Being told that you have an ovarian cyst can immediately raise questions.
Is it dangerous?
Is the cyst causing my pain?
Will it go away?
Could it affect my fertility?
Do I need surgery?
The reassuring answer is that most ovarian cysts are benign, and many cysts in women who are still having periods resolve without treatment.
But there is an equally important point:
Finding an ovarian cyst on an ultrasound does not automatically mean the cyst is causing your symptoms.
The pelvis contains many structures close together—the ovaries, uterus, fallopian tubes, bladder, bowel, pelvic floor muscles, nerves, and surrounding tissues. Pelvic pain can come from gynecologic, urinary, gastrointestinal, muscular, and other causes.
At Women’s Health Group Chicago, Dr. Michael Awad takes a comprehensive approach.
The goal is not simply to find a cyst.
It is to determine:
- What type of cyst is it?
- What does it look like on ultrasound?
- Is it likely to resolve?
- Does it need follow-up?
- Is it actually responsible for your pain?
- Could something else in the pelvis be causing your symptoms?
- Do you need treatment at all?
- If treatment is needed, is medical management appropriate or would surgery provide a better result?
- How does the treatment fit your fertility and long-term health goals?
Because the correct treatment starts with the correct diagnosis.
What Is an Ovarian Cyst?
An ovarian cyst is a sac containing fluid that develops on or within an ovary.
Not every mass found near the ovary is technically a cyst. An adnexal mass may be cystic, solid, or a combination of both. Determining what a finding actually represents is one of the main purposes of a careful ultrasound evaluation.
Ovarian cysts are very common.
During a normal menstrual cycle, a follicle develops in the ovary and releases an egg. Sometimes that normal process produces a temporary cyst.
Other cysts develop for completely different reasons.
That is why the words “ovarian cyst” describe many different conditions rather than one single diagnosis.
Different Types of Ovarian Cysts Require Different Approaches
The type of cyst matters.
A simple functional cyst in a 27-year-old is very different from an endometrioma in someone trying to become pregnant or a new complex ovarian mass after menopause.
Functional Ovarian Cysts
Functional cysts develop as part of normal ovarian activity.
They include follicular cysts and corpus luteum cysts.
These cysts are common in women who are still ovulating, and many disappear on their own over several menstrual cycles.
In many cases, the best treatment is simply careful observation.
Hemorrhagic Cysts
Sometimes bleeding occurs into a functional cyst, creating a hemorrhagic ovarian cyst.
These cysts can sometimes cause sudden or one-sided pelvic pain.
Many resolve on their own, but the correct management depends on the ultrasound appearance, the patient’s symptoms, age, and other clinical findings.
This is another situation where follow-up imaging can be useful.
Endometriomas
An endometrioma is an ovarian cyst associated with endometriosis.
Endometriosis can cause:
- Painful periods
- Chronic pelvic pain
- Pain during intercourse
- Fertility problems
Treatment may involve medication, surgery, or both, depending on the symptoms, imaging, fertility goals, and overall clinical picture. ACOG notes that when pain is the primary problem in endometriosis, medication is often considered before surgery.
An endometrioma therefore does not automatically mean surgery.
Dermoid Cysts
Dermoid cysts, also called mature cystic teratomas, are usually benign ovarian growths that can contain several types of tissue.
They do not usually disappear like a functional cyst.
Whether treatment is needed depends on factors such as:
- Size
- Symptoms
- Growth
- Ultrasound appearance
- Risk of complications
- Age and reproductive goals
Cystadenomas and Other Benign Ovarian Growths
Other benign ovarian tumors can appear cystic on ultrasound.
Some remain small and cause no problems.
Others can enlarge and cause pressure, discomfort, or other symptoms.
Again, the important question is not simply whether a cyst exists.
We need to understand what type of lesion it appears to be and what it is doing.
Is the Ovarian Cyst Actually Causing Your Pain?
This is one of the most important questions in ovarian cyst care.
A patient may have pelvic pain and an ultrasound may show an ovarian cyst.
It is tempting to immediately connect the two.
But that conclusion is not always correct.
