Ovarian Cyst: Symptoms, When to Worry, and Do You Need Surgery?

Being told "there is a cyst on your ovary" after an ultrasound is frightening, and the first question most women ask is whether it means surgery or cancer. An ovarian cyst is a sac filled with fluid or other material that forms in or on an ovary. Ovarian cysts are common, they are found at every age, and many of them never need an operation.

The ovary makes a small fluid-filled follicle every month as part of ovulation. Sometimes that follicle does not release its egg or does not shrink afterwards, and it is seen on a scan as a cyst. These are called functional cysts. They often cause no symptoms and frequently settle by themselves within one to three menstrual cycles.

Other types behave differently. An endometrioma, sometimes called a chocolate cyst, is linked to endometriosis and tends to stay or grow. A dermoid cyst contains tissue such as fat or hair and does not go away by itself. Cysts can also appear with polycystic ovary syndrome, although that is a different condition from a single cyst. Less often a cyst needs closer checking because its appearance on the scan is not typical.

Many cysts cause no symptoms at all and are found by chance. When there are symptoms, they can include a dull ache or heaviness on one side of the lower belly, bloating, pain during sex, pain with periods, changes in the menstrual cycle, or needing to pass urine more often if the cyst presses on the bladder.

Some symptoms need urgent care the same day: sudden, severe pain in the lower belly, pain with fever or vomiting, feeling faint or dizzy, or a fast heartbeat. These can be signs that a cyst has twisted or burst. Go to a hospital emergency department rather than waiting for a clinic appointment.

A cyst is assessed by putting the pieces together. The doctor asks about your symptoms, cycle and any chance of pregnancy, and examines you. An ultrasound shows the size of the cyst and what it looks like inside. Depending on age and the scan, blood tests or a repeat scan after a few weeks may be suggested. A cyst found after menopause is always looked at carefully.

What happens next depends on the type, the size, your symptoms, your age and whether you plan to have children. Often the plan is to watch and repeat the scan. Pain relief or hormonal treatment may be used for some situations, such as endometriosis. Surgery is considered when a cyst is large, keeps growing, causes ongoing symptoms, does not settle, or looks unusual on the scan. The doctor explains the reasons and the options before any decision, and results differ between individuals.

If an operation is advised, our clinic does not perform surgery on site. Operations are carried out at a partner hospital, and the doctor discusses the approach, including whether the ovary can be kept, before you decide.

If you have been told you have an ovarian cyst, or you have one-sided pain or bloating that keeps coming back, you do not have to wait and worry. Send us a message to ask whether you should be seen, and bring any previous scan results with you.