The vast majority of ovarian cysts are non-cancerous (benign) but some are cancerous (malignant), or may become cancerous over time. Many do not need any treatment as many go away on their own or cause no problems. Some ovarian cysts may need removal with an operation.
What are ovarian cysts?
A cyst is a fluid-filled sac. Cysts develop in various places in the body. Depending on the type of cyst, the fluid within the cyst can range from thin and watery to thick and paste-like. Some cysts have a thicker solid outer part with some fluid within.
What are the ovaries?
Women have two ovaries, one on either side of the womb (uterus) in the lower tummy (abdomen). Ovaries are small and round, each about the size of a walnut. The ovaries make eggs. In fertile women, each month an egg (ovum) is released from one of the ovaries. The egg passes down the Fallopian tube into the uterus where it may be fertilised by a sperm.
The ovaries also make chemicals (hormones) including the main female hormones - oestrogen and progesterone. These hormones pass into the bloodstream and have various effects on other parts of the body, including regulating the menstrual cycle and periods.
In women of childbearing age, an egg forms and matures each month in a tiny structure within an ovary, called a follicle. When the egg is released (at ovulation) the follicle turns into a small structure called a corpus luteum. If you become pregnant, the corpus luteum forms hormones to help with the pregnancy. If you do not become pregnant, the corpus luteum shrinks and goes away within a couple of weeks.
Cysts on the ovary are very common. Ovarian cysts can vary in size - from less than the size of a pea to the size of a large melon (occasionally even larger). There are various types which include the following:
Functional ovarian cysts
These are the most common type. They form in some women of childbearing age (women who still have periods) when there is a functional fault with ovulation. They are very common. There are two types:
- Follicular cysts. A follicle (see in 'Ovulation', above) can sometimes enlarge and fill with fluid. They can occur commonly in women who are receiving infertility treatment.
- Corpus luteum cysts. These occur when the corpus luteum (see in 'Ovulation', above) fills with fluid or blood to form a cyst. A blood-filled cyst is sometimes called a haemorrhagic cyst.
Both of these cysts can grow up to about 6 cm across. They usually do not need treatment, as they normally go away on their own within a few months.
Dermoid cysts (sometimes called benign mature cystic teratomas)
Dermoid cysts tend to occur in younger women. These cysts can grow quite large - up to 15 cm across. These cysts often contain odd contents such as hair, parts of teeth or bone, fatty tissue, etc. This is because these cysts develop from cells which make eggs in the ovary. An egg has the potential to develop into any type of cell. So, these cysts can make different types of tissue. In about 1 in 10 cases a dermoid cyst develops in both ovaries. Dermoid cysts can run in families.
These develop from cells which cover the outer part of the ovary. There are different types. For example, serous cystadenomas fill with a thin fluid and mucinous cystadenomas fill with a thick mucous-type fluid. These types of cysts are often attached to an ovary by a stalk rather than growing within the ovary itself. Some grow very large. They are usually benign but some are cancerous.
Many women who have endometriosis develop one or more cysts on their ovaries. Endometriosis is a condition where endometrial tissue (the tissue that lines the womb (uterus)) is found outside the uterus. It sometimes forms cysts which fill with blood. The old blood within these cysts looks like chocolate and so these cysts are sometimes called chocolate cysts. They are benign. See the separate leaflet called Endometriosis for more information.
Polycystic ovary syndrome (PCOS)
Polycystic means many cysts. If you have PCOS you develop many tiny benign cysts in your ovaries. The cysts develop due to a problem with ovulation, caused by an hormonal imbalance. PCOS is associated with period problems, reduced fertility, hair growth, obesity, and acne. See the separate leaflet called Polycystic Ovary Syndrome for more detail on PCOS.
There are also other rare types of ovarian cysts. There are also various types of benign ovarian tumours which are solid and not cystic (do not have fluid in the middle).
What are the symptoms, problems and possible complications?
Most ovarian cysts are small, non-cancerous (benign), and cause no symptoms. Some ovarian cysts cause problems which may include one or more of the following:
- Pain or discomfort in the lower tummy (abdomen). The pain may be constant or intermittent. Pain may only occur when you have sex.
