Cysts: When to Worry and When to Wait
Most ovarian cysts are harmless and resolve on their own — but some require treatment. Learn how to tell the difference and when to see a doctor.
By Dr. Amrendra Prasad Kushwaha
Ovarian cysts are fluid-filled sacs that form on or inside the ovary. They are extremely common — most women will develop at least one during their lifetime, often without knowing it. The good news is that the vast majority are benign and disappear on their own within a few menstrual cycles.
Types of Ovarian Cysts
Functional Cysts (Most Common)
These develop as part of the normal menstrual cycle and usually resolve without treatment:
- Follicular cysts — form when a follicle doesn't release an egg and continues to grow
- Corpus luteum cysts — develop after ovulation when the follicle doesn't dissolve as expected
Pathological Cysts
These are less common and may require treatment:
- Dermoid cysts — contain tissue such as hair or skin; rarely cancerous but can grow large
- Endometriomas — caused by endometriosis; can affect fertility
- Cystadenomas — grow from ovarian tissue and can become very large
- Polycystic ovaries (PCOS) — multiple small cysts associated with hormonal imbalance
Symptoms to Watch For
Many cysts cause no symptoms at all and are found incidentally during an ultrasound. However, see a doctor if you experience:
- Dull aching or sharp pain in the lower abdomen or pelvis
- Bloating or a feeling of fullness
- Irregular or painful periods
- Pain during intercourse
- Frequent urination
When to Seek Emergency Care
Go to the emergency department immediately if you have:
- Sudden, severe pelvic pain
- Fever and vomiting alongside pelvic pain
- Signs of shock (dizziness, rapid breathing, weakness)
These may indicate a ruptured cyst or ovarian torsion — both of which require urgent treatment.
How Are Cysts Diagnosed?
A pelvic ultrasound is the primary tool for diagnosing ovarian cysts. At Hope Hospital, we use high-resolution obstetric and
gynaecological ultrasound to:
- Measure the size of the cyst
- Determine whether it is simple (fluid only) or complex (mixed content)
- Monitor changes over time
In some cases, blood tests such as CA-125 may be requested, though elevated levels do not automatically indicate cancer.
Treatment Options
| Cyst Type | Approach |
|---|---|
| Small functional cyst | Watchful waiting (repeat ultrasound in 6–8 weeks) |
| Persistent or large cyst | Laparoscopic surgery |
| Endometrioma | Excision via laparoscopy + hormonal therapy |
| Suspected malignancy | Urgent surgical referral |
Laparoscopic Cystectomy
For cysts that require removal, laparoscopic surgery is the preferred approach. As a fellowship-trained laparoscopic gynaecologist, I
perform minimally invasive cyst removal that:
- Preserves the ovary wherever possible
- Involves only small incisions (0.5–1 cm)
- Allows same-day or next-day discharge
- Reduces risk of scarring and adhesions
Can Ovarian Cysts Affect Fertility?
Functional cysts generally do not affect fertility. However, endometriomas and cysts caused by PCOS can reduce ovarian reserve and
interfere with conception. Early diagnosis and appropriate management significantly improve fertility outcomes.
Key Takeaways
- Most ovarian cysts are harmless and resolve on their own
- Regular pelvic ultrasound is the best way to monitor them
- Sudden severe pain requires emergency evaluation
- Laparoscopic surgery offers safe, effective removal when needed
If you have been told you have an ovarian cyst or are experiencing pelvic pain, I encourage you to book a consultation for a proper
evaluation and personalised plan.
Contact: 984-3504431 | Hope Hospital, Kathmandu