What Are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that form inside or on the ovaries—which are female reproductive organs. During each menstrual cycle, inside the ovaries, an ovarian follicle matures and releases one egg. This process is known as ovulation.

There are several types of ovarian cysts, including ones that develop as a side effect of endometriosis. Generally, ovarian cysts do not cause symptoms and typically go away within three months—so you may not even know you have an ovarian cyst. However, some complications can occur and cause symptoms such as pelvic pain, bloating, nausea, and vomiting. While it's rare, some cysts can become cancerous.

If you get regular periods, unfortunately there's no way to prevent ovarian cysts from developing. However, it's important to note that only 8% of premenopausal people (or, people who have not started menopause) with ovarian cysts require treatment.

Types of Ovarian Cysts

There are several types of ovarian cysts, all of which may be functional or non-functional. Functional ovarian cysts include:

• Follicular cysts: These cysts can develop if an ovarian follicle does not release an egg during ovulation. The ovarian follicle fills with fluid, causing a cyst to form. 
• Corpus luteum cysts: The corpus luteum forms each month after ovulation. The corpus luteum releases hormones that thicken the inside of the uterus. However, a cyst can form if the corpus luteum fills with blood and other follicular matter. 
• Theca lutein cysts: These cysts can develop as a side effect of hormone therapies for infertility. 

Non-functional ovarian cysts include:

• Endometriomas: These cysts occur in some people with endometriosis. Endometriosis is a condition that occurs when tissue that is similar to the tissue that lines the inside of the uterus develops outside of the uterus. In some cases, that tissue is found inside the ovaries and forms a cyst. Endometriomas are also known as “chocolate cysts” since they are filled with thick, dark blood.
• Dermoid cysts: This type of cyst is actually a germ cell tumor and consists of skin cells and sebaceous glands, which secrete sebum (oil). The sebum accumulates inside the ovary and can form a cyst. Sometimes hair, teeth or even thyroid tissue can be found inside.
• Cancerous cysts: Although rare, cysts may become cancerous. Post-menopausal people have a higher risk of ovarian cancer than people with regular periods.

Symptoms

Usually, ovarian cysts do not cause symptoms. In fact, people may only notice symptoms if complications occur. In some cases, however, you might experience symptoms if your cysts are occurring as a result of an underlying condition, such as endometriosis or ovarian cancer.

Functional Cyst Symptoms

For the most part, people with functional cysts do not have symptoms. However, symptoms may occur if the cyst grows, bleeds, breaks open, or twists. You may experience:

• Bloating
• Pelvic pain during bowel movements, periods, or sexual intercourse
• Changes in periods, which are especially common with corpus luteum cysts
• Spotting between periods
• Nausea and vomiting

Sometimes, a functional cyst can twist the ovary, which is known as ovarian torsion. Torsion breaks off the blood supply to the ovary and causes sudden, severe pain. This is a surgical emergency and rapid intervention is necessary to preserve the function of the ovaries.

Endometriomas Symptoms

One of the hallmark symptoms of endometriosis is pelvic pain, which commonly occurs alongside period pain. Typically, pelvic pain starts two to three days before your period and ends a couple of days after the start of your period.

In addition to painful periods, symptoms of endometriomas include:

• Heavy flow during periods
• Back pain
• Pain during bowel movements, urination, or sexual intercourse
• Frequently urinating
• Nausea and vomiting
• Bloating
  

Dermoid Cysts Symptoms

Like functional cysts, dermoid cysts do not typically cause symptoms. Symptoms may occur if a dermoid cyst grows or ruptures. In such cases, dermoid cysts symptoms include:

• Abdominal pain
• Swelling in the stomach
• Fever may occur if the cyst ruptures
• Nausea and vomiting
• Changes in bowel movements

Cancerous Cysts Symptoms

While ovarian cancer rarely develops from cysts, it is possible for cysts to become cancerous. As a result, you might experience symptoms such as:

• Bloating
• Pelvic pain
• Trouble eating food or becoming full too quickly
• Sudden urge to urinate or frequently urinating
• Constipation
• Fatigue
• Nausea and vomiting
• Back pain
• Pelvic pain during sexual intercourse
• Weight loss

Causes

Ovarian cysts can develop if ovulation does not happen. During each menstrual cycle, one ovarian follicle matures an egg. Then, the ovarian follicle releases the egg during ovulation. However, a follicular cyst can develop if the egg stays inside the ovarian follicle instead of releasing.