The pelvis contains:
- Ovaries
- Uterus
- Fallopian tubes
- Bladder
- Bowel
- Pelvic floor muscles
- Blood vessels
- Nerves
- Supporting ligaments and connective tissues
Pelvic pain can have many causes, including endometriosis, adenomyosis, fibroids, bladder conditions, bowel disorders, pelvic floor dysfunction, infection, and other conditions. ACOG specifically recognizes that chronic pelvic pain can have multiple contributing causes.
So when an ultrasound finds a cyst, we ask:
Does the location, size, type, and appearance of this cyst actually fit the patient’s symptoms?
That distinction can help prevent unnecessary treatment.
Treat the Patient, Not Just the Ultrasound
Imagine two patients.
One has a 4-centimeter ovarian cyst and no pain.
Another has a smaller ovarian lesion but severe one-sided pain that repeatedly occurs at the same point in her menstrual cycle.
Those patients do not automatically need the same treatment.
Just like our approach to fibroids, imaging is an important part of the picture—but it is only part of the picture.
At Women’s Health Group Chicago, we look at:
- Your symptoms
- When the symptoms occur
- Where the pain is located
- Your menstrual cycle
- Previous imaging
- Changes over time
- Your examination
- Your age
- Your medications
- Your fertility plans
- Your family and medical history
- The detailed appearance of the cyst
Then we put those pieces together.
What Symptoms Can Ovarian Cysts Cause?
Many ovarian cysts cause no symptoms at all.
They may be discovered during an ultrasound performed for another reason.
When symptoms do occur, they may include:
- One-sided pelvic pain
- Pelvic pressure
- Abdominal fullness
- Bloating
- Pain during intercourse
- Pain associated with the menstrual cycle
- Sudden pain in some circumstances
The symptoms depend partly on the type, size, and location of the cyst.
Pelvic Pain
Ovarian cyst pain may feel:
- Dull
- Aching
- Sharp
- Intermittent
- One-sided
- Related to certain activities
- Related to the menstrual cycle
But pelvic pain should not automatically be blamed on a cyst simply because both are present.
The diagnosis needs to make sense clinically and on imaging.
Bloating, Pressure, and Fullness
Larger ovarian cysts or masses can sometimes produce:
- Pelvic pressure
- Abdominal fullness
- Bloating
- Heaviness
Persistent new bloating or abdominal changes deserve evaluation because ovarian cysts are only one possible cause.
Pain During Intercourse
Some ovarian cysts can contribute to deeper pelvic pain during intercourse.
But painful sex can also be associated with:
- Endometriosis
- Pelvic floor dysfunction
- Vaginal conditions
- Uterine conditions
- Infection
- Other pelvic disorders
This is another reason we evaluate the whole pelvis rather than treating an imaging finding in isolation.
Sudden Severe Pelvic Pain: When an Ovarian Cyst Can Be an Emergency
Most ovarian cysts are not emergencies.
However, sudden severe pelvic or abdominal pain should not be ignored.
Two important complications are:
Ovarian Torsion
The ovary can twist around the tissues supporting it, which may interfere with its blood supply.
Cyst Rupture
An ovarian cyst can rupture and release fluid or blood into the pelvis.
Seek urgent medical attention for sudden or severe pelvic pain, particularly when it occurs with symptoms such as:
- Nausea or vomiting
- Fainting
- Severe weakness
- Dizziness
- Heavy bleeding
- Fever
- Severe abdominal tenderness
Ovarian torsion is a time-sensitive condition that requires prompt medical evaluation.
Expert In-Office Ultrasound for Ovarian Cysts
For many ovarian cysts, ultrasound is the most important imaging test.
ACOG identifies pelvic ultrasound as a tool for evaluating pelvic masses such as ovarian cysts and investigating causes of pelvic pain. The American College of Radiology describes ultrasound as the primary imaging method for evaluating most ovarian and adnexal lesions.
At Women’s Health Group Chicago, we have invested in providing detailed gynecologic ultrasound directly within our office.
That means patients often do not need to schedule a separate trip to a hospital imaging department just to begin understanding what is happening.
What We Look for on an Ovarian Cyst Ultrasound
An ovarian ultrasound is about much more than measuring diameter.
