An ovarian cyst is one of the most common findings in gynecology. Sometimes it causes no noticeable symptoms and is discovered incidentally during an ultrasound examination, while in other cases it leads to pain, disrupts the menstrual cycle, and creates anxiety due to uncertainty. This is completely normal – the word “cyst” often sounds alarming, even though in reality ovarian cysts can be very different.
In this article, I will explain the topic in simple terms – what an ovarian cyst is, which types are most common, why it develops, which symptoms truly matter, how diagnosis is usually performed, and what treatment strategies doctors choose. Without unnecessary dramatization, but also without false reassurance: our goal is to understand the situation and make the right decision in a timely manner. In my clinical practice, I regularly encounter the fact that the same word “cyst” can represent completely different clinical situations in different women.
What Is an Ovarian Cyst and Where Is It Located
An ovarian cyst is a fluid-filled or more dense cavity-like formation that develops within the ovarian tissue or adjacent to it. Simply put, it is a “bubble” of varying size that arises for different reasons and behaves differently depending on its type.
The ovaries are paired organs located on either side of the uterus within the pelvic cavity. They are responsible for the monthly maturation of follicles containing eggs and for the production of female sex hormones. For this reason, most ovarian cysts are directly or indirectly related to hormonal function and the menstrual cycle.
An ovarian cyst may be located:
- inside the ovary itself,
- on its surface,
- next to the ovary, without anatomically being part of its tissue.
Ovarian cysts can appear quite different in structure. Some have thin walls and uniform fluid content, while others are denser and may contain inclusions or internal septations. This is why, during an ultrasound examination, the physician evaluates not only the size of the cyst but also its structure, shape, and location. Based on these ultrasound features, the doctor makes initial clinical judgments about the nature of the cyst and the need for further steps.
It is important to understand that the presence of a cyst does not automatically mean a “dangerous condition.” In many cases, it is a functional state related to the menstrual cycle that can resolve on its own. However, distinguishing a harmless situation from one that requires monitoring or treatment always calls for a professional medical assessment.
Types of Ovarian Cysts
When a woman first hears the phrase “you have an ovarian cyst” during an ultrasound examination, the natural next question is – what kind of cyst is it? This question is indeed important, because ovarian cysts differ not only in appearance but also in origin, behavior, and recommended follow-up strategies.
In clinical practice, ovarian cysts are conventionally divided into functional and non-functional types. This classification helps determine whether a cyst is related to the menstrual cycle and hormonal fluctuations or has a different underlying nature.
Functional Cysts
Functional cysts develop as part of the normal ovarian activity within the menstrual cycle. They most commonly occur in women of reproductive age and, in many cases, may resolve spontaneously.
A follicular ovarian cyst forms when a follicle containing an egg fails to ovulate and continues to increase in size. These cysts typically have thin walls, uniform fluid content, and often remain asymptomatic.
A hemorrhagic ovarian cyst develops when bleeding occurs into the cavity of a functional cyst. In such cases, pain, a sensation of pressure, or discomfort in the lower abdomen may appear, usually on one side.
Non-Functional Cysts
Non-functional cysts are not directly related to the phases of the menstrual cycle and generally do not resolve on their own. Their behavior and management depend on the type of cyst, the woman’s age, and the overall clinical picture.
An endometriotic ovarian cyst develops in the context of endometriosis – a condition in which tissue similar to the lining of the uterus grows outside the uterine cavity. These cysts are often associated with pain, particularly during menstruation, and require closer monitoring.
A dermoid ovarian cyst is a congenital formation that may contain dense tissues, such as fatty tissue or skin elements. It is often discovered incidentally and may remain asymptomatic for a long time.
A paraovarian ovarian cyst is located adjacent to the ovary but does not originate from its tissue. It usually grows slowly and can remain unnoticed for an extended period.
An atypical ovarian cyst is a term used when a formation has non-standard ultrasound features and requires additional evaluation. This does not automatically indicate a malignant process, but it serves as a signal for more thorough diagnostic assessment.
Understanding the type of cyst is a key factor in choosing further management. This is why the same diagnosis of “ovarian cyst” may imply very different monitoring and treatment scenarios for different women. In real clinical practice, determining the cyst type is the starting point for selecting an appropriate strategy – from careful observation to more active interventions.
