After being told at a health screening that there is a lump on the ovary, most women worry first about whether it is cancer or whether surgery is needed straight away. To give the conclusion first, most ovarian cysts are benign, and surgery does not often need to be considered as soon as a cyst is found.
However, some types of cyst disappear on their own and others do not, and once a cyst grows to 5 cm or more it can lead to an emergency in which the ovary twists, so it should not be left unchecked. This article sets out the types of ovarian cyst, the risks of leaving a cyst alone, and what to confirm at regular check-ups and when planning a pregnancy.
What types of ovarian cyst are there?
A functional cyst is a common ovarian cyst filled with clear fluid. It forms because of hormonal changes and usually disappears by itself over the course of the menstrual cycle. If there are no symptoms, its size is followed by ultrasound.
A chocolate cyst grows when endometrial tissue attaches to the ovary and blood collects inside it, and a teratoma is a cyst that contains a mixture of fat and hair. Both are benign and unrelated to cancer, but their size and position still need to be checked.
- Functional cyst — filled with clear fluid and often disappears naturally with the menstrual cycle
- Chocolate cyst (endometrioma) — a benign tumour formed by old blood that collects and does not go away by itself
- Teratoma — a benign tumour in which tissue such as fat or hair is found inside the cyst
What are the risks of leaving an ovarian cyst alone?
Ovarian torsion is a surgical emergency in which the ligament of the ovary twists and the blood flow is cut off. Published research names a mass of 5 cm or more in diameter as a major risk factor and considers that the risk of twisting rises as the mass grows.
Chocolate cysts and teratomas grow under the influence of hormones, so their risk of ovarian torsion is high. If the ovary twists, bleeding and tissue death can follow and fertility may be lost, which is why an early response is needed.
What should be confirmed at a regular check-up?
Anxiety after a diagnosis of ovarian cyst comes largely from a lack of information, and because management differs with size and nature, an explanation is needed. Relying only on online searches, or on being told it is nothing to worry about, can mean missing the right time for treatment and letting the condition progress.
Confirming whether there is pain, how high the risk of torsion is, and whether medication or surgery is needed leads to appropriate treatment at an early stage. The fuller the explanation, the more readily a patient understands and keeps to the timing of the next visit.
- Cyst size — the risk of ovarian torsion changes with the diameter in centimetres
- Internal nature — management differs depending on whether it is a functional cyst or a chocolate cyst or teratoma
- Pain — whether there is pain or a heavy, uncomfortable feeling affects the decision on when to treat
- Direction of treatment — whether to observe with medication or whether surgery is now needed should be confirmed together
How should an ovarian cyst be managed when planning a pregnancy?
When a pregnancy is planned, pre-pregnancy care that looks at ovarian function, which is directly linked to ovulation, is needed. An ovarian age test confirms that function and helps in planning the timing and method of conception.
Whether treatment is needed before pregnancy depends on whether the cyst is functional or a benign tumour. Chocolate cysts and teratomas rarely disappear, and during pregnancy they can affect ovarian function and carry a risk of torsion, so cyst management and pregnancy preparation are handled together.