We evaluate characteristics such as:
- Size
- Location
- Whether it is simple or complex
- Whether it contains clear fluid
- Internal echoes
- Septations or internal divisions
- Solid components
- Wall characteristics
- Blood flow when appropriate
- The appearance of both ovaries
- Fluid elsewhere in the pelvis
- Changes compared with previous imaging
These features help determine whether a cyst has a reassuring appearance, needs follow-up, or requires additional evaluation.
The ACR O-RADS Ultrasound system uses standardized ultrasound features to help describe adnexal lesions, assess their risk category, and guide appropriate management.
Imaging Performed With Skill and Reviewed From Multiple Perspectives
High-quality imaging depends on more than owning an ultrasound machine.
It begins with obtaining excellent images.
At Women’s Health Group Chicago, our ultrasound technologist Gabi is an important part of that process.
She is highly capable and technically skilled, but just as importantly, she is gentle, patient, and attentive to comfort during an examination that can feel very personal.
The images are then evaluated from more than one perspective.
Dr. Mike reviews the ultrasound in the context of the patient’s symptoms, examination, history, previous studies, and treatment goals. Our studies are also interpreted by an expert board-certified radiologist.
That gives us both:
Expert imaging interpretation
and
Clinical interpretation by the physician actually treating the patient.
The goal is not simply to produce an ultrasound report.
The goal is to determine what the imaging means for you.
In-Office Ultrasound May Also Reduce the Cost of Evaluation
There can also be a financial advantage to having imaging performed in the physician’s office rather than a hospital outpatient department.
Hospital outpatient services and physician-office services are paid differently. Under Medicare, hospital outpatient care can involve both a physician payment and a facility payment, while comparable office-based services use a physician-office payment structure. MedPAC has documented higher total Medicare payment for many services when they are delivered in hospital outpatient departments rather than physician offices.
For some patients, that means in-office ultrasound can be substantially less expensive—and may be a fraction of the cost of imaging performed in a hospital-based setting.
The exact cost difference depends on:
- Insurance company
- Deductible
- Coinsurance
- Network status
- Site of service
- The specific ultrasound performed
Our team can help review expected costs when possible.
The goal is to provide high-quality imaging without automatically adding the cost and inconvenience of a hospital imaging department.
What If the Ultrasound Is Not Enough?
Ultrasound answers many questions, but not every question.
Depending on the findings, additional evaluation may include:
- Repeat ultrasound
- Blood testing
- MRI
- Referral for additional imaging
- Surgical consultation
- Gynecologic oncology consultation when appropriate
The purpose of evaluating an adnexal mass is not only to determine whether treatment is needed but also to identify lesions with features that could require specialist evaluation.
Are Blood Tests Needed for Every Ovarian Cyst?
No.
There is no reason to order ovarian tumor-marker testing for every simple cyst.
Blood tests may be appropriate depending on:
- Age
- Menopausal status
- Symptoms
- Family history
- Ultrasound characteristics
- The type of mass being evaluated
Tumor markers are interpreted as one part of an overall risk assessment. They do not replace ultrasound and clinical judgment.
Not Every Ovarian Cyst Needs Surgery
This is one of the most important points for patients to understand.
Finding a cyst does not mean that it needs to be removed.
ACOG notes that many ovarian cysts can simply be monitored and often resolve without treatment.
Depending on the type of cyst, management may include:
- Observation
- Repeat imaging
- Treatment of pain
- Hormonal management in selected conditions
- Treatment of underlying endometriosis
- Ovulation suppression in selected patients
- Surgery when appropriate
The right choice depends on what kind of cyst we believe is present and what problem we are trying to solve.
When Watchful Waiting Is the Right Treatment
For a simple or functional cyst with reassuring imaging features, observation may be the safest and most appropriate option.
That can include:
- Reviewing your symptoms
- Reviewing the ultrasound characteristics
- Allowing time for a functional cyst to resolve
- Repeating the ultrasound when appropriate
- Comparing the new study with the previous images
Monitoring is active medical management.
We are asking whether the cyst:
- Disappears
- Shrinks
- Remains stable
- Grows
- Changes in appearance
Those changes can guide the next decision.
Medical Treatment for Ovarian Cysts
There is sometimes a misconception that every symptomatic ovarian cyst has two choices:
Wait or operate.
That is too simple.
Medical management can play an important role depending on the cause.
Pain Management
For selected patients with uncomplicated cyst-related discomfort, medication may be used to manage pain while the cyst is being observed.