Causes of Ovarian Cysts
The question “why does an ovarian cyst develop” is one I hear very often. And here it is important to say honestly from the start: in most cases, it is not a single cause but a combination of factors that influence ovarian function.
The most common basis for cyst formation is hormonal fluctuation. The ovaries are highly sensitive to changes in estrogen and progesterone levels, so disruptions in the menstrual cycle may lead to a follicle failing to ovulate or resolve on time. This is how functional cysts develop.
Other contributing factors may include:
- menstrual cycle irregularities,
- sudden hormonal changes,
- stress and physical or emotional overload,
- inflammatory processes of the pelvic organs,
- endocrine disorders, including thyroid dysfunction.
It is also important to mention endometriotic cysts. Their development is associated with endometriosis – a condition in which tissue similar to the uterine lining responds to hormonal changes and may form cystic structures within the ovaries.
In some cases, ovarian cysts develop independently of hormonal balance. For example, dermoid cysts are formed during fetal development and may remain asymptomatic for many years. Paraovarian cysts arise from tissues adjacent to the ovary and are not related to its function.
During consultations, I often hear the question of whether it was possible to prevent a cyst from developing. In most cases, the honest answer is no. It is important to understand that the presence of a cyst does not mean that a woman “did something wrong.” In the vast majority of cases, cyst formation is the result of complex biological processes that cannot be influenced by willpower or lifestyle changes. This is precisely why each situation requires an individual medical assessment rather than universal conclusions.
Symptoms and Signs of an Ovarian Cyst
The manifestations of an ovarian cyst can vary widely – from a complete absence of symptoms to a pronounced pain syndrome. This often causes confusion, as two women with cysts of similar size may experience very different sensations.
In many cases, a cyst causes no noticeable symptoms and is discovered incidentally, for example during a routine ultrasound examination. This is particularly characteristic of small functional cysts. However, there are situations in which the body does send warning signals.
The most common symptoms that bring patients to medical attention include:
- pulling or aching pain in the lower abdomen, usually on one side,
- a sensation of pressure or heaviness in the pelvic area,
- discomfort that intensifies during physical activity or sexual intercourse,
- pain during menstruation or worsening of usual menstrual pain,
- menstrual cycle disturbances.
A separate question that concerns many women is whether an ovarian cyst always causes pain. The answer is no. Pain more often occurs when a cyst increases in size, stretches the ovarian capsule, bleeds into the cyst cavity, or exerts pressure on neighboring organs.
In some cases, pain may radiate to the lower back or leg and be accompanied by a feeling of bloating or bowel disturbances. In rare situations, dizziness and general weakness may occur – symptoms that require particularly careful medical evaluation.
In clinical practice, we often see that subjective sensations do not always correspond to objective findings, which is why assessment must always be comprehensive. It is important to remember that the severity of symptoms is not always directly related to the size of the cyst. Even small formations may cause noticeable discomfort, while large cysts can sometimes remain almost asymptomatic for a long time. This is why relying solely on sensations is insufficient – medical evaluation always plays a key role.
How to Understand That You May Have an Ovarian Cyst
Most often, suspicion of an ovarian cyst does not arise suddenly but develops gradually. A woman begins to notice changes in her well-being that do not fit her usual menstrual pattern and intuitively feels that “something is not right.”
Reasons to start paying attention may include:
- pain or discomfort in the lower abdomen that recurs from cycle to cycle,
- a sensation of pressure on one side of the pelvis,
- unusual or more painful menstruation,
- pulling sensations occurring outside of menstruation,
- sudden pain after physical activity or sexual intercourse.
Sometimes it is not the presence of pain itself but its character that raises concern. For example, if menstruation previously passed relatively comfortably but then the pain became noticeably stronger or changed in quality. Or if discomfort is predominantly localized on one side and does not subside over time.
At the same time, it is important to understand that sensations alone cannot reliably determine whether a cyst is present, what type it is, or whether it requires treatment. The same symptoms may accompany ovulation, functional hormonal fluctuations, or other gynecological conditions.
Even for an experienced physician, complaints alone are not sufficient to establish a diagnosis – and without examination, this is simply impossible. This is why the key point is not self-diagnosis but timely medical evaluation. If symptoms recur, intensify, or cause concern, this is a sufficient reason to consult a doctor and address the situation professionally rather than drawing conclusions based on isolated signs.
