Ovarian cysts guide: Symptoms, causes & treatments

Dr Louise Hayes Dr Louise Hayes MBBS (Lond.) FRCOG, Consultant in Gynaecology & Women’s Health Published May 8th 2023

If you’ve learned you have, or think you might have, an ovarian cyst, it’s only natural to be concerned. But you shouldn’t worry. They’re completely natural, loads of women have them, and very few prove serious or have lasting effects. But what are the signs? And when should you seek help?

What is an ovarian cyst?

Imagine a blister, perhaps the size of a grain of rice. Thin skinned and fluid-filled, it appears on, or sometimes in, an ovary, stays there for a while, and then disappears. The chances are, if you have one, you’ll have no symptoms at all. Unless you happen to have a scan for some reason, you won’t even know it’s there.

Some cysts can cause discomfort, or even pain. Mostly this will be no more intrusive than, say, indigestion or wind, and can be controlled using basic painkillers and other remedies, until it goes away again.

In rare cases there may be an underlying cause demanding medical intervention, up to and possibly including surgery. But that’s unusual. Mostly ovarian cysts come, go, and no-one ever knows.

How do I know if I have an ovarian cyst?

As just described, there’s a good chance you won’t. They’re only likely to cause problems if they grow unusually large, burst, or twist preventing blood from reaching the ovaries.

If this happens, you may get:

  • Pelvic pain – anything from a dull, heavy feeling to a sudden stabbing pain
  • Pain or aches in the lower abdomen, lower back or thighs
  • Toilet problems – needing to wee all the time, or finding it hard to poo
  • Period issues – irregular, and/or unusually light or heavy
  • Bloating, swelling, feeling full when you’ve hardly eaten anything
  • Pain during sex

Obviously many of these symptoms could have other causes, so don’t assume you have an ovarian cyst just because, say, you feel bloated. But if you’re concerned, and especially if your symptoms don’t go away, or multiply, or get worse – you need to make an appointment with your doctor or gynaecologist.

When should I get medical attention immediately?

It’s worth saying again that complications and major issues are rare, but you should get immediate medical help if you experience:

  • Sharp, sudden and/or ‘serious’ (uncommonly severe) abdominal pain
  • Nausea or vomiting
  • Fever, rapid breathing, or clammy skin
  • Unusual diarrhoea or constipation
  • Dizziness or weakness

Any such symptoms could indicate a ruptured cyst, a twisted ovary, or another serious health condition that needs dealing with straightaway.

How will my doctor find out if I do have a cyst?

There are basically three diagnostic tools your doctor may use: hands, scans and bloods.

Almost certainly, diagnosis will begin with a physical exam, focusing on your pelvic area, with your doctor feeling for swelling near your ovaries. This may be enough to confirm a cyst – or pretty much rule one out. If it’s felt necessary, your doctor may also arrange:

  • USS – a scan tells for certain whether you have a cyst, and if so, how big it is, and where it is. You may need further scans MRI/CT
  • Blood tests – which can offer useful information on cysts and other related matters such as pregnancy, hormone levels, and possibly other conditions

What treatment will I receive?

Most likely, if you have a typical ovarian cyst – one which is small, fluid-filled, and doing no harm – none!

Your doctor will almost certainly recommend a course of ‘watchful waiting’. Basically a matter of you ‘keeping an eye on’ your own wellbeing, looking after yourself generally, and staying aware of your body and alert to anything that gets suddenly worse or otherwise just ‘doesn’t feel right’.

Home remedies that help some women relieve the symptoms and generally feel a bit less under the weather include:

  • Regular over-the-counter painkillers, like ibuprofen or paracetamol
  • Heat therapy, using a hot water bottle or electric heat pad to relieve pain and cramps
  • Hot baths, with added Epsom salts, again to help you relax, and ease cramping
  • Hot drinks – chamomile or ginger teas, for example

If at any point anything feels seriously wrong, or changes suddenly, seek help. Other than that, for the most part it’s just a matter of waiting it out, knowing it will go away in its own time. A scan after a few weeks is sometimes used to confirm you’re completely clear.

What if it’s more serious?

Up to this point we’ve focused on simple or ‘functional’ cysts – by far the most common, particularly pre-menopause. ‘Functional’ basically refers to the fact that such cysts don’t suggest malfunction – something wrong. They’re entirely normal, are a natural part of the ovulation process, and will go away with your regular monthly cycle.

