Understanding Ovarian Cysts

May 8, 2010 at 2:57 pm 38 comments

Ovarian cysts are very common and can affect women of all ages.  Most women will have an ovarian cyst at some time in their reproductive lives.  Although they are less common after a woman stops menstruating, they are present in up to 14.8% of postmenopausal women.

But what is an ovarian cyst?  An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary (one of a pair of organs in the pelvis responsible for producing female hormones and eggs).  Eggs normally mature within the ovaries in small, fluid filled spaces called follicles.  Any ovarian follicle larger than two centimeters can be called an ovarian cyst.  They vary greatly in size (as big as a cantaloupe or larger!) and in etiology.  Most ovarian cysts are benign (non-cancerous) in nature.  Several common types are

  1. functional (or simple) ovarian cysts, which are related to the menstrual cycle and often resolve on their own
  2. endometrioid cysts, which are due to endometriosis, are often called “chocolate” cysts or endometriomas
  3. dermoid cysts (or teratomas) which can have solid components like hair or teeth

 

Many ovarian cysts are asymptomatic and are discovered only incidentally at the time of an exam or ultrasound.  However, some ovarian cysts cause problems.  Rupture of an ovarian cyst can cause bleeding or pain.  An enlarged ovarian cyst can cause an ovary to twist on the stalk containing its blood supply, a condition called torsion.  Ovarian cysts may also interfere with fertility treatments and goals. 

Surgery may be required to remove large cysts or to make sure a cancer is not present.

If you think you have symptoms consistent with an ovarian cyst, it is important to be evaluated by a physician.  Ultrasound or other imaging as well as simple blood tests may be done to help determine whether treatment is necessary. 

 

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38 Comments Add your own

  • 1. Michelle  |  June 23, 2010 at 5:30 pm

    Hello Dr. Nicoll,

    First of all, thanks for having a blog – i love it and visit your site frequently!

    I have had 2 prior surgeries for endometriomas, the latest one in March 2009 just prior to starting fertility treatments. I am now 3 months pregnant, but my doctor is following new endometriomas on both ovaries. I was wondering if these can be removed during a planned c-section when I’m due for birth?

    Your feedback is much appreciated! I can be reached at ***removed for privacy***

    Reply
    • 2. drnicoll  |  June 25, 2010 at 10:08 pm

      Hi Michelle,
      Thanks for the feedback! And congratulations on the pregnancy :o)

      If ovarian cysts need to be removed, the best time to do so is often during the second trimester of pregnancy — between 12-20 weeks on average — because this minimizes the risk of miscarriage (as compared to the first trimester) or preterm contractions/labor (as compared to the third trimester). Laparoscopy and other minimally invasive options often offer the best approach.

      You should ask your doctor whether your endometriomas need to be removed at all (are they causing pain? are they particularly large? is there concern they are not endometriomas but could represent an occult malignancy?). If not, they can often be safely followed during pregnancy.

      Removing ovarian cysts during a planned cesarean section is often tempting. You’re having surgery anyway, right? But reproductive tissue, including the ovary, can be much more vascular during pregnancy (an increase in the number and size of blood vessels). This can increase the risk of bleeding compared to when surgery is performed when you are no longer pregnant. That’s why we also don’t remove fibroids when we find them during a cesarean section.

      That being said, there are times when taking out an ovarian cyst during a cesarean section is safe, efficient, and an overall good idea. We’ve all done it. But it’s usually planned well in advance.

      Tallk to your doctor. Understand his or her reasoning for whatever plan you formulate together. If needed, get a second opinion. Then enjoy a healthy pregnancy and a safe delivery!

      Best regards,
      Dr Nicoll

      Reply
  • 3. 2010 in review « The Gynecologist  |  January 3, 2011 at 12:22 am

    […] Understanding Ovarian Cysts May 2010 2 comments 5 […]

    Reply
  • 4. Cindy  |  June 4, 2011 at 4:15 am

    Hello Dr. Nicoll,

    Thanks for this wonderful post.

    I recently had an emergency c section. During this surgery my right ovary was removed due to them finding a benign tumor. I did not consent to this. Is this something that doctors can do? I had no prior talks with OB about problems with my ovary, I had no pain or anything. I just wanted to know if this is something I should have expected going in for a c section or did they need my consent to remove it? I did a lot of research and you can live with a benign tumor. I would have liked to talk about treatment and get a second opinion before removing my ovary. I’m only 26 years old. Sorry for the rant. I just wanted to know if this is standard procedure.

    Thanks!

