Ovarian Cysts

Ovarian cysts are a common condition that affects many women during their premenopausal years. However, only around 8% of women have cysts large enough to cause symptoms or require treatment. Most are functional cysts (related to ovulation), benign and resolve on their own within a few menstrual cycles. Less often, a cyst can rupture or cause ovarian torsion, both medical emergencies that need immediate care. At Houston Methodist, our OB-GYN specialists know how to tell a cyst that just needs watchful waiting versus one that requires prompt treatment.

What Are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that form in and on the ovaries. Each month, one ovary releases an egg from a small sac called a follicle. This is ovulation. Most ovarian cysts form when the follicle doesn’t release its egg or doesn’t dissolve after releasing it, causing the sac to fill with fluid. Cysts can form on one or both ovaries and range from the size of a pea to several inches across. Most are noncancerous, though a small number can be malignant, which is why a cyst that doesn’t resolve on its own is usually monitored with imaging.

Why Choose Houston Methodist for Ovarian Cyst Care

Not every ovarian cyst needs surgery, and knowing the difference can help set your mind at ease. Houston Methodist's team of experienced and expert OB-GYNs monitor cysts closely and recommend treatment based on the individual patient.

It helps to look for a specialist who can effectively explain whether your cyst needs watching, medication or surgery, and who takes your symptoms seriously. Our team works closely with other departments, including gynecologic oncology specialists, any time there is concern of ovarian cancer.

Common Causes of Ovarian Cysts

Ovarian cysts are a fairly normal occurrence for most women, and many will never know they have them. The causes of these ovarian cysts can vary widely, and often include:

• Normal ovulation: Functional cysts are the most common type and are typically the least concerning
• Hormonal problems: Imbalances in natural hormones or added hormones (e.g. fertility drugs) can cause ovarian cysts
• Endometriosis: Cysts called endometriomas or chocolate cysts can form when endometrial tissue grows on the ovary
• Pregnancy: A corpus luteum cyst can originate and last throughout a pregnancy
• Pelvic infections: Serious infections can spread to the ovaries, causing cysts to develop
• Polyendocrine metabolic ovarian syndrome (PMOS): Formerly known as polycystic ovarian syndrome (PCOS), this condition can cause multiple small cysts to form on the ovaries

Types of Ovarian Cysts

Most ovarian cysts fall into a few common categories, including:

• Follicular cyst: Forms when a follicle doesn’t release its egg during ovulation
• Corpus luteum cyst: Forms when the follicle reseals and fills with fluid after releasing an egg
• Dermoid cyst: Contains tissue such as hair, skin or teeth and is present from birth
• Cystadenoma: Develops from cells on the outer surface of the ovary and can grow very large
• Endometrioma: Called chocolate cysts, these form when endometriosis tissue grows on the ovary

Signs and Symptoms of Ovarian Cysts

Many ovarian cysts cause no symptoms and are found during a routine pelvic exam or imaging done for another reason. However, in cases of certain types of cysts, number of cysts or location, symptoms may be present.

• Pelvic pain and pressure: Pelvic pain or pressure in the lower abdomen is one of the most common symptoms of an ovarian cyst
• Bloating and abdominal fullness: Feeling bloated or unusually full, especially when you haven’t eaten, is common for women with some types of ovarian cysts.
• Pain during sex: Ovarian cysts can cause painful intercourse, especially when a cyst is large or located close to the fallopian tube.
• Ruptured cyst or ovarian torsion: A cyst that ruptures or twists, called ovarian torsion, causes sudden, sharp pain and is a medical emergency. Other signs of rupture or torsion include fever, dizziness, feeling faint, nausea or vomiting. Seek immediate care if these symptoms occur.
• Irregular menstrual bleeding: Ovarian cysts sometimes disrupt the menstrual cycle, causing irregular periods or noticeable changes in bleeding heaviness or frequency.
• Frequent urination: Ovarian cysts can sometimes press on the bladder, which causes frequent urination, an increased urge to pee and other urinary symptoms.

How Ovarian Cysts Are Diagnosed

There are several methods physicians can use to accurately diagnose ovarian cysts and create an appropriate treatment plan. These diagnostic tests include:

 

• Clinical evaluation based on symptoms and a pelvic exam
• Pelvic ultrasound to create an image of the ovary that indicates size, location and type of cyst
• Blood tests to check hormone levels or, in some cases, a tumor marker if there’s concern about ovarian cancer
• Imaging tests such as CT scans or MRI may be used for a closer look at a more complex or persistent cyst

Treatment Options for Ovarian Cystss

Treatment depends on the size, type and symptoms associated with the cyst, and whether or not it’s likely to resolve on its own. Most physicians often prefer a more conservative approach to start, but surgical options are available and effective when needed.

Non-Surgical Treatments

Non-surgical treatments for ovarian cysts include:

 

• Watchful waiting: Most functional cysts resolve within two to three cycles without treatment
• Pain medications: Over-the-counter anti-inflammatories can help with discomfort associated with ovarian cysts
• Hormonal management: Many physicians prescribe birth control pills to prevent new cysts from forming

Surgical Treatments

Surgical treatment options for ovarian cysts include:

 

• Cystectomy: Surgical removal of the cyst that preserves the ovary, usually performed via minimally invasive laparoscopy
• Oophorectomy: Surgical removal of the entire ovary and sometimes the fallopian tube, typically only recommended when a cyst is very large, persistent or malignant