One of the reasons why ovulation may not occur is due to a hormone imbalance. For example, theca lutein cysts develop as a side effect of hormone therapies or as a result of high HCG levels, which can occur in twin or molar pregnancies. Other ovarian cysts can form due to different causes, such as endometriosis.

Risk Factors

Anyone with ovaries can develop ovarian cysts. However, some people have a higher risk of ovarian cysts than others. You may be at an increased risk of ovarian cysts if you align with one or more of the following risk factors:

• Hormonal imbalance: Some ovarian cysts develop if there’s an imbalance of hormones that regulate your menstrual cycle. Hormone therapies for infertility can also increase the risk of ovarian cysts.
• Pregnancy: Typically, an ovarian cyst forms at the start of pregnancy. The cyst supports early pregnancy while the placenta develops. After the placenta forms, the cyst goes away on its own. However, in some cases, the cyst remains throughout pregnancy. Theca lutein cysts can also occur due to pregnancy.
• Pelvic infection: If severe infections spread to the ovaries, the risk of ovarian cysts increases which can cause ovarian abscesses.
• Age: The risk of cancerous cysts increases with age. People who are in menopause particularly have a higher risk of ovarian cancer than others.

Diagnosis

Most ovarian cysts do not cause symptoms, so a provider might only find a cyst if you're visiting them for other reasons, such as an annual exam. If you are experiencing symptoms or complications of an ovarian cyst, it's a good idea to get tested. To get you an accurate diagnosis, your provider may:

• Ask about your medical history and current symptoms
• Conduct a pelvic exam by inserting one or two fingers inside your vagina
• Order an ultrasound to take a picture of your ovaries to check for the size, shape, and location of a cyst, if needed
• Perform a doppler flow study, which is done during an ultrasound to show if blood is flowing to the ovaries
• Use imaging tests like a CT scan or MRI, if your provider suspects ovarian cancer
• Get your blood tested to check for hormonal imbalances, pregnancy, or cancer

Treatment

Depending on the type of ovarian cyst you have, treatment goals may include reducing the reoccurrence of the cyst, alleviating pain, or treating the underlying health condition. However, ovarian cysts usually go away without treatment in eight to 12 weeks.

Currently, there is no cure for ovarian cysts. However, oral contraceptives such as birth control pills can help you regulate your hormones and ovulation and reduce the risk of cysts if you get them often. It's important to note that contraceptives do not treat active cysts.

For active cysts, your provider may advise using non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to treat painful symptoms. Your provider may also recommend surgery if:

• Your cyst persists longer than 12 weeks
• Your symptoms do not go away
• The cyst grows larger than 10 centimeters
• You're going through menopause

One of the most common types of surgery for ovarian cysts is laparoscopy. With laparoscopy, a surgeon makes small incisions (cuts) in the stomach. The surgeon inserts a thin device with a tiny camera to closely examine the cyst. If the surgeon suspects cancer, they will acquire a sample of your tissue or try to remove the cyst and send it for a biopsy.

In severe cases, the surgeon may remove one or both of your ovaries—which is only common if you have ovarian cancer. However, the removal of ovaries can cause other symptoms such as hot flashes, headache, infertility, and nausea.

How To Prevent Ovarian Cysts

If you get regular periods, there is no surefire way to prevent ovarian cysts. However, oral contraceptives can reduce the risk of cysts and regulate ovulation. Specifically, birth control pills stop ovarian follicles from maturing an egg and cysts are less likely to form if the ovarian follicles do not grow.

Living With Ovarian Cysts

For the most part, ovarian cysts are benign (noncancerous). In as many as 80% of cases, ovarian cysts go away without treatment, and rarely do cysts become cancerous. Early-stage ovarian cancer has an overall five-year survival rate of 86.2%. However, your chance of surviving may decrease if a provider detects cancer late.

Many people with ovarian cysts can wait for them to go away on their own, typically within three months. Since most cysts do not cause symptoms, accommodations are not usually necessary.

However, in the case your cyst ruptures, grows, bleeds, or twists, you may experience symptoms such as:

• Sudden, severe pelvic pain
• Nausea and vomiting
• Fever
• Feeling dizzy 
• Trouble breathing

If any of these symptoms occur suddenly, it's a good idea to talk to your healthcare provider and get tested.