    Cindy

    Reply
    • 5. drnicoll  |  June 6, 2011 at 3:33 am

      Hi Cindy,
      I am sorry you had a difficult experience during your cesarean section. But I don’t feel this is an approriate question for me to answer as our interaction will only be online and therefore of a limited nature.
      You should discuss these questions with your doctor or seek out consultation with another physician (in person) for a “second opinion” if you desire an outside perspective.
      Wishing you the best of luck,
      Dr. N

      Reply
  • 6. gracey  |  October 1, 2011 at 1:22 am

    hi Dr. N.

    Im searching for the right website about ovarian cyst. and i’ve found out this one. tnxx for the blog…

    Last month i had a lower abdomen ultrasound and it says that my right ovary measures 2.9 x 1.6 x 1.9 cm with note of vari-sized subcentimeter cystic foci. and my left ovary measures 2.9×1.4 c 1.6 cm… what does it mean? do i have ovarain cyst? and if i have, how severe it was?? im afraid that someday. i cant have achild… btw. i 18 now.. i have no time for consulting the doc. because my schedule is full. . sorry for the demand ,,, i just want to know. i hope you can help me..

    thanks

    G.

    Reply
    • 7. drnicoll  |  October 3, 2011 at 7:47 pm

      Hi Gracey,
      I don’t give out individual medical advice over the internet.

      You should make an appointment to talk to your doctor (preferably in person) and get all the answers you’re looking for. If you can’t make an appointment because your schedule is full, you should either request a telephone consultation with your doctor, or you need to take time away from work to receive medical care.

      If you’re not satisfied with the answers you receive, I strongly suggest you make an appointment with another provider for a second opinion. In the meantime I hope you are well and wish you the best of luck.
      -Dr. N

      Reply
  • 8. uknowat1  |  June 5, 2012 at 9:11 pm

    Hi…i just had a cyst that rupture and it caused me to bleed along time. Bt I always have had irregular periods and thats what I went in the doctor for because im tired of it. Some doctors say its normal for some women to hve irregular cycles,bt perscribed me birth control to balance it out. Nw im ttc I need to get off the birth control and someone said(not saying if its true) since my cyst bust its nw easier for me to get pregnant. Im 25 and ready to start my family but scared I may not be able because my cycle n dat cyst.HELP

    Reply
    • 9. drnicoll  |  June 5, 2012 at 10:53 pm

      Hi Uknow,
      I would like to stress again that I don’t give out individual medical advice over the internet.

      Birth control pills are often prescribed to regulate the menstrual cycle and to reduce the likelihood of recurrent ovarian cysts. However, oral contraceptives are are usually discontinued if pregnancy is desired. Some women with a history of ovarian cysts struggle with infertility, or are diagnosed with a new cyst after discontinuing use of the Pill. However, most women with a history of ovarian cysts conceive without medical assistance and go on to have healthy pregnancies.

      A consultation with the gynecologist can help answer any questions related to how an individual’s history of ovarian cysts (or a history of surgery to remove them) may impact the ability to have children.

      Wishing you all the best!
      -Dr. N

      Reply
  • 10. Noori  |  June 7, 2012 at 10:44 am

    Hi..dr.Nicoll, i m 28 years old and i have an overion cyst measuring about 9 cms. I m 14 weeks pregnment.i hv always a mild pain on my left side. My doctor advise me for rest n try to avoid c section. The left overion cyst is nt cancerous as doctor told. Plz give ur suggestion fr me. Thamx

    Reply
    • 11. drnicoll  |  July 3, 2012 at 4:17 pm

      Hi Noori,
      I do not give out individual medical advice on my blog. Please speak with your doctor or, if you need a second opinion, see another provider (in person). Your doctor can suggest a specialist or a colleague who can provide a second opinion. Alternatively, you can do your own research to find a doctor in your area. A good place to start is by calling nearby hospitals. Most have a referral service and can give you doctors’ contact information.
      Best of luck and congrats on the pregnancy!
      -Dr. N

      Reply
  • 12. Glazel P. Nabua  |  June 13, 2012 at 7:37 am

    Thanks for your blog i learn a lot here.