Large Ovarian Cysts
Large ovarian cysts deserve particular attention. They are most often the source of anxiety and the reason for active information searches, although size alone does not answer the question of appropriate management. In practice, it is often the word “large” that causes concern, even though clinical significance depends not only on size but also on the behavior of the cyst.
In gynecology, there is no strict universal size threshold beyond which a cyst is automatically considered dangerous. The physician evaluates not only the diameter of the formation but also its type, structure, growth rate, the woman’s age, and accompanying symptoms.
A large cyst may manifest as:
- a sensation of pressure or fullness in the lower abdomen,
- asymmetrical abdominal enlargement,
- pain that intensifies with movement, bending, or physical exertion,
- discomfort involving the bowel or bladder due to compression of adjacent organs.
At the same time, there are situations in which even a fairly large cyst does not cause pronounced complaints for a long period and is discovered incidentally. Conversely, a relatively small formation may produce noticeable symptoms.
It is important to understand that the main potential issue with large cysts is not size alone but the risk of complications. Therefore, such situations require closer monitoring and regular assessment over time. Decisions regarding further steps are always made on an individual basis, taking into account the clinical picture and examination results, rather than relying solely on the numerical measurement in an ultrasound report.
Ovarian Cysts and Pregnancy
The topic of ovarian cysts during pregnancy often causes significant anxiety, which is completely understandable. Pregnancy is a period when any deviation is perceived especially acutely. The good news is that the presence of a cyst does not necessarily pose a threat to conception or carrying a pregnancy. In such situations, the physician’s task is not to rush to conclusions but to assess risks over time, prioritizing the safety of the pregnancy.
Small functional cysts are often detected after pregnancy has already begun and frequently do not require active intervention. In these cases, the physician evaluates the size of the formation, its structure, and its behavior over time, with observation being the primary management approach.
A separate question is whether an ovarian cyst affects pregnancy. This depends on the type of cyst, its size, and its location. Some formations do not interfere with pregnancy development at all, while others may require closer monitoring, particularly if there is a risk of complications.
An ovarian cyst may also be detected in women during menopause, and the approach in such situations differs. At this stage of life, any ovarian formations are assessed with particular care, taking into account hormonal status and the overall clinical picture.
It is important to understand that there are no universal scenarios in these situations. During pregnancy and in the menopausal period, decisions are always made on an individual basis, taking into account the safety of the woman and her future child. This is why, when a cyst is detected during these periods, specialist follow-up and regular assessment are especially important.
Diagnosis of an Ovarian Cyst
The diagnosis of an ovarian cyst begins with a routine gynecological examination and collection of patient complaints, but instrumental evaluation plays a key role. It is this assessment that allows the physician to understand what type of formation is present and which management strategy is the most reasonable.
The primary diagnostic method is ultrasound examination of the pelvic organs. During ultrasound, the physician evaluates:
- the size of the cyst,
- its shape and contours,
- the structure of its contents,
- its location in relation to the ovary and uterus,
- the presence of additional features that require attention.
In real clinical practice, it is the combination of ultrasound characteristics, the patient’s age, and clinical symptoms that determines further management. The same cyst size in different women may require completely different decisions.
It is important for the physician to consider not only the presence of a cyst itself but also its ultrasound appearance. Homogeneous fluid content and thin walls usually support a functional nature of the formation, whereas septations, dense inclusions, or heterogeneity require more careful evaluation.
In some situations, additional diagnostic tests may be required. This does not mean that the situation is dangerous, but it helps clarify the nature of the cyst and rule out other conditions. The scope of evaluation is always selected individually and depends on the woman’s age, symptoms, and ultrasound findings.
It is also important to emphasize that a diagnosis of “ovarian cyst” is not made based on a single examination without analysis of the clinical picture. The physician always assesses data comprehensively and, when necessary, monitors the formation over time. This approach helps avoid both unnecessary anxiety and unjustified decisions.
How Ovarian Cysts Are Treated
The management strategy for an ovarian cyst always depends on its type, size, symptoms, and the woman’s age. There is no universal solution suitable for everyone, and this is important to understand from the very beginning.
In some cases, active treatment is not required at all. Functional cysts often resolve spontaneously over several menstrual cycles. In such situations, the physician chooses a watchful waiting approach with follow-up examinations to ensure that the formation is decreasing in size and does not cause complications.
