What Are Ovarian Cysts?
An ovarian cyst is a fluid-filled sac within or on the surface of an ovary. They are extraordinarily common — the majority of ovulating women will develop at least one ovarian cyst during their lifetime. Most are functional: they form as part of the normal menstrual cycle and resolve spontaneously within one to three menstrual cycles without any treatment.
However, some ovarian cysts require monitoring or surgical management. Understanding the difference between a functional cyst and a cyst that needs further evaluation is the essential clinical question.
Types of Ovarian Cysts
- Follicular cysts — the most common type, form when a follicle fails to release an egg. Typically resolve within 6 weeks.
- Corpus luteum cysts — form after ovulation, can bleed internally and cause acute pain if they rupture.
- Endometriomas — “chocolate cysts” filled with old blood from endometriosis implants. Associated with pain and fertility problems.
- Dermoid cysts (teratomas) — contain tissue such as hair, skin, or teeth; usually benign but can grow large.
- Cystadenomas — arise from the ovarian surface; can become very large. Serous and mucinous types exist.
- Polycystic ovaries — multiple small follicular cysts associated with PCOS; not a traditional “cyst” requiring surgery.
When to Watch and When to Worry
A simple, unilocular (single-compartment), thin-walled cyst under 5 cm in a premenopausal woman is almost certainly benign and appropriate for watchful waiting with a repeat ultrasound in 8–12 weeks.
Features that warrant further evaluation include:
- Cyst diameter greater than 5–7 cm
- Complex features: thick walls, internal septations, solid components, or papillary projections
- Bilateral cysts (on both ovaries)
- Elevated CA-125 blood test (noting this marker is not cancer-specific)
- Cyst in a postmenopausal woman — any new cyst after menopause needs careful evaluation
- Rapidly enlarging cyst on serial imaging
- Associated ascites (fluid in the abdomen)
Can an Ovarian Cyst Be Cancer?
The vast majority of ovarian cysts — particularly in premenopausal women — are benign. However, ovarian cancer can present as a cyst or as a cystic-solid mass on ultrasound. The critical point: if a cyst has complex features or is in a postmenopausal woman, it should be assessed by a gynaecological oncologist before any surgery is undertaken. Surgery for an ovarian cyst that turns out to be cancer should never be performed by a surgeon without oncological training — incomplete excision significantly worsens prognosis.
For specialist assessment of an ovarian cyst in Ahmedabad, contact Dr. Nishtha Tripathi Patel at +91 76988 00333.