    Reply
    • 13. drnicoll  |  July 3, 2012 at 4:13 pm

      Thank you very much!
      -Dr. N

      Reply
  • 14. Mckenzie  |  August 1, 2012 at 3:49 pm

    Hi dr. I’m currently 32 weeks pregnant and found out I have an ovarian cyst that is twisting. I was wondering if I would still be able to deliver vaginally or if I would have to have a c section. I’m really scared that the cyst could rupture during labor. Since my due date is coming up I would like to know what you think. Thank you

    Reply
    • 15. drnicoll  |  August 6, 2012 at 11:17 pm

      Hi Mckenzie,
      I don’t dispense individual advice on the internet. Your concerns about whether your cyst will impact your pregnancy and delivery are best served by talking them over with your doctor. Only he or she knows the details of your medical conditions, the course of your pregnancy, and the features of your cyst, all of which play a role in the answer to your question. If you’re looking for a second opinion, it is best to get copies of your records and to review them with another provider in person. Best of luck and congrats on your little one’s upcoming arrival.
      Dr. N

      Reply
  • 16. rebecca  |  February 2, 2013 at 11:13 am

    Hi nicoll I am a 19 year olf female who suffers with overain cyst and cyst in the right follopian tube I usually get a lot of pain ecery two days now it used to be every month but is getting worse my dcotor thought it was m appendix the pain was that bad do you think that all this could be connected with my cyst, thanks.

    Reply
    • 17. drnicoll  |  February 5, 2013 at 4:21 am

      Hi Rebecca,
      I don’t dispense individual medical advice on this blog. Abdominal or pelvic pain can be a symptom of ovarian cysts or other medical conditions. A doctor can do tests to determine whether ovarian cysts, an inflamed appendix, or other medical conditions are causing the pain and whether they require treatment. If you’re unsure of your diagnosis even after consulting with your doctor, seeking a second opinion from a gynecologist or other women’s health specialist may be helpful.
      Best of luck,
      Dr N

      Reply
  • 18. Justin  |  June 26, 2013 at 5:50 am

    Everything is very open with a clear description of the issues.
    It was really informative. Your site is extremely helpful.

    Thanks for sharing!

    Reply
  • 19. Ben  |  July 30, 2013 at 5:38 pm

    great submit, very informative. I’m wondering why the other specialists of this sector don’t realize this.

    You must proceed your writing. I am confident, you’ve a huge readers’ base
    already!

    Reply
  • 20. Sameera  |  August 1, 2013 at 5:45 pm

    Hello Dr. Nicoll,
    I have few question about the follicle cyst. Does the follicle cyst grows every month? And if so does it interrupt from becoming pregnant? And lastly under what circumstances the follicle cyst be removed ( for instance even its 1.9 cm small causing lot of pain)?
    Thanks! I appreciate any help.

    Reply
    • 21. drnicoll  |  August 2, 2013 at 1:44 am

      Hi Sameera,
      A follicle develops on the ovary every month in a woman who is ovulating regularly. The follicle normally must burst (rupture) in order to release an egg. If an egg is released and fertilized, a pregnancy may result. If a follicle doesn’t burst and persists as a cyst, it can become enlarged. Most follicular cysts do not become extremely large, and follicular cysts larger than 6-8 centimeters are unusual. A follicular cyst that doesn’t burst may prevent ovulation for a few weeks or months until the follicle goes away. But these cysts almost always go away (resolve) on their own. A cyst can resolve by rupturing (although by that time it usually won’t release an egg). This may cause pain, but the pain will also go away on its own (i.e. without treatment). The cyst may resolve more slowly by being re-absorbed into the ovary. This does not usually cause pain. Whatever the method by which the follicle resolves, after it goes away, a new menstrual cycle begins. A new follicle is usually produced with each menstrual cycle.
      Small (less than 3-4 cm) follicular cysts usually don’t cause pain. However, any patient who is having a lot of pain should be evaluated by a physician immediately. Any questions related to individual care should be referred to a patient’s doctor, as I don’t give individual advice on this site.
      Best regards,
      Dr. N

      Reply
  • 22. helen  |  October 8, 2013 at 9:36 pm

    Hello Dr. Nicoll:

    I have no pain or symptons with this ovarian cyst

    Thank You

    Reply
    • 23. drnicoll  |  January 26, 2014 at 3:24 am

      Dear Helen,
      As I’ve said before, I don’t offer individual medical advice on this blog. Go see a doctor.
      Best of luck,
      -Dr N

      Reply
  • 24. Kaye  |  October 15, 2013 at 3:53 pm

    Hi, not seeking a diagnose.i went to dr bc of somewhat irregular periods(no history) seeking to confirm menopause(42 yr); US shows bilateral complex cysts.high risk bc mom with Breast ca;paternal g.mther-uterine ca;MRI done confirms cysts no indication of cancer. Should I proceed with surgery to remove cyst/ovary n have a biopsy?

    Reply
    • 25. drnicoll  |  January 26, 2014 at 3:23 am

      Dear Kaye,
      You need to go see a doctor. If you already saw one and you need a second opinion or you didn’t like what you heard, see another doctor.
      The internet is no place to seek an opinion on whether to have surgery.
      I hope you find a great physician and wish you the best of health.
      -Dr N

      Reply
  • 26. endometriosis diet shopping list  |  April 21, 2014 at 7:42 pm

    This post is truly a nice one it helps new net people, who are wishing for
    blogging.

