Ovarian cyst

An ovarian cyst is a fluid-filled sac that develops on an ovary. They're very common and do not usually cause any symptoms.

Most ovarian cysts are generally harmless and disappear without treatment in a few months.

Small cysts are normal in the ovary. There may only be a problem is there are a large number of cysts, they're persistent, or become particularly large.

Ovarian cysts may affect both ovaries at the same time, or they may only affect one.

What are ovaries?

The ovaries are part of the female reproductive system. They are 2 small, bean-shaped organs, one each side of the womb (uterus).

The ovaries have 2 main functions. They are:

to release an egg around every 28 days as part of the menstrual cycle
to release the female sex hormones, oestrogen and progesterone

Types of ovarian cyst

The 2 main types of ovarian are:

functional ovarian cysts (most common) – develop as part of the menstrual cycle and are usually harmless and short-lived
pathological ovarian cysts (much less common) – occur due to abnormal cell growth

Ovarian cysts can sometimes also be caused by an underlying condition, such as endometriosis.

The vast majority of ovarian cysts are non-cancerous (benign). But a small number are cancerous (malignant).

Signs and symptoms

Most cysts are found by chance during a scan. They're unlikely to cause any symptoms unless they're large or abnormal.

An ovarian cyst will usually only cause symptoms if it splits (ruptures), is very large, or it blocks the blood supply to the ovaries.

Urgent advice: Contact your GP practice if:

you have sudden, severe pelvic pain

If your GP is closed, phone 111.

Non-urgent advice: Contact your GP practice if:

You're worried about your symptoms or you regularly have:

pelvic pain – this can range from a dull, heavy sensation to a sudden, severe and sharp pain
pain during sex
difficulty having a poo
a frequent need to urinate
heavy periods, irregular periods or lighter periods than normal
bloating and a swollen tummy
feeling very full after only eating a little
difficulty getting pregnant

If your GP practice is closed, phone 111.

Useful information for your doctor

It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. You can then discuss this with your doctor who can decide if any tests or treatments might be needed.

If you’re seeing your doctor, there are some useful pieces of information to think about beforehand:

the first day of your last period (when it started)
how many days your period usually lasts
what was the shortest time between your periods (from the first day of one period to the first day of the next)
what was the longest time between your periods (from the first day of one period to the first day of the next)
how often you need to change your period products on a heavy day
if you are over 25, when you had your last smear test

Diagnosing ovarian cysts

If your GP thinks you may have an ovarian cyst, you may be referred for an ultrasound scan. This is carried out by using a probe placed inside your vagina.

As this is a very intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isn’t a female doctor available, you can ask if there’s a female health professional who could carry out the examination.

If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks. Or your doctor may refer you to a gynaecologist, who specialises in female reproductive health.

Your doctor may also arrange blood tests to check for any other conditions.

Treatment

In most cases, ovarian cysts disappear in a few months without treatment. A follow-up ultrasound scan may be used to confirm this.

Most ovarian cysts do not need treatment or surgery.

Treatment will depend on:

size and appearance of the cysts
whether you have any symptoms
whether you're post-menopausal (due to the slightly higher risk of ovarian cancer)

If you're post-menopausal, you'll usually have regular ultrasound scans and blood tests over the course of a year to monitor the cyst.

Large cysts, those causing symptoms, and those that could be cancerous, may need to be surgically removed.

Your care team can talk with you about what to expect, and answer any questions you have.

Types of surgery

There are 2 types of surgery used to remove ovarian cysts:

laparoscopy
laparotomy

These are usually carried out under general anaesthetic.

Laparoscopy

Most cysts can be removed using laparoscopy. This is a type of keyhole surgery. Small cuts are made in your tummy and gas is blown into the pelvis to allow the surgeon to access your ovaries.

A laparoscopy is a procedure where a camera (a laparoscope) is inserted into the pelvis via a small cut near the belly button so the surgeon can see your internal organs. The surgeon then removes the cyst through the small cuts in your skin.

After the cyst has been removed, the cuts will be closed using dissolvable stitches.

A laparoscopy is preferred because it causes less pain and has a quicker recovery time. You'll usually be able to go home on the same day or the following day.

Laparotomy

If your cyst is particularly large, or there is a chance it could be cancerous, a laparotomy may be recommended.

During a laparotomy, a single, larger cut is made in your tummy to give the surgeon better access to the cyst.

The whole cyst and ovary may be removed and sent to a laboratory to check whether it's cancerous. Stitches or staples will be used to close the incision.

You may need to stay in hospital for a few days after the procedure.

After the surgery

After the ovarian cyst has been removed, you'll feel pain in your tummy. This should improve in a day or two.

If you have had a laparoscopy, you'll probably need to take things easy for 2 weeks. Recovery after a laparotomy will usually take longer, possibly around 6 to 8 weeks.

If the cyst has been sent for testing, the results should come back in a few weeks. Your doctor will discuss with you whether you need any further treatment.

Contact your GP if you notice the following symptoms after surgery, as they may indicate an infection:

heavy bleeding
severe pain or swelling in your abdomen
a high temperature (fever)
dark or smelly vaginal discharge

Your fertility after surgery

If you have not been through the menopause, your surgeon will try to preserve as much of your reproductive system as they can.

Make sure you discuss your fertility concerns with your surgeon before your operation.

It's often possible to just remove the cyst and leave both ovaries intact, which means your fertility should be largely unaffected.

If one of your ovaries needs to be removed, the remaining ovary will still release hormones and eggs as usual. Your fertility shouldn't be significantly affected. But you may find it slightly harder to get pregnant.

Occasionally, it may be necessary to remove both ovaries. This will trigger an early menopause. You'll no longer produce any eggs and will not be able to get pregnant.

It may still be possible to have a baby by having a donated egg implanted into your womb. You can speak to your doctor for more information about this.

If you've been through the menopause, both ovaries may be removed because they no longer produce eggs.