The short answer: Most ovarian cysts do not need an operation. Surgery is usually advised when a cyst is large or growing, causes pain, does not go away on repeat scans, looks complex (for example, has solid parts) or is found after menopause. Whenever possible, the surgeon removes only the cyst and keeps the ovary; this is called cystectomy. The whole ovary is removed (oophorectomy) mainly when little healthy ovary is left, after menopause, or when cancer cannot be ruled out before surgery. In Hindi this is often searched as ovary me ganth ka operation (ओवरी में गांठ का ऑपरेशन).
If you want to understand what your scan report means and the different types of cyst, start with our guide to the assessment of ovarian cysts. This page focuses on the operation itself.
On this page
- Managing an Ovarian Cyst: The Surgical Decision
- Indications for Surgery
- Cystectomy vs Oophorectomy
- Why the Choice of Surgeon Matters
Managing an Ovarian Cyst: The Surgical Decision
Not every ovarian cyst requires surgery. The decision is based on the cyst’s size, how it looks on ultrasound, whether you have reached menopause, your symptoms and, often, a score that combines the scan, the CA-125 blood test and menopause status (the risk of malignancy index, RMI). Knowing when surgery is really needed, and when it is safe to watch, avoids both unnecessary operations and harmful delays.
Does the size of the cyst decide surgery? Size is one factor, not the only one. As a rough guide, a simple cyst under about 5 cm is usually re-scanned in 6–12 weeks; a cyst of about 5–10 cm, or one that is growing, is followed more closely; and a cyst over about 8–10 cm, one with solid parts, or one found after menopause is more likely to be reviewed by a specialist. Many cysts in these groups still turn out to be harmless.
Indications for Surgery
- A large cyst, roughly over 8–10 cm, especially with symptoms (large cysts are more likely to twist the ovary or burst)
- A complex cyst (with solid parts or thick walls) after menopause, which is usually reviewed by a specialist and often removed
- A high RMI (risk of malignancy index) score, meaning the scan, CA-125 and menopause status together raise concern
- Endometrioma causing fertility problems or significant pain
- Acute pain from a suspected torsion (twisted ovary) — a surgical emergency
- Cyst that has grown on serial imaging or failed to resolve over 3–6 months
- Dermoid cyst (mature cystic teratoma) of any significant size — these do not spontaneously resolve
Cystectomy vs Oophorectomy
Ovarian cystectomy — removes only the cyst while preserving the ovarian tissue. This is the preferred approach in premenopausal women where preserving ovarian function and fertility matters. For endometriomas (chocolate cysts) and dermoid cysts in young women, keyhole (laparoscopic) cystectomy is the usual approach.
Most cyst operations can be done by keyhole surgery, through a few small cuts, which usually means less pain and a quicker return home than open surgery. Dr. Nishtha Tripathi Patel performs laparoscopic surgery at Sterling Hospitals, KD Hospital and Welcare Speciality Hospital, Ahmedabad. Open surgery may be safer for a very large cyst or when cancer is suspected, so that the cyst can be removed in one piece. Your surgeon will explain which approach suits you and what recovery to expect.
Oophorectomy — removes the entire ovary. Indicated when ovarian tissue is completely replaced by the cyst, in postmenopausal women, when cancer cannot be excluded preoperatively, or when the woman has completed her family and has risk factors for ovarian cancer (BRCA mutation, strong family history).
Why the Choice of Surgeon Matters
Most ovarian cyst operations are done safely by gynaecologists. When the scan or blood tests suggest a cyst could be cancer, it is safer for a gynaecological oncologist (a women’s cancer surgeon) to operate. If a cyst turns out to be cancer and bursts during surgery or is removed in pieces, the cancer stage can go up and more treatment, often chemotherapy, may be needed. A gynaecological oncologist can also do the staging steps at the same operation (washings from the abdomen, biopsies and, when needed, lymph node assessment), which can avoid a second operation.
Frequently Asked Questions
Will cyst surgery affect my chances of pregnancy?
Removing only the cyst is chosen whenever possible to protect the ovary and future fertility. Even if one ovary has to be removed, the other ovary usually keeps working and pregnancy is often still possible. Read more about life with one ovary.
How much does ovarian cyst surgery cost?
The cost depends on the hospital, keyhole or open surgery, the length of stay, tests, the room category and insurance cover. Ask the hospital for a written estimate before surgery.
Should every cyst be checked by a cancer specialist?
No. Most cysts are looked after well by a gynaecologist. A gynaecological oncologist is helpful when a cyst looks complex, is found after menopause, comes with a clearly raised CA-125, or there is a strong family history of ovarian or breast cancer. See also when to watch and when to worry.
For specialist ovarian cyst management in Ahmedabad, contact Dr. Nishtha Tripathi Patel at +91 76988 00333. Before your visit, see our guide to preparing for a specialist appointment.