Ovarian Cyst: Symptoms, Types and When to Worry

"There is a cyst on your ovary" is one of the most alarming sentences a woman can hear at an ultrasound, and one of the least alarming findings a doctor can see. Most ovarian cysts are a normal part of how ovaries work, cause no symptoms, and disappear within a few cycles without any treatment. A minority need monitoring or surgery. This guide explains how to tell which kind you are dealing with, and the warning signs that need same-day care.

What an ovarian cyst is

A cyst is simply a fluid-filled sac. Every month, one of your ovaries grows a small sac (a follicle) that releases an egg. When that process runs slightly off script, the sac keeps growing instead of releasing or shrinking, and the result is a cyst. Because this is part of the normal cycle, cysts of this type are called functional cysts, and they are extremely common in women who have periods.

Functional cysts: the common, harmless kind

Follicular cysts form when the follicle does not release its egg and keeps filling with fluid. Corpus luteum cysts form after the egg is released, when the leftover sac seals up and swells. Both are usually under 5 cm, cause no symptoms or only mild one-sided ache, and go away on their own within one to three cycles. The standard advice for a simple cyst found on ultrasound is a repeat scan after six to eight weeks, and most of the time there is nothing left to see.

Cysts that need more attention

Endometriomas ("chocolate cysts") are filled with old blood and are a sign of endometriosis. They do not resolve on their own and can affect fertility; our endometriosis guide covers this in detail. Dermoid cysts grow slowly from cells present since birth and are almost always benign, but they are removed if large because they can twist the ovary. Cystadenomas are fluid- or mucus-filled growths that can become large and also usually need removal. After menopause, any new ovarian cyst deserves proper investigation, because the balance of probabilities changes with age.

One common confusion: polycystic ovaries in PCOS are not really cysts at all. They are many small immature follicles, and they are managed completely differently. If your report says "polycystic ovaries", read our PCOS guide rather than worrying about cyst surgery.

Symptoms to look out for

Most cysts cause nothing. When they do cause symptoms, the usual ones are a dull ache or pressure on one side of the lower belly, bloating or heaviness, pain during intimacy, discomfort with bowel movements or urination if the cyst presses on nearby organs, and sometimes irregular or delayed periods. Symptoms from a cyst are typically one-sided, which is a useful clue for your doctor.

Red flags: rupture and torsion

Two complications turn a harmless cyst into an emergency. A rupture (the cyst bursts) causes sudden sharp one-sided pain, sometimes with light bleeding. Many small ruptures settle with rest and painkillers, but severe pain, dizziness or fainting needs hospital care because of internal bleeding. Torsion (the cyst makes the ovary twist on its stalk) causes sudden severe pain with nausea and vomiting, and it cuts off the ovary''s blood supply. Torsion is a surgical emergency: the sooner it is untwisted, the better the chance of saving the ovary. Sudden severe pelvic pain on one side, especially with vomiting or fever, means go to a hospital the same day, not a clinic appointment next week.

Diagnosis and costs in Pakistan

A pelvic ultrasound (abdominal or transvaginal) is the main test and costs roughly Rs 1,500 to 4,000 at private labs and hospitals in most cities. The report will describe the cyst''s size and whether it is simple (thin-walled, fluid only, almost always benign) or complex (solid areas, thick walls, needs follow-up). Doctors sometimes add a CA-125 blood test for complex cysts; know that CA-125 rises with many harmless conditions, including endometriosis and even periods, so a mildly raised result in a young woman is rarely the bad news it sounds like.

Treatment: usually patience, sometimes surgery

Simple functional cysts are watched, not treated; the repeat scan is the treatment. Hormonal pills do not shrink an existing cyst, though they can reduce new ones forming. Surgery (usually laparoscopic, through keyhole cuts) is reserved for cysts that are large, growing, complex, causing significant pain, or of a type that will not resolve, such as dermoids and endometriomas. Surgeons remove the cyst and leave healthy ovary behind whenever possible, which matters if you plan to have children.

Cysts and fertility

Ordinary functional cysts do not harm fertility. Endometriomas and PCOS can, and both are manageable with the right care. If you are trying to conceive, our trying-to-conceive guide covers the practical steps, and the free Fertile Days Finder helps you time each cycle well.

This article is for education and does not replace medical advice. Reviewed for accuracy by our medical review board.