Signs You Have an Ovarian Cyst — and What to Do About It

Most are harmless and painless

Illulstration of a cyst on an ovary

If you’re having abdominal pain or discomfort that doesn’t seem quite normal, it’s possible that you have an ovarian cyst. These small fluid- or tissue-filled pouches on or in the ovary are actually very common. Here’s what Ob/Gyn Mark Dassel, MD, says you need to know.

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Not all ovarian cysts are the same

The good news is that the vast majority of ovarian cysts are harmless. Here’s a look at the most common types.

Functional cysts. This is the most common kind of cyst, occurring as part of the normal menstrual cycle due to ovulation, says Dr. Dassel. Every once in a while, a functional cyst may fill up with blood, making it swell and cause pain, but they’re normally painless and generally go away on their own over the course of a few months.

Dermoid cysts or teratomas. Women are often born with this type of cyst and “it can be full of all kinds of things that the body grows, like hair, teeth and even thyroid and brain tissue,” Dr. Dassel says. Very rarely, teratomas may become cancerous.

Cystadenomas. While a cystadenoma can get quite large, “it’s like a mole in that it’s usually a normal, benign growth,” explains Dr. Dassel. “And like a mole, sometimes we need to remove these to make sure they’re not cancerous.”

Endometriomas. “These cysts develop from endometriosis (a condition in which your uterine cells grow outside of your uterus) and they can be very tender and painful,” Dr. Dassel says.

Cancerous cysts. Fortunately, ovarian cancer is rare. “There’s a lifetime risk of about 1½ percent,” says Dr. Dassel. If you have a first-degree family member with ovarian cancer, this risk increases to 5 percent. “Women who have certain genetic conditions like BRCA1, BRCA2 or Lynch syndrome also need to be more concerned if they develop a cyst.”

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Why do ovarian cysts develop anyways?

Beyond ovulation, endometriosis and the abnormal reproduction of cells, a pelvic infection like pelvic inflammatory disease (PID) can also cause ovarian cysts.

Do you always know if you have an ovarian cyst?

Ovarian cysts are usually small enough that most women don’t even realize they have one. In fact, Dr. Dassel says that many cysts are diagnosed during annual pelvic exams or imaging tests that are performed for another reason.

Even cysts that become enlarged often go unnoticed. However, “if a cyst gets big enough, it may create a feeling of pressure or even pain,” Dr. Dassel says.

Other possible symptoms of large cysts include:

  • Feeling bloated.
  • Pain with sexual intercourse.
  • Changes in bowel movements or urinary habits.
  • Unanticipated weight loss or gain.
  • Feeling full too quickly when you eat.
  • Pain on one side of your lower abdomen.
  • Painful periods.

These symptoms can be easy to ignore, and one by itself may not be concerning. But if you’re noticing many of these together, that’s a good reason to see your doctor for an evaluation.

A cyst that bleeds, bursts or causes your ovary to twist on itself (a condition called ovarian torsion) can cause sudden, severe pain.

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What happens if you do have an ovarian cyst?

If your doctor finds an ovarian cyst, you’ll most likely have a pelvic ultrasound to see what’s going on and treatment will depend on your situation.

“Many times, if we have a slightly concerning cyst, we’ll wait six to eight weeks to see if it goes away on its own,” says Dr. Dassel. “A lot of cysts look just like a water balloon. There’s nothing inside them and they can be present even after menopause. It’s very reasonable just to watch these with an ultrasound every year to make sure they’re not growing.”

Occasionally, a cyst needs to be surgically removed. “There are a few things we look at in a cyst to evaluate whether or not it needs to be removed,” Dr. Dassel says. “If it’s causing painful symptoms, we may want to remove it for comfort reasons.”

You may also need surgery if the cyst is larger than 10 centimeters or if it looks abnormal on the ultrasound. “If, for instance, the cyst has extra solid tissue growing inside it, we’ll usually get tumor marker blood tests. The most common one is cancer antigen 125 (CA125),” says Dr. Dassel. “Elevated levels make us more concerned about cancer, especially after menopause.”

When you should see your doctor

If you experience intense pelvic pain, especially if it happens quickly, you need to get help immediately. Since a twisted ovary can reduce or stop blood flow, the sooner you get medical attention, the better chance there is for your ovary to be saved.

For general pelvic pain, “there can be a lot of causes, and sometimes they can be difficult to differentiate. In these cases, it’s best to go see someone who’s trained in pelvic exams to see if they can localize where that pain is because sometimes it’s very obvious,” advises Dr. Dassel.

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