An ovarian cyst is a fluid-filled sac that forms in the ovary. Ovarian cysts are common and, in the vast majority of cases, they are benign (noncancerous). They vary in size and may occur at different sites in the ovary; the most common type develops when an egg-producing follicle does not rupture and release the egg but instead swells with fluid and forms a follicular cyst.

Cysts often disappear on their own without treatment, but in some cases they may require surgical removal. In rare cases a cyst that twists or ruptures may cause serious complications warranting emergency surgery.

At Johns Hopkins, our physicians are experts at diagnosing and treating ovarian cysts. While ovarian cysts are mostly benign and harmless, there are cases where they can be cancerous or dangerous to a woman’s future fertility. That is why it is so critical to be evaluated by an ovarian cyst expert at Johns Hopkins.

Symptoms can include:

• In many cases, ovarian cysts produce no symptoms.
• Mild abdominal ache.
• Abdominal swelling or a feeling of fullness or pressure.
• Pain during sexual intercourse.
• Menstrual irregularities including absence of menstrual bleeding (amenorrhea), heavy bleeding (menorrhagia), and painful periods (dysmenorrhea).
• Unusual hair growth on the face and body caused by an increased production of masculinizing hormones (hirsutism).
• Sudden, sharp abdominal pain, fever, and nausea if a cyst becomes twisted or ruptures.
• Rarely, painful, frequent urination-or urinary retention-if a cyst presses against the bladder.

If you experience any of the symptoms of ovarian cysts, call a gynecologist. If you have been diagnosed with an ovarian cyst and you experience sudden, sharp abdominal pain, fever, or vomiting, see a doctor immediately.

Diagnosis of ovarian cysts

A gynecological examination is necessary to diagnose an ovarian cyst. If a lump or mass in the ovary is detected, further tests are necessary to rule out the possibility of ovarian cancer.

Your doctor may perform one or more tests to diagnose a benign ovarian cyst:

• Pelvic Exam: Oftentimes, ovarian cysts are detected during a routine pelvic exam. But because the pelvic exam cannot produce a definitive diagnosis, the next step is to perform a vaginal sonogram.
• Vaginal sonogram: This imaging test allows a physician to get the most accurate picture of the ovary and cyst. The test is performed by inserting a small instrument into the vagina, which then bounces sound waves off your uterus, fallopian tubes and ovaries, forming a picture on a monitor. This image enables the doctor to determine with accuracy the size of the cyst and, just as importantly, to see inside it and detect whether it is solid or fluid-filled. While the vaginal sonogram detects the presence of a cyst, it cannot verify whether it is benign or malignant. Therefore, if the sonogram detects a cyst, the next step may be the surgical removal of the cyst to find out if it is malignant or benign.
• Laparoscopy: This minimally invasive surgical procedure allows your doctor to see and remove the cyst by making a small incision in the abdomen rather than a long cut. The laparoscope, a thin lighted telescope, is inserted through a small incision into your abdomen. Small instruments placed near the pubic bone allow the doctor to then remove the cyst.

Treatment of ovarian cysts

Ovarian cysts often disappear without treatment. Surgery to remove the cyst may be needed if cancer is suspected, if the cyst does not go away, or if it causes symptoms. In many cases it can be taken out without damaging the ovary, but sometimes the ovary has to be removed. In rare cases an ovarian cyst may be drained during laparoscopy.

Your doctor may recommend hormonal therapy for preventing future ovarian cysts.