- Periods sometimes become irregular, or may become heavier or lighter than usual.
- Sometimes a cyst may bleed into itself, or burst. This can cause a sudden severe pain in the lower abdomen.
- Occasionally, a cyst which is growing on a stalk from an ovary may twist the stalk on itself (a torsion). This stops the blood flowing through the stalk to the cyst and causes the cyst to lose its blood supply. This can cause sudden severe pain in your lower abdomen.
- Large cysts can cause your abdomen to swell, or press on nearby structures. For example, they may press on your bladder or rectum, which may cause urinary symptoms or constipation.
- Although most cysts are benign, some types have a risk of becoming cancerous. (See the separate leaflet called Ovarian Cancer for more details.)
- Rarely, some ovarian cysts make abnormal amounts of female (or male) chemicals (hormones) which can cause unusual symptoms.
How is an ovarian cyst diagnosed?
As most ovarian cysts cause no symptoms, many cysts are diagnosed by chance - for example, during a routine examination, or if you have an ultrasound scan for another reason.
If you have symptoms suggestive of an ovarian cyst, your doctor may examine your tummy (abdomen) and perform an internal (vaginal) examination. He or she may be able to feel an abnormal swelling which may be a cyst.
An ultrasound scan can confirm an ovarian cyst. An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. The probe of the scanner may be placed on your abdomen to scan the ovaries. A small probe is also often placed inside your vagina to scan your ovaries, to obtain more detailed images.
A blood test called a CA125 test is often done as well as an ultrasound scan. If this test is normal it is unlikely your cyst is cancerous. In itself a normal blood test does not completely rule out ovarian cancer, but it can do in combination with an ultrasound appearance of a benign cyst.
Some women may have other tests - for example, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan. For the most common type of benign ovarian cysts this is not needed. It may be useful when the ultrasound scan is not conclusive and/or the CA125 result is higher than normal.
What is the treatment for ovarian cysts?
Your specialist will advise on the best course of action. This depends on factors such as:
- Your age.
- Whether you are past the menopause.
- The appearance and size of your cyst from the ultrasound scan.
- Whether you have any symptoms.
Many small ovarian cysts will resolve and disappear over a few months. You may be advised to have a repeat ultrasound scan after a few months or so. If the cyst goes away then no further action is needed.
Removal of an ovarian cyst may be advised, especially if you have symptoms or if the cyst is large. Sometimes the specialist may want to remove it to determine exactly which type of cyst it is and to make sure there are no cancer cells in it. Most smaller cysts can be removed by 'keyhole' (laparoscopic) surgery. Some cysts require a more open style of operation, with a cut in the lower part of the tummy.
The type of operation depends on factors such as the type of cyst, your age, and whether cancer is suspected or ruled out. In some cases, just the cyst is removed and the ovary tissue preserved. In some cases, the ovary is also removed, and sometimes other nearby structures such as the womb (uterus) and the other ovary. Your specialist will advise on the options for your individual situation.
Endometriosis-related cysts and polycystic ovary syndrome (PCOS)
Further reading and references
Management of Suspected Ovarian Masses in Premenopausal Women; Royal College of Obstetricians and Gynaecologists (December 2011)
The Management of Ovarian Cysts in Postmenopausal Women; Royal College of Obstetricians and Gynaecologists (2016)
Ovarian cancer - the recognition and initial management of ovarian cancer; NICE Clinical Guideline (April 2011)
Smorgick N, Maymon R; Assessment of adnexal masses using ultrasound: a practical review. Int J Womens Health. 2014 Sep 236:857-63. doi: 10.2147/IJWH.S47075. eCollection 2014.
Biggs WS, Marks ST; Diagnosis and Management of Adnexal Masses. Am Fam Physician. 2016 Apr 1593(8):676-81.
Grimes DA, Jones LB, Lopez LM, et al; Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev. 2014 Apr 294:CD006134. doi: 10.1002/14651858.CD006134.pub5.
I recently had a Pelvic/Abdominal CT scan done where they saw a Hypodense 2cm structure in the right ovary and said it may represent a cyst. "hypodense structure" sounds scary... I am 48 and have...Owl555
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