Ovarian Cysts: Symptoms, Types, Diagnosis and Treatment

If your doctor suspects you have an ovarian cyst, you may have questions about the condition. This guide will explain what ovarian cysts are, how they are treated and how to prepare for a pelvic ultrasound, a common screening used for diagnosis.

While this guide provides helpful information about ovarian cysts, your doctor will give the official interpretation of your results during a follow-up appointment or phone call. If you’d like early access to your results, PocketHealth offers secure, instant access to your report when it is available. This allows you to review the findings in advance and prepare any questions for your follow-up appointment.

 

 

What is an ovarian cyst?

Ovaries are two small glands located on each side of the uterus. They produce female sex hormones and also create, store, and release eggs for reproduction. Ovarian cysts are fluid-filled sacs found on or within the ovary. Cysts can vary in size and type and may require different treatments. This condition is common and often without symptoms or complications. However, they can cause discomfort for some patients, and other types can be caused by underlying conditions that may need treatment.

 

Types of ovarian cysts

There are different types of ovarian cysts, which can affect their cause, symptoms and treatment. Below is a brief overview of the categories and variations.

Functional cysts

Also called simple cysts, these are the most common type and are not usually caused by underlying conditions. Each month, the ovaries release an egg during ovulation. This occurs through a follicle, a small, fluid-filled sac that contains an immature egg. The ovaries have thousands of these follicles, each with the potential to release an egg, though usually only one egg is released. This process can sometimes lead to the formation of an ovarian cyst. Here are the variations of these functional cysts:

• Corpus luteum cysts: Once the follicle releases an egg, it forms the corpus luteum, a group of cells that produce hormones. Sometimes, fluid collects and grows in these cells, forming a cyst.
• Follicular cysts: If the follicle does not release an egg, it may fill with fluid and grow in size, becoming a cyst.
• Hemorrhagic Ovarian Cysts: Functional cysts may sometimes fill with blood. If these cysts rupture, the pelvic area can fill with blood and cause pain and nausea. Usually these cysts resolve on their own. If they bleed excessively, however, it is recommended to see a doctor for their removal.

Other types of ovarian cysts (complex cysts)

Some types of ovarian cysts have underlying causes other than the menstrual cycle, and they may contain solid or partially solid masses. Treatment or supervision will depend on the type:

• Dermoid cysts: Patients with these cysts are born with them. Dermoid cysts form when tissues, cells and glands found in the skin collect within a cyst. Sometimes, even brain tissue, hair and teeth are found within these cysts. They often occur throughout the body, particularly in the head and neck, but can also form on the ovaries and grow over time. They are usually harmless, but can be removed if necessary.
• Cystadenomas: Often called tumors, these cysts grow on the ovary’s surface and may be filled with thick, mucous-like substances or thin, watery substances. They can grow quite large, but they are usually benign and have an excellent prognosis for treatment.
• Cancerous ovarian cysts: Made of solid masses of cells, some complex ovarian cysts can be a sign of cancer, but this is thankfully rare.
• Endometriomas: Endometriosis occurs when cells similar to those lining the uterus form outside of it. If these cells attach to the ovary, they can become a cyst called an endometrioma. Because they are filled with old menstrual blood, they are often called chocolate cysts due to the dark color of the fluid. Due to their similarity to hemorrhagic cysts, they can often be mistaken for them, leading to a delay in an endometriosis diagnosis.

 

What causes ovarian cysts?

Causes of ovarian cysts vary. Here are the most common reasons these growths form:

• Ovulation: Cysts may form during ovulation if the follicle doesn’t release an egg or if fluid collects in the corpus luteum.
• Irregular cell reproduction: Abnormalities in cell growth can lead to the formation of cystadenomas and dermoid cysts.
• Pelvic inflammatory disease (PID): The most common cause of PID is untreated sexually transmitted bacteria that spread to internal reproductive organs, such as the ovaries. This can cause infections and even lead to ovarian cysts.
• Endometriosis: Typically, endometriomas result from advanced cases of endometriosis.

 

Ovarian cyst symptoms

Often, patients won’t have any symptoms or pain with smaller ovarian cysts. Otherwise, common symptoms include:

• Dull or sharp pain near the location of the ovary that may come and go
• Feeling full or bloated
• Pain during menstruation
• Pain during sex
• Significant pain and nausea with rupturing of hemorrhagic or other types of cysts

 

How is an ovarian cyst diagnosed?

There are several ways ovarian cysts are diagnosed, with medical imaging being the most common. Here’s how they work:

Pelvic exam

The medical provider will perform a pelvic exam to check for any lumps or abnormalities. However, this alone is not enough to diagnose a cyst. Imaging will be used to confirm the diagnosis.

