Ovarian cysts: why most of them are not operated on
Ovarian cyst: dangerous? does it need surgery? – gynaecologist Basel
FMH Gynecology
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Spalenvorstadt 3
4051 Basel
An ovarian cyst is a fluid-filled space on the ovary. Most arise in the normal cycle: a follicle does not rupture, or the corpus luteum fills with fluid. Such functional cysts are a sign of a working ovary, not a disease.
The word «cyst» sounds threatening and often leads to operations that were not necessary. Every ovarian operation also removes healthy tissue and reduces the egg reserve.
Cysts occur at any age, most commonly during the fertile years. After menopause cysts are assessed more carefully, but are also usually benign.
Key facts
At a glance.
- Most cysts are functional and disappear within six to twelve weeks.
- A simple, thin-walled cyst without internal structures is virtually always benign.
- Size alone is not a reason to operate – suspicious features are.
- Every ovarian operation costs reserve; that matters with a wish for children.
- Sudden severe one-sided pain may be torsion – that is an emergency.
- Tumour markers such as CA-125 are often falsely elevated in young women and are used selectively.
Causes
Background and risk factors.
Functional cysts arise from the follicle or the corpus luteum and disappear with the next cycle. In addition there are endometriomas (chocolate cysts in endometriosis), dermoid cysts (congenital tissue inclusions), cystadenomas (benign neoplasms) and – far more rarely – malignant changes, whose risk increases with age.
Risk factors
- Fertile years with active ovulation
- Endometriosis
- Fertility treatment with stimulation
- PCOS
- Family history of ovarian cancer (BRCA)
Frequency
Ovarian cysts are a very common ultrasound finding. The vast majority are benign and self-limiting.
Symptoms & findings
How does it present?
Typical symptoms
- Pulling or pressure on one side of the lower abdomen
- Pain around ovulation or during intercourse
- Shift in the cycle
- Bloating with larger cysts
Common incidental findings
- Incidental finding on routine ultrasound, entirely symptom-free
- A cyst that has already disappeared at the follow-up scan
When to act immediately
Sudden, very severe one-sided lower abdominal pain with nausea or vomiting may mean torsion or rupture. That is an emergency – please go to an emergency department or hospital immediately. Increasing abdominal girth, persistent bloating, weight loss or bleeding after menopause also need prompt assessment.
Diagnostics
How the diagnosis is made.
Transvaginal ultrasound assesses size, wall thickness, internal structures, solid parts and blood flow. These features – not the diameter – decide the approach. For a probably functional cyst we repeat the scan after six to twelve weeks, ideally in the first half of the cycle.
Tumour markers are used selectively, not routinely
in young women CA-125 is often elevated for harmless reasons.
Examinations
- Transvaginal ultrasound with assessment of cyst features
- Repeat ultrasound after 6–12 weeks
- Pregnancy test with acute pain
- Tumour markers only in the appropriate setting
- Specialist ultrasound if endometrioma is suspected
What do the findings mean?
Simple, smoothly outlined, echo-free, no solid parts, no abnormal blood flow: that is the picture of a harmless cyst. Solid parts, thick septa, papillary structures, free fluid or strong vascularity lead to further assessment – then the finding belongs in specialist hands.
Treatment
Possible approach.
Watchful waiting
Watching and rescanning is the treatment of choice for a simple cyst. Most cysts have already gone by the follow-up scan. If a small, simple cyst stays stable and symptom-free, further interval checks are enough.
Medication
Hormonal contraception does not make an existing cyst disappear faster, but it can reduce new functional cysts. Pain is treated with NSAIDs. For an endometrioma the treatment follows the endometriosis as a whole, not the cyst alone.
Surgery
Surgery is indicated for persistent or severe symptoms, growth over time, suspicious ultrasound features, large dermoids and torsion. The procedure is usually laparoscopic and as ovary-sparing as possible. With a wish for children we weigh the loss of ovarian reserve particularly carefully. We do not perform these operations ourselves – we assess, interpret and refer specifically.
Prevention
What you can do yourself.
- Have incidentally found simple cysts rechecked instead of operated straight away
- Plan the follow-up scan in the first half of the cycle
- Include ovarian reserve in the decision if you want children
- Seek immediate help for sudden severe pain
- Before proposed surgery, have the ultrasound features explained
One appointment. One main concern. So we can give you our full, unhurried attention, we address one main topic per appointment. We're happy to schedule additional or complex questions in a separate appointment. This is what allows consultations to run on time and without long waiting times – thank you for your understanding.
Frequently asked questions
FAQ.
Related topics
Keep reading.
- Premium check-up with ultrasound
Assessment and follow-up of cysts with ultrasound.
- What we deliberately don't do
- Gynaecological ultrasound
- Endometriosis & adenomyosis
- PCOS
Medically responsible.
Dr. med. Anna Margareta Wagner is a board-certified FMH specialist in gynecology and obstetrics with her own practice at Spalenvorstadt 3 in Basel. Special focus on surgical gynecology; further focus areas: gynecological check-ups, colposcopy and dysplasia consultations, intimate surgery, pregnancy care, and consultations for girls and adolescents.
- FMH specialist certification in gynecology and obstetrics
- Special focus: surgical gynecology
- SGGG member
- Certified colposcopy diploma
- Languages: German, English
- Service area: Basel-Stadt, Basel-Landschaft, northwestern Switzerland
The content on this page is reviewed regularly against current specialist medical recommendations.
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