An ovarian cyst is a fluid-filled sac in or on an ovary. Most are harmless. In women who still have periods, the commonest are functional cysts, a follicle or corpus luteum that has not collapsed as usual after ovulation, and they generally disappear on their own within one to three cycles.
Other cysts do not go away by themselves: a dermoid cyst, an endometrioma (a “chocolate cyst” caused by endometriosis) or a cystadenoma. These may need removal, especially if they are large, growing or causing pain. A small number of ovarian swellings, more often after menopause, are cancers, which is why careful assessment matters. The first job is always to identify what kind of cyst it is, and only then decide whether it needs watching, medicines or surgery.
Dr. Devang Patel is a laparoscopic surgeon who has performed more than 3,000 surgeries, and removes ovarian cysts by keyhole surgery at Divine Women’s Hospital, Gota, aiming to preserve as much healthy ovarian tissue as possible for hormones and future fertility.
Types of ovarian cyst
The type of cyst decides almost everything that follows. Ultrasound can usually tell them apart with good accuracy.
| Type | What it is | Typical behaviour | Usual approach |
|---|---|---|---|
| Follicular or corpus luteum cyst | A functional cyst from the normal cycle | Resolves in 1–3 cycles | Reassurance, repeat scan if large |
| Haemorrhagic cyst | A functional cyst with bleeding inside | Can be painful; usually resolves in 6–12 weeks | Pain relief, repeat scan |
| Endometrioma (chocolate cyst) | Cyst lined by endometriosis tissue, filled with old blood | Persists; linked with pain and fertility problems | Medical treatment or laparoscopic cystectomy |
| Dermoid cyst (mature teratoma) | Benign cyst containing fat, hair or teeth | Grows slowly; does not resolve; risk of torsion | Laparoscopic cystectomy if symptomatic or growing |
| Serous or mucinous cystadenoma | Benign growth of the ovary surface | Can become very large | Laparoscopic removal |
| Complex or solid mass | Mixed solid and fluid areas | Needs assessment for possible tumour | Further imaging, markers, oncology input if concerning |
Symptoms, and when there are none
Most cysts cause no symptoms and are found by chance on a scan done for another reason. When symptoms do occur, they depend on the size and type of cyst.
- A dull ache or heaviness on one side of the lower abdomen
- Bloating, a feeling of fullness or a visible swelling with larger cysts
- Painful periods and pain during intercourse, especially with endometriomas
- Pressure on the bladder or bowel
- Irregular periods with some functional cysts
- Sudden severe pain if a cyst bleeds, ruptures or twists the ovary (torsion)
How a cyst is assessed
A transvaginal ultrasound by an experienced operator is the key test. The size, wall, internal contents and blood flow are described using structured systems such as the IOTA simple rules or O-RADS, which sort cysts into those that are almost certainly benign and those that need further imaging or specialist review. Women who are not sexually active are scanned abdominally.
Blood tests are chosen according to age and scan findings. CA-125 is useful after menopause but is often raised for benign reasons in younger women, for example with endometriosis, fibroids, infection or even during a period. In girls and young women with complex cysts, markers such as AFP, LDH and hCG may be added. An MRI is requested when the ultrasound picture is unclear.
After menopause, the scan score, CA-125 level and menopausal status are combined into a Risk of Malignancy Index (RMI). A score below 200 suggests a low risk, while a higher score prompts referral to a gynaecological oncology team.
Watch, treat or operate
In women before menopause, following RCOG guidance, a simple cyst under 5 cm usually needs no follow-up at all. Simple cysts between 5 and 7 cm are generally re-scanned, often yearly, to make sure they are not growing. Cysts larger than 7 cm are usually considered for further imaging or surgery, as are persistent, complex or painful cysts.
After menopause, a small simple cyst with a normal CA-125 can often be monitored with repeat scans over a year, and many resolve. Cysts with any concerning features, or a raised RMI, are managed with or by a gynaecological oncology team.
The contraceptive pill does not shrink an existing cyst, but it can prevent new functional cysts in women who get them repeatedly. Hormonal treatments such as dienogest help endometriosis pain and may slow the growth of endometriomas.
For most women, the right answer to a simple ovarian cyst is a clear explanation and, at most, a repeat scan rather than an operation.
Emergencies: torsion and rupture
Ovarian torsion can happen at any age, including in girls and in pregnancy. Dermoid cysts and enlarged ovaries during fertility treatment carry a particular risk, because their weight makes the ovary more likely to swing on its supporting ligaments.
When an ovary, usually enlarged by a cyst of 5 cm or more, twists on its blood supply, it causes sudden severe one-sided pain, often with nausea and vomiting, and needs emergency laparoscopy to untwist the ovary. Even an ovary that looks dark at surgery often recovers after untwisting, so it is preserved whenever possible, especially in young women.
A ruptured or bleeding cyst causes sudden pain that may spread across the abdomen. Most settle with pain relief and observation, but heavy internal bleeding needs surgery. Both conditions are why sudden pelvic pain should be seen the same day.
Laparoscopic cystectomy: what to expect
When surgery is needed, most benign cysts are removed laparoscopically through three or four small cuts. The cyst wall is peeled away from the ovary and the healthy ovarian tissue is left behind, which matters for hormones and future fertility. Dermoid cysts are removed whole where possible, inside a retrieval bag, to avoid spilling their contents.
Removing the whole ovary is reserved for situations where it cannot be saved or where it is the safer option, such as some cysts after menopause. Most women go home within one or two days and return to desk work in one to two weeks. Every cyst is sent for histology, and the report is discussed at follow-up.
