Ovarian Cyst Symptoms and When to See a Doctor

What is an ovarian cyst?

An ovarian cyst is a fluid-filled sac on or inside an ovary. The most common type is a functional cyst, which develops as a normal part of ovulation 1Ref 1American College of Obstetricians and Gynecologists (2016).ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses.Types of ovarian cysts, diagnostic approach with transvaginal ultrasound, watchful waiting for simple cysts, surgical indications, and CA-125 use:

• Follicular cysts — form when a follicle (the sac that holds a developing egg) does not rupture at ovulation and continues to grow
• Corpus luteum cysts — form after the egg is released; the corpus luteum fills with fluid instead of breaking down normally

Functional cysts are very common, usually cause no symptoms, and typically resolve within one to three menstrual cycles without treatment.

Less common types include dermoid cysts (which can contain tissue like hair or skin), endometriomas (cysts filled with old blood, associated with endometriosis), and cystadenomas. These may require different management 1Ref 1American College of Obstetricians and Gynecologists (2016).ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses.Types of ovarian cysts, diagnostic approach with transvaginal ultrasound, watchful waiting for simple cysts, surgical indications, and CA-125 use.

What symptoms does an ovarian cyst cause?

Many ovarian cysts — especially small ones — are found incidentally on ultrasound and cause no symptoms. When symptoms occur, they can include 1Ref 1American College of Obstetricians and Gynecologists (2016).ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses.Types of ovarian cysts, diagnostic approach with transvaginal ultrasound, watchful waiting for simple cysts, surgical indications, and CA-125 use:

• Dull or achy pelvic pain on one side, which may worsen during or around menstruation
• Bloating or a sense of fullness in the lower abdomen
• Pressure on the bladder or rectum — a need to urinate frequently, or difficulty fully emptying the bladder
• Pain during sex — particularly with deep penetration
• Irregular periods — larger cysts can affect hormone levels and disrupt cycles
• Spotting between periods in some cases

These symptoms overlap significantly with other conditions including endometriosis, fibroids, and pelvic inflammatory disease. An ultrasound is the standard way to identify a cyst and assess its characteristics.

What are the signs that something more serious is happening?

Two complications of ovarian cysts are considered emergencies:

Ovarian torsion — when the ovary (and sometimes the fallopian tube) twists on its ligament, cutting off blood supply. This is a true surgical emergency 2Ref 2Baron SL, Mathai JK (2023).Ovarian Torsion.Ovarian torsion as a true surgical emergency; symptoms (sudden severe pain, nausea, vomiting); time-critical nature of surgery for ovarian preservation. Symptoms include sudden, severe, often one-sided pain that may come in waves, accompanied by nausea, vomiting, and sometimes fever. Torsion requires surgery within hours to preserve the ovary — the longer blood flow is interrupted, the lower the likelihood of salvaging ovarian function 2Ref 2Baron SL, Mathai JK (2023).Ovarian Torsion.Ovarian torsion as a true surgical emergency; symptoms (sudden severe pain, nausea, vomiting); time-critical nature of surgery for ovarian preservation.

Ruptured cyst — when a cyst bursts. A small rupture may cause a brief, sharp pain that then eases and often resolves without intervention. A larger rupture can cause significant internal bleeding, leading to severe ongoing pain, dizziness, or fainting.

Either of these situations requires immediate emergency evaluation.

How is an ovarian cyst diagnosed?

An ob-gyn or gynecologist will typically:

1. Take a history of your symptoms, menstrual cycle, and any prior cysts 2. Perform a pelvic exam — a large cyst may be palpable 3. Order a pelvic or transvaginal ultrasound — this is the primary imaging tool; it shows the size, location, and internal characteristics of the cyst 1Ref 1American College of Obstetricians and Gynecologists (2016).ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses.Types of ovarian cysts, diagnostic approach with transvaginal ultrasound, watchful waiting for simple cysts, surgical indications, and CA-125 use

Blood tests may include a CA-125 level in certain circumstances — though CA-125 is not a reliable screening test and can be elevated by many benign conditions. It is used selectively, not routinely, for most reproductive-age cysts 1Ref 1American College of Obstetricians and Gynecologists (2016).ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses.Types of ovarian cysts, diagnostic approach with transvaginal ultrasound, watchful waiting for simple cysts, surgical indications, and CA-125 use.

What are the treatment options?

Watchful waiting — for simple, small functional cysts in reproductive-age people, no treatment is usually needed. A repeat ultrasound in 6–12 weeks checks whether the cyst has resolved. Simple cysts can be safely followed without intervention 1Ref 1American College of Obstetricians and Gynecologists (2016).ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses.Types of ovarian cysts, diagnostic approach with transvaginal ultrasound, watchful waiting for simple cysts, surgical indications, and CA-125 use.

Hormonal contraception — birth control pills do not treat an existing cyst but may reduce the likelihood of new functional cysts forming. Their role in management is primarily preventive.

Surgery — for cysts that are large, complex, growing, not resolving, causing significant symptoms, or look atypical on imaging, removal may be recommended. A laparoscopic cystectomy (removing the cyst while preserving the ovary) is the most common approach. In some situations — particularly if cancer is a concern — the ovary or more tissue may need to be removed 1Ref 1American College of Obstetricians and Gynecologists (2016).ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses.Types of ovarian cysts, diagnostic approach with transvaginal ultrasound, watchful waiting for simple cysts, surgical indications, and CA-125 use.

Most people with a newly found simple ovarian cyst do not require surgery. Your gynecologist will track the cyst and advise based on its characteristics and your symptoms.