Ultrasounds

Ultrasounds are the most common way to diagnose an ovarian cyst. This imaging technique uses high-frequency sound waves produced by a handheld device called a transducer. As the sound waves bounce off internal structures and organs, the echoes produce images that can be captured on a screen for later analysis. There are two types of ultrasounds used to detect ovarian cysts. Many patients commonly have both performed at the same appointment:

• Transvaginal ultrasound: A transvaginal ultrasound involves inserting the wand-like transducer into the vagina to get a clearer view of the pelvic organs.
• Transabdominal ultrasound: In a transabdominal ultrasound, a clear conductive gel is applied to the lower abdomen, and the transducer is moved across the skin to capture detailed images of the ovaries and uterus.

MRIs (magnetic resonance imaging)

MRIs are another way to diagnose ovarian cysts. They can be especially helpful in detecting endometriomas and other signs of endometriosis. This imaging method uses magnets and radio waves to produce detailed images of the body. Patients lie on a table inside a tube-like machine, staying as still as possible for the duration of the scan. Because of the magnetic nature of this technology, metal should be avoided, and any metal implants should be disclosed before the appointment so that alternatives or accommodations can be arranged.

While MRIs are very effective, ultrasounds are more commonly used for initial screenings because they are easier to schedule and less expensive. Also, insurance often requires ultrasounds to be performed first before they will authorize an MRI.

Laparoscopy

This surgical procedure is performed under anesthesia. The surgeon inserts a tiny camera on a thin tube through a small incision in the abdomen. This allows them to view the pelvic area and organs in great detail. If a cyst is found, the surgeon can remove it using specialized tools that require only minimal incisions. While this is not typically the first step in diagnosing an ovarian cyst, it may be discovered during an unrelated laparoscopic procedure, at which point it can be diagnosed and treated. This type of surgery is less invasive and has a faster recovery than more traditional surgical methods.

 

How is an ovarian cyst treated?

For most cysts, especially functional ones, no treatment is needed. These typically resolve on their own within weeks or a few months. Even many complex cysts don’t require treatment if they aren’t causing significant discomfort. These are often monitored with periodic ultrasounds to ensure the cyst doesn’t grow or undergo other changes. Birth control can reduce the chances of new cysts forming, but it doesn’t affect existing cysts.

When ovarian cysts are causing significant discomfort, laparoscopic removal is a common technique. If the cyst is large or the ovary has been damaged, more extensive surgeries may be required, including an oophorectomy (ovary removal) or open abdominal surgery (laparotomy).

 

How to prepare for an ovarian cyst ultrasound

Since an ultrasound is the most common diagnostic tool for ovarian cysts, here are some helpful tips for preparation. Note that appointments typically last around 30 minutes, and patients can return to their usual routines afterward.

Before your appointment

• Review your requisition: Re-reading any instructions on your requisition can help ensure you don’t miss any steps or preparations.
• Ask if you need a full bladder: Transabdominal ultrasounds require a full bladder to improve imaging angles and help the sound waves travel more effectively. If you’re only having a transvaginal ultrasound, this step won’t be necessary.

The day of your appointment

• Bring your requisition form: If the imaging clinic does not already have your ultrasound orders, bringing the form can save time during check-in. Also, bring your health card and ID.
• Arrive with a full bladder (if applicable): A typical bladder preparation involves urinating an hour before your appointment and then drinking 32 ounces of water. If you are having both a transabdominal and transvaginal ultrasound, the abdominal portion will be performed first, requiring the full bladder. You can then urinate and return for the vaginal portion a few minutes later.
• Wear comfortable clothes: You will need to wear a hospital gown for the transvaginal part of the scan, so choose clothing that is easy to remove.

 

Getting your results

Ultrasound result turnaround times depend on the radiologist’s and your referring doctor’s schedules. It can sometimes take a week or more, especially if you receive them at your follow-up appointment.

PocketHealth provides faster access, allowing you to see your results as soon as they’re uploaded by the radiologist, giving you time to review findings and prepare questions. For added support, MyCare Navigator generates questions to ask your doctor based on findings in your report and highlights any follow-up recommendations found in the report.

 

 

Understanding your results

Although your doctor will explain your results to you, accessing your report before your appointment can give you an early preview. When reviewing your report, it’s common to find the medical terminology complex and confusing. PocketHealth Report Reader simplifies this by offering clear, straightforward definitions for medical terms—simply tap or click on any underlined words to reveal their meaning.

This guide will briefly discuss some common findings in bone scan reports. It’s also important to remember that results can often be perfectly normal, with no ovarian cysts found. In these cases, terms like “unremarkable” or a similar variation are commonly used. You may also see measurements of the ovaries, uterus and other surrounding structures, which simply serve to establish a baseline for future reference. Now that we have reviewed the common elements of a typical report, let’s examine what abnormal results you can come across and what they may mean.