    Reply
  • 27. Mari  |  June 2, 2014 at 7:26 pm

    Hi doctor, just wanna ask if this endometrioma 1.9cm in size is it dangerous?thanks in advance.

    Reply
    • 28. drnicoll  |  February 20, 2015 at 7:42 pm

      Dear Mari,
      As I have written many times before on this site, I do not give out individual medical advice on this blog. Please contact your doctor ASAP.
      Best regards,
      Dr N

      Reply
  • 29. Myss  |  June 18, 2014 at 2:49 am

    I am not sure if this is something that can be answered in this forum, but if so, please advise. I read a earlier post and it helped a but, but i wanted to be a bit more specific. Is it unusual for a woman with no uterus (1 ovary)…who is on hormone therapy to not ovulate to have re-occuring sub-centimeter follicles…and those present as consistently painful?

    Reply
    • 30. drnicoll  |  February 20, 2015 at 7:41 pm

      Hi Myss,
      I am sorry, but I do not give out individual medical advice on this blog. If this question is about your health, please contact your doctor ASAP.
      Best regards,
      Dr N

      Reply
  • 31. Amy  |  October 2, 2015 at 3:35 pm

    For the pet 19 days I’ve been in pain. Thinking ovary cysts which I’ve had in the past. 2nd period started 13tg (only 9 days after regular cycle) heavy, severe bloating, sharp pain, nauseous, couldn’t eat without pain. New obgyn said both ultrasounds looked ok and to go to GI. GI said blood and urine ok and ordered CT of abdominal and pelvic region. Was told everything “OK” again. As I suffer with debilitating pain

    Reply
  • 32. Amy  |  October 2, 2015 at 3:40 pm

    For the pet 19 days I’ve been in pain. Thinking ovary cysts which I’ve had in the past. 2nd period started 13tg (only 9 days after regular cycle) heavy, severe bloating, sharp pain, nauseous, couldn’t eat without pain. New obgyn said both ultrasounds looked ok but they couldn’t find left ovary and to go to GI. GI said blood and urine ok and ordered CT of abdominal and pelvic region and said it would show everything including left ovary. Was told everything “OK” again. Saw my obgyn for pap and pelvic exam. Her concern was with my pain level and said possible chemical pregnancy. As I suffer with constant debilitating pain I decided to get my own records of CT. And it’s not normal! Fluid in endometrial cavity and dominate cyst on right ovary. And nothing about my left ovary!!! Need help! Have another obgyn appt at 1:15 but think I just need to go to ER

    Reply
    • 33. drnicoll  |  October 2, 2015 at 4:42 pm

      Hi Amy,
      I am sorry you’re not well. As I have said before, I do not dispense individual medical advice on this blog. Please either call your doctor or go to an emergency room/urgent care to see a physician.
      Best regards,
      Dr N

      Reply
  • 34. Tanisha  |  March 25, 2016 at 3:34 pm

    Hiii,i m 31yrs old & married for 4yrs.i have subcentimetric cyst in right ovary due to which not having ovaluation…please suggest what should to get rid of it & remedies
    Thanks

    Reply
    • 35. drnicoll  |  September 8, 2016 at 2:46 pm

      Hi Tanisha,
      I don’t dispense individual advice over my website. Please discuss your concerns with your doctor.
      -LN

      Reply
  • 36. Stephanie Sedore  |  August 10, 2016 at 7:54 pm

    Hi there! I’ve recently had issues regarding a pain in my uterine area. I’ve had two c sections but my doctor says that is no issue.

    I was sent for ultrasounds on my pelvis and vagina, as well as abdomen. I have two small nabothian cysts on my cervix, my right ovary has a cyst of 1.9 cm, and my left is clear but has several small follicles. My doctor seemed unconcerned but I often have a lot of pain in my right side. I don’t feel like I have all the answers I’m looking for.

    Does this sound concern able to you? Should I be worried about the ovary cyst? Sometimes I can’t even walk or pee without pain. . Something I have told my doctor.

    Thanks!!

    – Steph

    Reply
    • 37. drnicoll  |  September 8, 2016 at 2:36 pm

      Hi Steph,
      I’m sorry but I don’t dispense individual advice on this site. In general, if you are unhappy with your doctor’s care or think there may be more to the story than what you’ve been told, it’s always a good idea to seek out a second opinion (by visiting another provider, not online). A new provider’s fresh perspective can often shed light on the problem.
      -LN

      Reply
  • 38. Stephanie  |  October 20, 2016 at 7:50 am

    Thank you so much I found this so helpful

    Reply

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Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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