When to Consider Surgery for Your Ovarian Cysts

Ovarian cysts are exceptionally common. In most cases, they’re completely harmless and go away independently. But it may be time to consider surgery when they persist, grow larger, or cause bothersome symptoms. Here’s what you should know.

An ovarian cyst is a tissue- or fluid-filled sac that forms on or inside one of your ovaries. While ovarian cysts are exceptionally common, most are completely harmless (benign) and go away independently without causing gynecological symptoms or problems. Virtually all women develop ovarian cysts at some point in their lives, and most don’t even know. 

Unfortunately, some ovarian cysts become problematic — they may persist, grow larger, bleed, burst, or twist the ovary, causing pain and other bothersome symptoms. They may also look unusual on the ultrasound, triggering concerns about the rare possibility of cancer.

At New Beginnings OB/GYN in Shenandoah, Texas, our skilled team specializes in identifying and resolving troublesome ovarian cysts. Here, Dr. Rania Ibrahim and Dr. Christina Parmar discuss ovarian cyst complications, explore conservative treatment options, and explain when surgery may be the best solution.

Understanding ovarian cyst formation

The most common ovarian cysts are a normal byproduct of your menstrual cycle. Known as functional cysts, they form when an ovary releases its egg each month (ovulation).

Follicular cysts

Each month during your menstrual cycle, a follicle (cyst) grows on the outer surface of one of your ovaries. The follicle contains the developing egg, which it releases once the egg is ready. This process is called ovulation. 

Sometimes, the follicle fails to break open and release its mature egg. When the egg remains in its follicle, it forms a follicular cyst. These cysts usually have no symptoms and go away within 1 to 3 menstrual cycles. 

Corpus luteum cysts

Another functional ovarian cyst type forms after an egg’s release. The empty follicle sac shrinks into a mass of cells (called corpus luteum) that makes hormones to prepare for the next egg. 

Sometimes, the follicle doesn’t contract — it seals itself and collects fluid, forming a corpus luteum cyst. Most corpus luteum cysts resolve within a few weeks. 

When ovarian cysts are problematic

While most ovarian cysts go away in relatively little time, some may persist or grow larger. An ovarian cyst is far more likely to cause symptoms if it’s very large, interferes with blood supply to the ovary, breaks open or bleeds, or causes the ovary to twist (torsion). 

In such cases, you may experience pressure, bloating, or swelling on the side of the cyst. When a large cyst causes an ovary to twist, you may feel sharp or dull pelvic pain sensations that come on quickly and persist or come and go over time. 

Less commonly, a problematic ovarian cyst may cause:

An ovarian cyst that ruptures can cause sudden, severe pain, with or without heavy bleeding, fever, dizziness, weakness, and vomiting. If you experience any of these symptoms, seek immediate medical care.

Finding the right treatment approach 

Because most ovarian cysts are a byproduct of the menstrual cycle, women are far more likely to get them during their childbearing years (between puberty and menopause). Only about 8% of premenopausal women develop problematic ovarian cysts that require treatment. 

Watchful waiting 

Suppose our team discovers an average ovarian cyst during a routine pelvic exam or ultrasound. In that case, we will likely recommend a period of “watchful waiting,” using periodic ultrasound imaging to check its size and progress. 

Again, most ovarian cysts resolve on their own — even those that cause mild symptoms may go away on their own after a few menstrual cycles. In the meantime, pain relievers can help. 

Fewer new cysts

Suppose you have frequent ovarian cysts and you’re not actively trying to conceive. In that case, we may also prescribe hormonal birth control (the pill, patch, vaginal ring, or shot) to help reduce your risk of developing new ovarian cysts.

Surgical cyst removal

While ovarian cyst removal (cystectomy) is rarely required, it’s often the best solution for a cyst that:

  • Doesn’t go away on its own
  • Is large or increasing in size 
  • Causes bothersome symptoms
  • Looks atypical on the ultrasound

We highly recommend surgical removal for any ovarian cyst that occurs near or after normal menopause, simply because — while rare — ovarian cysts can become cancerous, and the risk for ovarian cancer increases with age. Up to one in five ovarian cysts that are removed are found to be cancerous. 

If you’re dealing with a problematic ovarian cyst, our team at New Beginnings OB/GYN can help. Call or click online to schedule an appointment today.