Risks include bleeding, infection, injury to nearby organs, and reduced ovarian reserve. Recurrence is uncommon for dermoid cysts but more frequent with endometriomas, where hormonal treatment after surgery lowers the chance of the cyst coming back.
Cysts, fertility and pregnancy
Functional cysts do not affect long-term fertility. Endometriomas are linked with endometriosis, which can, and surgery on them can lower the ovarian reserve as measured by AMH. For this reason, small endometriomas in women planning IVF are sometimes left alone, and an AMH test is often done before surgery. The timing of any operation is planned around your fertility goals.
Cysts are often found on early pregnancy scans. Most are corpus luteum cysts, which support the pregnancy and resolve by about 14–16 weeks. Persistent or large cysts are monitored, and if surgery is needed, it is usually done laparoscopically in the second trimester, when the risk to the pregnancy is lowest, unless torsion makes it urgent.
Ovarian cyst care at Divine Women’s Hospital
Dr. Devang Patel reviews your scan, repeats or refines it if needed, and explains in Gujarati, Hindi or English what type of cyst it most likely is and what that means for you. Many women leave reassured with no treatment or a single repeat scan.
When surgery is advised, laparoscopic cystectomy is performed at Divine Women’s Hospital, Gota, an NABH-accredited hospital. Emergencies such as torsion are operated on at any hour through the 24 × 7 emergency service, and cysts with concerning features are managed together with a gynaecological oncology team.
Your care, step by step
- Ultrasound reviewThe cyst is characterised by size, wall, contents and blood flow using structured scoring.
- Blood tests if neededTumour markers are chosen according to your age and the scan findings.
- A clear planYou are told whether the cyst needs no follow-up, a repeat scan, medicines or surgery, and why.
- Surgery if neededLaparoscopic cystectomy preserving healthy ovary, usually a one- or two-day stay.
- Follow-upThe histology report is reviewed, and a plan made for future scans or fertility.
When to book a visit
- A cyst found on a scan that has not been explained to you
- Persistent bloating, pelvic pressure or a feeling of fullness
- Painful periods or pain during intercourse with a known cyst
- A cyst that has not gone away on a repeat scan
- A cyst found in early pregnancy
- Any ovarian cyst found after menopause
Warning signs - get same-day care
- Sudden, severe pain on one side of the lower abdomen, especially with vomiting, which may mean torsion
- Severe abdominal pain with fainting, dizziness or a racing pulse, which may mean internal bleeding
- Abdominal pain with a positive pregnancy test, to rule out an ectopic pregnancy
- Pelvic pain with fever
- Rapidly increasing abdominal swelling with breathlessness
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: Every ovarian cyst needs to be removed.
Most cysts in women who have periods are functional and disappear on their own. Surgery is reserved for persistent, large, complex or symptomatic cysts.
Myth: An ovarian cyst means PCOS.
A single cyst is different from PCOS, where many small follicles are present and diagnosis needs other features too.
Myth: A raised CA-125 means cancer.
In younger women CA-125 is often raised by endometriosis, fibroids, infection or even a period. It is interpreted alongside the scan and age.
Myth: Cyst surgery always means losing the ovary.
Cystectomy removes the cyst and leaves healthy ovarian tissue. Removing the ovary is reserved for specific situations.
Frequently asked questions
Can ovarian cysts go away on their own?
Yes. Functional cysts, the commonest type before menopause, usually disappear within one to three menstrual cycles without any treatment. A repeat scan after six to twelve weeks confirms this. Dermoid cysts, endometriomas and cystadenomas do not resolve on their own.
What size of ovarian cyst needs surgery?
Size is only one factor. Simple cysts under 5 cm in women before menopause usually need nothing. Cysts larger than about 7 cm, those that persist or grow, those with complex features, and those causing pain are usually considered for removal.
Can an ovarian cyst affect my fertility?
Most functional cysts do not. Endometriomas are linked with endometriosis, which can affect fertility, and surgery on any cyst should preserve as much healthy ovary as possible. If you are planning a pregnancy, this is discussed before any operation.
What is ovarian torsion?
Torsion is when an ovary, usually enlarged by a cyst, twists on its blood supply. It causes sudden, severe one-sided pain, often with nausea and vomiting, and needs emergency surgery to untwist and save the ovary.
Can medicines dissolve an ovarian cyst?
No medicine dissolves an existing cyst. The contraceptive pill can prevent new functional cysts in women who get them repeatedly, and hormonal treatment can help endometriosis, but established dermoid cysts and cystadenomas need surgery if treatment is required.
Is an ovarian cyst cancer?
Most ovarian cysts, especially in younger women, are benign. The risk of cancer is higher after menopause and with solid areas, thick partitions or abnormal blood flow on the scan, which is why those cysts are assessed in more detail.
What is a chocolate cyst?
A chocolate cyst, or endometrioma, is an ovarian cyst caused by endometriosis and filled with thick old blood that looks like melted chocolate. It often causes painful periods and may affect fertility.
Is an ovarian cyst dangerous in pregnancy?
Usually not. Most cysts seen in early pregnancy are corpus luteum cysts that support the pregnancy and resolve by the second trimester. Larger or persistent cysts are monitored, and surgery is rarely needed.
How many days rest after laparoscopic cyst removal?
Most women go home within a day or two, walk the same evening and return to desk work in one to two weeks. Heavy lifting and strenuous exercise should be avoided for about four weeks.