An ovarian cyst is a fluid-filled sac on or in the ovary, most often a harmless functional cyst that forms around ovulation and goes away on its own. Some cysts bleed, rupture or twist the ovary, and a few in older women may be cancer.
Key symptoms
- Often no symptoms; found on imaging
- Dull, one-sided pelvic pain or pressure
- Bloating or feeling full quickly
- Sudden sharp pain after sex or exercise if it ruptures
- Irregular periods
What you find on exam
- Vital signs; look for fever or shock
- Tender adnexal mass on bimanual exam
- Peritoneal signs: guarding, rebound
- Abdominal distension or ascites
Tests
- Pregnancy test to rule out ectopic pregnancy
- Transvaginal ultrasound: size, simple or complex
- Doppler ultrasound for ovarian blood flow if torsion is suspected
- CA-125 for a complex mass after menopause
Treatment basics
- Simple cyst before menopause: watch and repeat ultrasound in 6 to 12 weeks
- Pain relief with NSAIDs such as ibuprofen
- Laparoscopic surgery for large, persistent or suspicious cysts
- Referral to gynecologic oncology for a mass suspicious for cancer
- Emergency surgery for torsion or major bleeding
Red flags
- Sudden severe pain with nausea and vomiting (ovarian torsion)
- Dizziness, low blood pressure or falling hemoglobin (bleeding cyst)
- Complex mass with ascites or weight loss after menopause
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.