren’t clear
- Blood tests, including tumor markers, may be ordered if certain features raise concern
Not every cyst needs extensive testing. Evaluation is stepwise and based on the overall picture — not just the presence of a cyst.
Common Types of Ovarian Cysts
Functional cysts (the most common):
Functional cysts form as part of the ovary’s normal job and are often related to ovulation.
Common types include:
- Follicular cysts, which are fluid-filled sacs that house a maturing egg
- Corpus luteum cysts, which form after ovulation and stick around to help support a pregnancy if one occurs
- Hemorrhagic cysts, which happen when bleeding occurs into a functional cyst
These cysts are expected and usually resolve on their own over time.
Common but benign abnormal cysts:
Some cysts are not part of normal ovarian function, but are still common and benign, meaning not cancer.
These include:
- Endometriomas, which are associated with endometriosis and typically cause pain
- Dermoid cysts, which develop from germ cells (the cells involved in reproduction) and can contain material such as hair or teeth (!)
- Cystadenomas, which are often larger cysts that may be filled with fluid or mucus
These cysts are more likely to persist or grow rather than disappear on their own. They’re often monitored and are sometimes surgically removed depending on size, symptoms, or growth over time.
Less common cysts and tumors
A smaller number of ovarian cysts represent tumors, including precancerous or cancerous growths. These are much rarer than functional or benign cysts.
Concern is based on imaging features, age, and how a cyst behaves over time - not simply on the word cyst. Most people with ovarian cysts do not have cancer.
When Do Ovarian Cysts Cause Symptoms?
Many ovarian cysts cause no symptoms at all.
When symptoms occur, they may include:
- Pelvic pain or pressure
- Bloating or a feeling of fullness
- Pain during sex
Symptoms don’t always correlate with size. A small cyst can be painful, while a larger one may cause no symptoms.
A Note on Cyst Rupture
Some cysts can rupture. When this happens, it may cause:
- Sudden, sharp pelvic pain
- Pain that improves quickly or lingers
- Occasionally, light bleeding or dizziness
While rupture is often self-limited, severe or worsening pain should be evaluated.
A Note on Ovarian Torsion
Large or heavy cysts can sometimes cause the ovary to twist on itself, cutting off blood flow. This is called ovarian torsion.
Torsion causes sudden, severe pain and often nausea or vomiting. It’s uncommon, but when it happens, it’s an emergency and needs immediate medical care.
When to Seek Care Urgently
You should seek urgent evaluation if you experience:
- Sudden, severe pelvic or lower abdominal pain
- Pain with nausea or vomiting
- Dizziness, fainting, or signs of internal bleeding
Any of these symptoms could point to rupture, bleeding, or torsion, which need to be evaluated and treated in an emergency room.
How Are Ovarian Cysts Treated?
Treatment depends on the type of cyst and whether it’s causing symptoms.
For functional cysts, management is often conservative. These cysts frequently resolve on their own, and treatment may focus on symptom relief, such as pain medication, heat packs, or rest. Follow-up imaging may be used to confirm the cyst is shrinking or gone.
In people with recurrent functional cysts or frequent rupture, certain types of hormonal birth control may reduce the risk of developing new cysts.
For abnormal cysts, management often involves monitoring with ultrasound over time. Some cysts may need to be surgically removed depending on symptoms, size, growth, or imaging features.
When surgery is needed, it’s often minimally invasive and conservative. The type of surgery depends on the cyst itself, symptoms, fertility goals, and individual patient factors. Any abnormal cyst warrants a discussion with your provider to decide next steps.
The Bottom Line
Ovarian cysts are extremely common.
Most are benign and temporary.
Some need monitoring.
A small number require intervention.
What matters most isn’t the word cyst — it’s the context.
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