Something like one cyst in ten doesn’t meet this description. Such cysts – known as ‘complex’ cysts – do indicate that something is wrong, will need checking out by a medical professional, and may require treatment, up to and possibly including surgery.

Complex cysts – more common among post-menopausal women – are caused by abnormal cell growth, and are not part of the ovulation process. They may be:

  • Unusually large
  • Containing blood or solids
  • Cancerous

Your doctor may recommend surgery if you have particularly severe symptoms, if cancer is suspected or confirmed, or if he or she believes the cyst may be a sign of a deeper underlying health condition.

Depending on the size and severity of your ovarian cyst, surgery will be either:

  • Laparoscopic – ‘keyhole’ surgery, undertaken through a small incision
  • Laparotomic – more traditional surgery involving more invasive incision

Depending on the surgery you have, and how extensive it is, you may have to stay in hospital after your operation for a few days.

What happens after surgery?

How long it takes to recover after surgery differs from person to person. You’ll almost certainly feel tender and painful in the immediate area of the surgery, though this should ease after a few days. Full recovery can take weeks, or even months.

In the meantime take it easy and keep comfortable. Contact your doctor immediately if you notice:

  • Heavy bleeding
  • Severe pain or swelling of your abdomen
  • High temperature (fever)
  • Dark/smelly vaginal discharge

Such symptoms may indicate an infection – unlikely to be serious, and easily sorted out with a course of antibiotics, but certainly you should get help.

Can a complex ovarian cyst/operation affect my chances of getting pregnant?

Ovarian cysts don’t generally prevent you getting pregnant, though they can sometimes make it harder.

If you need to have surgery, your surgeon will certainly do everything they can not to affect your fertility. They will, for example, wherever possible, remove just the cyst and leave the ovaries intact. If medically necessary, they will remove one ovary but leave the other, meaning you will still be able to produce eggs and get pregnant.

If test results show your cyst to be cancerous, both of your ovaries, your womb (uterus) and some of the surrounding tissue may need to be removed, which would mean you’re no longer able to get pregnant.

Your surgeon will discuss potential effects on your future fertility before any operation is undertaken.

What are the long term effects of ovarian cysts?

The outlook is generally very good, especially for simple ovarian cysts – the overwhelming majority, particularly for pre-menopausal women.

For complex ovarian cysts, it all depends on the cause and treatment.

Even if you have to have surgery to remove a cyst, you’re unlikely to end up with any long-term health issues once you’ve recovered from the operation.

In more extreme cases, such as those involving severe endometriosis, PCOS (polycystic ovary syndrome) or cancer, surgery may be more invasive and recovery longer, and there may be long term effects. Your doctor will discuss your situation and options at the time.

Is there anything I can do to prevent ovarian cysts?

If you keep having ovarian cysts, your doctor may prescribe oral contraceptives, which stop you ovulating and prevent the development of new cysts.

Routine gynaecological examinations can also help early detection. And early is always best. Many women from mainland Europe routinely have ‘wellwoman’ checks every 12 or even six months. As well as helping maintain your general health, and gaining the peace of mind that comes with knowing everything is as it should be, such checks also offer the best possible chance of discovering potential problems before they become big problems.

You should in any case always keep an eye on your own wellbeing, and seek help if you experience symptoms like:

  • Changes to your menstrual cycle
  • Pelvic pain that doesn’t go away – or gets worse
  • Loss of appetite
  • Unexplained weight loss
  • Feeling full after eating very little

Imagine a blister, perhaps the size of a grain of rice. Thin skinned and fluid-filled, it appears on, or sometimes in, an ovary, stays there for a while, and then disappears.

Most often, you can’t. Most ovarian cysts have no symptoms, and you will never even know you have one unless you happen to have a scan for some reason.

The vast majority of ovarian cysts cause few if any symptoms, go away of their own accord within a month or two, and leave no lasting effects whatsoever.

For most ovarian cysts, nothing. Most ovarian cysts are entirely natural, totally harmless, and will go away of their own accord. ‘Watchful waiting’ is the best prescription.

If ‘something’s not right’ – real discomfort, unusual pain, or bloating, say, make an appointment. In the event of sudden changes, and severe symptoms like nausea, dizziness or ‘serious’ abdominal pain – ring for help now.

The vast majority of ovarian cysts disappear as mysteriously as they arrived within a month or two as part of your natural cycle, and leave no trace.

Meeting with a professional is always recommended when concerned.

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