 

What abnormal ultrasound results may mean

Here are some common descriptors ultrasound reports often contain that can indicate ovarian cysts:

• Cystic lesions: A lesion is a term for a growth, such as a tumor or cyst.
  Bilateral/unilateral: Bilateral refers to both ovaries, such as bilateral cysts. Unilateral means the cyst is on only one side.
• Hemorrhagic contents/proteinaceous debris: This describes possible blood or protein debris found within the cyst, as seen in a hemorrhagic cyst.
• Measurements: If a cyst is found, its size will be provided, often in centimeters. Average sizes range from 1-3 centimeters, though there are many exceptions.
• Echo descriptions: How ultrasound echoes bounce back can provide insight into the conditions of the area being scanned. Hypoechoic means the area absorbs few sound waves, indicating a solid structure like bone. Hyperechoic produces many sound waves, indicating something filled with fat or air (like the lungs). Anechoic means no echoes are produced, appearing darker than surrounding tissue and often indicating fluid, as with an ovarian cyst.
• Vascularity: If vascularity is noted, it can suggest that the cyst is developing blood vessels or actively bleeding. This may be a sign of cancerous qualities. Fortunately, this is rare, and most ultrasounds will report “no internal vascularity.”
• Complex or simple: These categories are commonly used in ultrasound reports to describe the cyst’s appearance.

 

What is polycystic ovary syndrome (PCOS)?

PCOS is a hormonal condition that often appears around puberty, though sometimes symptoms don’t start until later. Much is still unknown about PCOS, but it is known that some patients don’t produce enough of the hormones required to ovulate regularly. When ovulation is skipped, the ovaries can form multiple cysts. These cysts can produce androgens, hormones typically found in greater quantities in individuals assigned male at birth. AFAB patients naturally have low levels of androgens too, but those with PCOS have abnormally high levels of these hormones, which cause symptoms such as:

• Menstrual cycle irregularity
• Enlarged ovaries with multiple cysts
• Fertility issues
• Thinning hair or male-pattern baldness
• Skin tags and dark patches of skin
• Weight gain
• Acne
• Excess body hair
• Metabolic syndrome
• Type 2 diabetes or pre-diabetes

The cause of PCOS is still being studied, but there seems to be a link with insulin resistance and obesity. Whether these are causes or effects of the condition is still unclear. Hormone testing and ultrasounds are used for diagnosis.

Treatment includes lifestyle changes to improve insulin sensitivity and weight, diabetes medications, medications to lower androgen levels, fertility treatments (if desired) and other hormone therapies. While treatments are still being improved, they can do much to alleviate symptoms of PCOS. This condition is also being widely studied for further insights on causes and management.

 

Frequently asked questions

Here are some commonly asked questions regarding ovarian cysts.

What is ovarian torsion?

Ovarian torsion occurs when the ovary (or fallopian tube) twists around surrounding tissues. This can cut off the blood supply to the ovary, causing severe lower abdominal pain, along with nausea, vomiting and fever. It is considered a medical emergency because without blood flow, the affected ovary can die, requiring its removal.

Growths, such as ovarian cysts, can add excess weight to the ovary, disrupting its usual balance and making it more prone to twisting or moving inappropriately. Fortunately, this is a rare occurrence, even with ovarian cysts. Treatment involves a diagnostic ultrasound to confirm the torsion, followed by a laparoscopy to untwist the ovary and remove the cyst. If treated quickly, this approach is usually successful.

Is an ovarian cyst a serious problem?

Most of the time, no. The majority of ovarian cysts are functional cysts, which go away on their own and don’t require treatment. Complex cysts are often just monitored with regular ultrasounds for any changes but usually don’t need intervention. Ovarian cysts only become a serious problem in rare cases when they are cancerous, rupture or experience torsion.

How is a ruptured ovarian cyst treated?

Often, a ruptured ovarian cyst will only cause minor symptoms and can be treated with over-the-counter pain medications. In severe cases, they can cause significant pain and internal bleeding. When this happens, it is considered a medical emergency and the patient should go to the ER where they will be treated with fluids, pain relievers and possibly surgery. If surgery is required, bleeding will be controlled, excess fluid and blood clots removed and the cyst or entire ovary may be removed if necessary. Severe ruptured ovarian cysts are, thankfully, a rare occurrence.

How common are ovarian cysts?

It is estimated that 10 out of 100 people assigned female at birth (AFAB) get ovarian cysts. Of those affected, the majority are functional cysts that go away on their own.

Take control of your health with PocketHealth

PocketHealth makes it simple to keep track of your medical reports and ultrasound scans. All of your medical imaging is in one secure location and can be accessed online anytime. If needed, reports can also be easily shared with other physicians in your care team, including gynecologists and other specialists. When used in conjunction with your medical provider’s professional advice, it is a powerful tool for organizing and understanding your imaging results and your health.