Ovarian cysts:
When to watch and when to worry.

By Dr. Sharon R. Hontiveros

What are ovarian cysts?

Ovarian cysts are fluid-filled sacs on or within an ovary. Functional cysts develop as part of the menstrual cycle and are the most common type before menopause. Many resolve naturally over a few months.

Other types, including cysts associated with endometriosis, may behave differently. Most ovarian cysts are non-cancerous, but not every cyst can be assumed to be a temporary functional cyst.

Symptoms to discuss with your OB-GYN

Many cysts cause no symptoms. Others can cause pelvic discomfort, bloating, pain during sex, urinary pressure, or changes in periods. Persistent or new symptoms deserve assessment.

When to seek urgent care

Seek urgent medical assessment for sudden, severe pelvic pain, particularly with nausea or vomiting. A ruptured cyst or twisting of the ovary (ovarian torsion) can require urgent treatment.

Do not wait for a routine appointment if pain is severe. Your symptoms need evaluation rather than assuming a known cyst is the cause.

How are cysts assessed?

A pelvic examination may suggest a problem, but ultrasound helps assess a cyst’s size and appearance. Your OB-GYN will also consider symptoms, whether you have reached menopause, and whether the cyst persists or changes.

Further tests may be appropriate if the findings are concerning. A cyst after menopause deserves individual assessment because the risk of malignancy is higher than before menopause.

Monitoring and treatment

• Watchful waiting: For an appropriately selected cyst, repeat ultrasound after a planned interval can check whether it resolves or changes. Follow the schedule your doctor recommends.
• Medication: Medicines may help symptoms or an underlying condition. Combined birth control pills do not make an existing functional cyst disappear faster.
• Surgery: This may be considered for a large, persistent, symptomatic, or suspicious cyst, or for complications. The decision depends on the whole assessment, not size alone.

If surgery is recommended, discuss fertility goals and options for preserving ovarian tissue where appropriate.

The takeaway

Not every ovarian cyst needs treatment, but every monitoring plan should be clear. Ask what type of cyst is suspected, when follow-up is needed, and which symptoms should prompt urgent care.