Dr. M.J. Bazos, MD.
Ovarian cysts are fluid filled structures that
develop in the ovary. Ovarian cysts develop with every menstrual cycle. Fluid
collects around developing eggs; one egg becomes “dominant” and that
egg ovulates (leaves the ovary and goes into the fallopian tube). The ovulated
egg leaves a cyst behind in the ovary. This cyst is usually 2–3
centimeters (1–2 inches) in diameter. This type of cyst is called a
“physiologic cyst,” “follicular cyst,” or “simple
cyst.” If the cyst remains a normal size, it does not cause any symptoms.
If the cyst grows larger, 4 centimeters or larger, it can cause pain.
Symptomatic cysts are very common; in most cases, the cyst and symptoms will
resolve without any treatment. Occasionally, cysts can bleed into themselves. A
very small blood vessel in the wall of the cyst breaks, and the blood goes into
the cyst. These are called “hemorrhagic cysts” and sometimes are
more painful. Hemorrhagic cysts are common as well. Occasionally, hemorrhagic
cysts can rupture, and the blood goes into the abdominal cavity. No blood is
seen out of the vagina. If a cyst ruptures, it is usually very painful.
Hemorrhagic cysts that rupture are less common. Most hemorrhagic cysts are
selflimiting; some need surgical intervention (see below). Even if the
hemorrhagic cyst ruptures, in many cases it will resolve without surgery.
Sometimes surgery is necessary. Another condition that can occur with ovarian
cysts is “torsion” or twisting of the ovary and fallopian tube. If
the ovary and tube twist a little, this can cause pain, but it is not dangerous.
If the ovary and tube twist completely around, this is very painful and
immediate surgical treatment is necessary. Cysts are usually diagnosed by pelvic
ultrasound. This is a painless test in which the ovaries, fallopian tubes, and
uterus can be seen so the cyst can be confirmed. If the cyst appears to be
“clear” inside, the diagnosis of a physiologic cyst is made. If the
cyst is not clear inside, then it is possible a hemorrhagic cyst is
Living With Your
Ovarian cysts can cause
pelvic pain. The pain can be sharp, dull, or feel like pressure. It may be
localized to one side of the abdomen, or it may be more diffuse across the lower
abdomen. Activity such as walking, exercise, or intercourse will often make the
pain worse. Usually bladder or bowel habits are not affected, although sometimes
pelvic pain can cause urinary frequency (make you feel like you need to empty
your bladder more often). Usually, the appetite is not affected unless the pain
is severe. If the pain is from a physiologic cyst or from a hemorrhagic cyst, it
will usually resolve in a few days up to 10–14 days (by the next period).
If the pain is from a ruptured hemorrhagic cyst or an ovarian cyst that is
twisting, the pain usually worsens until it is extremely severe, necessitating
you have a physiologic cyst that grew larger than it should have, usually no
treatment is necessary except to decrease the pain. Ibuprofen can be taken to
decrease the pain: 400 milligrams every 4 hours or 600 milligrams every 6 hours
or 800 milligrams every 8 hours. (Obviously, do not take ibuprofen if you have
been told you should not take it because of a medical condition, an allergy to
it, or because it is incompatible with another medication you are taking.)
Sometimes a prescription pain medication will be prescribed if ibuprofen does
not relieve the pain enough or cannot be taken. Sometimes a warm bath or heating
pad can help lessen the discomfort. Often a follow-up pelvic ultrasound will be
recommended to make sure the cyst has resolved. If you have a ruptured or
twisting cyst, you may need laparoscopic surgery. This is a procedure in which a
telescope-like instrument and other instruments are placed into the abdominal
cavity through very small incisions. The cyst can be seen and the bleeding
stopped by cauterizing it. If the ovary and fallopian tube are twisting,
sometimes the ovary and tube can be untwisted, or sometimes the ovary and tube
have to be removed. If you have recurrent ovarian cysts, birth control pills may
be recommended. Birth control pills prevent most ovulation, so cysts do not
• Take ibuprofen 400
milligrams every 4 hours or 600 milligrams every 6 hours or 800 milligrams every
8 hours for pain. (Do not take ibuprofen if have been told you should not take
it because of a medical condition, an allergy to it, or because it is
incompatible with another medication you are
• Sometimes a hot tub or
heating pad can help relieve the
• Refrain from
strenuous activity (e.g., exercise, sexual activity). Activity will make the
When to Call Your
• If the pain gets worse
instead of gradually decreasing.
a fever, or nausea and vomiting develop.