Gynaecology Ovarian Cysts

Ovarian Cysts

The presence of an ovarian cyst can cause concern and anxiety for many women. Fortunately, most cases are benign and resolve on their own, but if persistent, may need investigation or medical intervention.

Ovarian cysts are exceedingly common; most women will develop a cyst at some point in their lives, including during adolescence and up to post-menopause. The majority of these are asymptomatic and may only be discovered incidentally during investigation for another issue. Other cysts may cause symptoms requiring specialist treatment.


What causes ovarian cysts?

An ovarian cyst is a fluid-filled sac in an ovary, and is especially common in women of childbearing age. There are several different types of ovarian cysts with different causes:

  • Functional cysts develop during your menstrual cycle associated with ovulation; these typically self-resolve within 2-3 months
  • Other non-cancerous cysts can arise from conditions such as endometriosis (known as an endometrioma or chocolate cyst due to their colour), hormone changes, or congenital abnormalities 
  • Cancerous cysts indicating ovarian cancer are rare, the cause of which is currently not fully understood

Diagnosis of ovarian cysts

An ovarian cyst may be diagnosed based on your presenting symptoms or found incidentally, such as during fertility testing. It is not always necessary to seek a formal diagnosis for an ovarian cyst if you are not experiencing any problems and there are no suspicious features of the cyst on ultrasound that suggest cancerous changes.

Symptoms of ovarian cysts

Most women with an ovarian cyst are asymptomatic. If symptoms are present, you may experience:

  • Pain in your abdomen or pelvis that comes and goes, and may be more prominent around your menstrual period
  • Painful intercourse
  • Pain during bowel movements
  • A bloated, heavy feeling in your abdomen
  • Irregular menstrual periods

Uncommonly, an ovarian cyst can cause your ovary to twist. This ovarian torsion causes an abrupt cut-off of the ovary’s circulation, which can result in sudden abdominal pain that radiates to your back or sides, nausea and vomiting, swelling in your belly, and a fever. 

How are ovarian cysts diagnosed?

The presence of an ovarian cyst can be confirmed with an ultrasound, usually performed transvaginally (through your vagina). This examination can also provide valuable information about the type and characteristics of the cyst. A repeat ultrasound is often required six weeks to three months after the initial scan to see if the cyst has self-resolved over time. 

Additional tests may occasionally be required, including:

  • Blood tests to look for biomarkers that may indicate a risk of ovarian cancer
  • CT or MRI imaging
  • A pregnancy test to exclude the presence of an ectopic pregnancy, which may present with similar symptoms to an ovarian cyst

How are ovarian cysts treated?

Most ovarian cysts will resolve on their own without any treatment. Dr Huang may recommend medical or surgical intervention if the cyst persists beyond three months, is particularly large or progressively getting larger, is causing you bothersome symptoms including infertility, or if there is a risk of malignancy.

Hormone medications

Hormone therapies such as the oral contraceptive pill or other hormone medications more commonly used as contraception, can be prescribed to reduce the formation of new cysts. These treatments do not play a significant role in shrinking existing cysts.

Surgery

Surgery is the treatment of choice for persistent or symptomatic cysts, as it is the most direct way to confirm the type of cyst and also provides a definitive treatment. 

Most surgical treatments for ovarian cysts are performed via laparoscopy, a minimally-invasive endoscopic surgery involving two to four keyhole incisions in your abdomen. Surgical tools such as a long, thin camera known as a laparoscope are inserted via these incisions, as well as other instruments used for excision of the cyst. A laparoscopy is performed as a day procedure under general anaesthesia. 

Some larger or more complex ovarian cysts may require open abdominal surgery known as a laparotomy. Open surgery requires a larger incision and a longer hospital stay after your operation.

Any surgical approach to treating ovarian cysts aims to remove only the cyst while leaving your ovary intact. However, if the cyst is very large or unable to be cleanly separated from the surrounding ovarian tissue, part or all of the ovary may need to be taken out.

What can fertility testing identify?

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Frequently Asked Questions

The majority of ovarian cysts have no impact on your fertility. However, certain types of cysts are associated with hormonal imbalances, and it is the disruption to your normal hormone function that may interfere with ovulation and, subsequently, your ability to fall pregnant.

Complications arising from an ovarian cyst are rare but can be a medical emergency. Ovarian torsion occurs when the cyst causes the ovary to twist, pinching off its blood supply, and accounts for around 3% of all gynaecological surgical emergencies. An ovarian cyst may also rupture or bleed, which is in fact a common and usually uneventful occurrence, particularly with functional cysts. However, if it is a different type of cyst, or if there is a history of poor blood clotting, a ruptured cyst may result in pain and/or shock from internal bleeding.

An ovarian cyst only needs intervention if it’s causing you bothersome symptoms, interfering with your chances of conceiving, or if your gynaecologist identifies it as being very large, persistent, or growing. Ovarian cysts with a suspicion of malignancy must also be removed. Otherwise, most cysts will resolve on their own with time and can safely be monitored without treatment. 

Features that may need more urgent assessment include severe or sudden pain, vomiting, fever, dizziness, fainting, or signs that the cyst may have twisted, ruptured, or is bleeding. Larger, persistent, or complex cysts may also need closer review.

Yes. Many ovarian cysts, especially functional cysts, resolve without treatment over a few menstrual cycles. This is why follow-up ultrasound is often recommended before deciding whether intervention is needed.

Surgery may be recommended if a cyst is persistent, enlarging, causing pain, affecting fertility, or has suspicious features of malignancy on imaging. The most appropriate approach depends on the cyst’s size, appearance, and your symptoms.

Need expert gynaecology care? Contact Dr Alice Huang, Melbourne gynaecologist and surgeon, today

Dr Huang has been providing comprehensive gynaecology care for women for over 20 years, with a focus on clear communication and patient-centred, evidence-based care that guides you through the journey step by step. Her expertise includes surgical procedures such as laparoscopy, hysteroscopy, and endometrial ablation, as well as in-office procedures including pelvic ultrasound and colposcopy. Her rooms are conveniently located at Epworth Freemasons Hospital in East Melbourne.

Contact Dr Huang’s rooms today to arrange your appointment.

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