Ovarian Cysts

Ovarian cysts are growths that are present within or on the ovary. These can be benign (non-cancerous) or cancerous. Generally, benign cysts are filled with clear body fluid (“simple” cysts), but cysts can also be filled with fatty tissue, gel-like mucinous material, or other contents. 

A pre-menstrual person with ovaries that is not taking any medications to suppress the ovaries will ovulate once a month. Every month, the ovary will develop several small (milimeters) fluid filled sacs – eventually one of these sacs will become dominant and be called a follicular cyst. The word cyst used in the phrase follicular cyst can be a little misleading – the development of a follicular cyst is completely normal and expected. At time of ovulation, the follicular cyst will rupture, releasing the egg. The actual process of ovulation can be painful and some women will be very aware while it is happening (called “Mittelschmertz”). 

In general, follicular cysts are < 3 cm in size.

Ovarian cysts can be diagnosed by physical exam. In general, an ovarian cyst would be larger than 5 cm to be palpable during a pelvic exam. Ultrasound is a mainstay of diagnosis. 

Ovarian cysts can sometimes be found by accident - on physical exam or an imaging test, but there are no symptoms.

However, some women will have symptoms including painful periods, pelvic pain, or painful sex.

Sometimes, ovarian cysts can also impact fertility.

Stratifying your risk of cancer is very important. A full family history is an important place to start. Ultrasonographic features of the ovarian cyst are important to analyze. Certain features, like mural nodules or papillary excrescences (unusual growths within the cyst), will increase our suspicion for cancer. Other features can be reassuring. In some cases, blood tests in addition monitoring the cyst with ultrasound over time may be the best option.

Depending on your  symptoms, risk for cancer, and fertility plans, it may be reasonable to start with watchful waiting. This means we will perform serial ultrasounds as needed. Some women may need another ultrasound within 6-12 weeks; for other women, waiting 6 - 12 months may be more appropriate.

If you ultimately decide surgery (called ovarian cystectomy) is the right option for you, this can be performed robotically or laparoscopically. Most people who undergo ovarian cystectomy are back to desk work in 2-4 weeks.