What are ovarian cysts and how are they treated?

Ovarian cysts, a common condition in women, occur due to imbalances in the body’s hormonal system and can lead to various health problems. It is estimated that around 7% of women worldwide experience an ovarian cyst at some point in their lives [1]. Although the majority are benign, they should be regularly monitored due to the potential risk of malignant transformation.

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Most ovarian cysts resolve on their own and do not require treatment. However, in large, persistent, or suspicious cysts, early diagnosis and proper follow-up can be life-saving.

What Is the Ovary?

The ovary is a female reproductive organ where eggs are produced. It consists of two symmetrical glands located on either side of the uterus. From puberty onward, the ovaries produce an egg during each menstrual cycle and release it into the fallopian tubes. This process is essential for pregnancy. Ovulation, which occurs between days 11 and 16 of the cycle, continues until menopause.

Why Do Ovarian Cysts Form?

The primary cause of ovarian cyst formation is hormonal imbalance. If the hormones responsible for ovulation are disrupted, follicles may fail to mature and rupture, preventing the release of the egg. These unruptured follicles can turn into cysts over time. The cysts formed may further disrupt hormonal balance, creating a vicious cycle [2].

What Types of Ovarian Cysts Are There?

Ovarian cysts are classified according to their structure and formation mechanisms [2, 3]:

• Simple (functional) cysts: The most common type; caused by fluid accumulation in the follicle and usually resolve within 6–8 weeks [2].
• Follicular cysts: Occur when the egg is not released; typically resolve after menstruation.
• Corpus luteum cysts: Develop after ovulation and usually resolve spontaneously.
• Endometrioma (chocolate cyst): Formed by endometrial tissue in the ovaries; can grow from 1–3 cm to over 20 cm, cause severe pain, and lead to infertility. Laparoscopic cystectomy is recommended as the primary diagnostic and treatment method [4].
• Polycystic ovarian cysts: Result from irregular ovulation and may cause menstrual irregularities and excess hair growth.
• Serous cystadenoma: One of the most common cyst types; can grow up to 5–15 cm and usually requires surgery.
• Mucinous cystadenoma: Does not resolve spontaneously and can reach 15–50 cm; surgical treatment is required.

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What Are the Symptoms of Ovarian Cysts?

Most cysts do not cause symptoms and are detected during routine examinations. When symptoms occur, the most common include [2, 3]:

• Menstrual irregularities and severe period pain
• Severe groin pain
• Abdominal bloating
• Urinary complaints
• Nausea and vomiting
• Digestive problems
• Pain during sexual intercourse
• Infertility
• Excess hair growth

Emergency situation: Sudden severe abdominal pain accompanied by fever and vomiting may indicate ovarian torsion and requires immediate medical attention [3].

How Are Ovarian Cysts Diagnosed and Treated?

Ovarian cysts are usually detected via ultrasound during routine check-ups. Whether the mass is benign or malignant can be determined through ultrasound, MRI, and blood tests. Blood tests include markers such as CA-125, AFP, Beta-HCG, CEA, and CA 19-9. CA-125 is elevated in about 80% of epithelial ovarian cancers, but it is not recommended as a standalone screening test [1].

Treatment options [1, 2, 3]:

• Observation: Since many cysts resolve on their own, monitoring is preferred for asymptomatic patients. ACOG states that simple cysts can be safely followed without intervention even in postmenopausal women [1].
• Medications: Oral contraceptives may prevent new functional cysts but do not shrink existing ones [1].
• Surgery: If the cyst has solid components, is larger than 10 cm, grows rapidly, is immobile, or there is suspicion of cancer, surgical removal is recommended. Laparoscopic surgery is preferred for benign cysts [2, 3].

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