Hormonal treatment may sometimes be considered. Its goal is not to “dissolve” the cyst immediately but to stabilize hormonal balance and reduce the likelihood of new functional cyst formation. Hormonal medications are always prescribed on an individual basis and only after contraindications have been evaluated.
There are situations in which surgical treatment is required. This decision is based not only on the size of the cyst but also on its structure, growth rate, symptom severity, and risk of complications. The decision to proceed with surgery is made carefully and after discussing all possible options with the patient.
It is important to emphasize that modern clinical approaches to the treatment of ovarian cysts aim to preserve ovarian function and a woman’s reproductive health. Therefore, management strategies are always selected to be as gentle as possible, based on the specific clinical situation.
What Happens If an Ovarian Cyst Is Not Treated
This question arises at almost every appointment, and it is entirely logical. The answer cannot be the same for everyone, because the future behavior of a cyst depends directly on its type and characteristics.
In some cases, especially when functional cysts are involved, there may be no negative consequences at all. Such formations can decrease in size and resolve on their own without intervention, provided that medical observation is maintained.
However, other scenarios are also possible. If a cyst persists for a long time, increases in size, or is non-functional in nature, the risk of complications increases. These may include worsening pain, pressure on adjacent organs, and in certain situations, acute conditions requiring urgent medical care.
Special attention is required for cysts with atypical ultrasound features or those detected in women after menopause. In such cases, a “wait and see” approach may be unsafe and requires more active management.
Therefore, the key principle here is not to ignore the diagnosis but to understand that “not treating” does not mean “doing nothing.” Even in the absence of active intervention, medical follow-up is necessary in order to adjust management in a timely manner and avoid undesirable consequences.
Frequently Asked Questions
Can an ovarian cyst appear and disappear on its own?
Yes, this is possible. Most often, this applies to functional cysts that are related to the menstrual cycle. They may decrease in size and resolve over several months without active treatment, provided that medical observation is maintained.
Is an ovarian cyst always associated with hormonal disorders?
No. Although hormonal factors play a significant role, there are cysts that are not related to hormones or the menstrual cycle. For example, dermoid or paraovarian cysts have a different origin and behave differently.
Can an ovarian cyst affect weight or cause abdominal bloating?
An indirect connection is possible. Large cysts may create a sensation of bloating or pressure, but the cyst itself is rarely the direct cause of weight gain. If such symptoms are pronounced, further evaluation is warranted.
Is it dangerous to exercise if you have an ovarian cyst?
This depends on the size and type of the cyst. With small formations, moderate physical activity is usually acceptable. With large cysts or significant pain, a physician may recommend temporary restrictions to reduce the risk of complications.
Can ultrasound immediately determine whether a cyst is benign?
Ultrasound provides a great deal of information but does not always give definitive answers. In most cases, a physician can assess the nature of the formation based on a combination of features, but sometimes dynamic observation or additional studies are required.
If a cyst does not cause pain, does that mean it is not dangerous?
The absence of pain does not always indicate safety. Some cysts are indeed asymptomatic but still require monitoring. Assessment is always based not only on sensations but also on examination findings.
Can an ovarian cyst affect fertility?
The impact depends on the type of cyst and associated factors. Many cysts do not interfere with conception, but in certain cases they may be associated with conditions that affect reproductive function. This is why it is important to understand the underlying cause rather than focusing solely on the presence of a cyst.
Is it necessary to make an immediate decision if a cyst is found on ultrasound?
In most cases, no. Decisions in gynecology are rarely made based on a single examination. A dynamic assessment of the situation and consideration of the clinical picture are far more important.
Conclusion
An ovarian cyst is not a single diagnosis but a broad spectrum of conditions that can behave differently and require different approaches. In some women, a cyst resolves quietly without intervention, while in others it becomes a source of discomfort or a reason for closer monitoring.
The most important thing to remember is that relying solely on symptoms or, conversely, ignoring an ultrasound finding is not the most reliable strategy. Evaluation of the cyst type, its behavior, and potential risks should always be comprehensive and individualized.
If pain develops, menstrual changes occur, or questions and doubts remain, consultation with a specialist helps clarify the situation and choose the most reasonable management approach. A calm and balanced approach to one’s health is always more effective than anxious assumptions or waiting for things to “resolve on their own.” This is exactly the balanced approach I consider most appropriate in working with patients – without haste, but also without ignoring the body’s signals.
