When an Ovarian Cyst Ruptures: Is It an Emergency?

Chances are, if you’re a woman with a period, you’ve had an ovarian cyst at some point. Ovarian cysts — fluid- or tissue-filled pouches in or on your ovaries — are extremely common and usually don’t mean anything is wrong, even when they burst.

“Normal, physiologic cysts can grow, rupture and bleed every month, as part of your normal menstrual cycle,” says Cara King, DO, Director of Benign Gynecologic Surgery.

But then there are other ovarian cysts that aren’t so normal. These types — which Dr. King calls pathologic cysts — include dermoid cysts, cystadenomas and endometriomas.

“These are rare,” she says. “And cancerous cysts are even more rare. However, when these pathologic cysts rupture, it can be an urgent situation.”

Why do ovarian cysts burst?

Usually we don’t know what makes a cyst burst, Dr. King admits.

Size can be a factor. The bigger the cyst, the more likely it’ll pop, like an overfilled water balloon. Yet there can be huge cysts that are so slow-growing that they don’t rupture — as well as small, fast-growing cysts that do.

Sex and intense exercise also can cause a cyst to rupture.

“Some ovarian cysts cause pain in your lower abdomen and other symptoms,” says Dr. King. “But there’s no specific warning sign that a cyst is about to rupture.”

Besides intense pain, watch for infection and bleeding

For many women, a ruptured cyst can be excruciating. Some say it feels like an attack of appendicitis, especially since ovarian cysts are more common on your lower right side, near your appendix.

However, the pain can be on either or both sides of your abdomen. And it may come with:

• Nausea and/or vomiting. Depending on the cyst, contents that leak into your abdomen can make you really sick.
• Fever. This is a sign that you may have an infection of an ovarian cyst.
• Dizziness. This can indicate there’s a lot of bleeding in your belly. Other symptoms of hemorrhage include vision changes and a racing heartbeat. Not all ruptured cysts cause excessive bleeding, but you’re at a higher risk if you take blood thinners or have a bleeding disorder.

“If you have any of these symptoms, get to a doctor right away,” says Dr. King. “Excessive bleeding or an infection is an emergency that may require surgery or antibiotics.”

Typically, the surgery is minimally invasive. The gynecologic surgeon will use a laparoscope to find the area that’s bleeding, take out the cyst, and remove all the blood and infection-causing material.

Where do the contents go?

Most of the time, a ruptured cyst doesn’t require surgery. If you can manage the pain with over-the-counter pain relievers and don’t have any signs of heavy bleeding or infection, you’ll likely recover on your own.

Absorbing the fluid from normal, physiologic cysts happens pretty quickly — within 24 hours. Other content can take longer. For example, thickened blood from an endometrioma may take weeks to absorb. And the pain can linger while unabsorbed blood continues to irritate your abdominal lining.

“Most ovarian cysts are no cause for concern,” says Dr. King. “Even if they rupture, your body usually takes care of the healing and cleanup. It’s really only when you have sudden severe symptoms that you should seek medical care.”