The important first step is making sure the symptoms do not suggest torsion, significant bleeding, infection, or another urgent condition.
Hormonal Treatment and Ovulation Suppression
Hormonal treatment can be useful in selected patients, particularly when recurrent ovulation-related symptoms or an underlying condition such as endometriosis is part of the problem.
However, there is an important distinction:
Birth-control pills have not been shown to make an existing functional ovarian cyst resolve faster.
A Cochrane review of randomized trials found that combined oral contraceptives did not speed the resolution of functional ovarian cysts compared with observation.
That does not mean hormonal treatment has no role.
It means we should use medication for the right reason, rather than prescribing it with the expectation that it will make an existing functional cyst disappear.
Medical Treatment for Endometriosis and Endometriomas
When an ovarian cyst is associated with endometriosis, the treatment conversation becomes different.
ACOG recognizes both medical and surgical treatment for endometriosis. When pain is the main concern, medical treatment is commonly considered before surgery.
Treatment decisions may take into account:
- Pain
- Age
- Cyst characteristics
- Previous treatment
- Fertility goals
- Ovarian reserve
- Whether pregnancy is desired now
- Whether surgery could affect healthy ovarian tissue
The goal is not simply to remove an image from the ultrasound screen.
It is to choose the treatment that provides the best overall result for the patient.
When Does an Ovarian Cyst Need Surgery?
Surgery may be considered when a cyst:
- Persists
- Continues to grow
- Causes significant symptoms
- Has concerning ultrasound features
- Is associated with complications
- Cannot be adequately characterized
- Creates a significant risk of torsion or other problems
- Requires tissue diagnosis
- Raises concern for malignancy
Age, menopausal status, symptoms, fertility goals, cyst characteristics, and overall health all influence the decision.
If Surgery Is Needed, Preserving the Ovary May Matter
For women who want future fertility, the conversation should include more than simply whether a cyst can be removed.
We also think about preserving healthy ovarian tissue whenever medically appropriate.
Depending on the situation, surgery may involve removing the cyst while preserving the ovary rather than removing the entire ovary.
The appropriate operation depends on:
- Cyst type
- Size
- Location
- Appearance
- Age
- Cancer risk
- Remaining healthy ovarian tissue
- Fertility plans
This is especially important with endometriomas and other situations where ovarian reserve may already be a concern.
Ovarian Cysts and Fertility
Most ovarian cysts do not cause infertility.
A functional cyst, for example, is generally related to normal ovarian function.
However, some underlying conditions associated with ovarian cysts can affect fertility.
The most important example is endometriosis.
If fertility is important to you, that should be part of the conversation before deciding on treatment.
We may consider:
- Whether the cyst needs treatment at all
- Whether treatment can wait
- Whether medical management is appropriate
- Whether surgery could affect ovarian reserve
- Whether the cyst is related to endometriosis
- Your age and reproductive timeline
Treatment should support your long-term goals whenever medically possible.
What About Ovarian Cysts After Menopause?
Ovarian and adnexal cysts can still be found after menopause.
They do not automatically mean cancer.
However, age and menopausal status change how an ovarian mass is evaluated. Ultrasound appearance, symptoms, size, persistence, and other risk factors may lead to closer monitoring or additional testing.
A new ovarian mass after menopause therefore deserves appropriate evaluation rather than being dismissed or automatically assumed to be malignant.
Why Following the Same Cyst Over Time Matters
Sometimes the most useful test is not a completely new test.
It is a comparison.
Did the cyst measure 4 centimeters six months ago and 2 centimeters today?
Has it stayed exactly the same for years?
Did a previously simple cyst develop new features?
Did the cyst disappear but the patient’s pain remain?
That last question can be particularly important.
If the cyst resolves but the pain continues, it tells us to look elsewhere for the cause of the pain.
This is why continuity and access to prior imaging can be so valuable.
Frequently Asked Questions About Ovarian Cysts
Are most ovarian cysts cancerous?
No. Most ovarian cysts are benign.
However, some ovarian and adnexal masses require further evaluation based on their ultrasound appearance, symptoms, age, menopausal status, and other risk factors.
Can an ovarian cyst go away on its own?
Yes.
Many functional ovarian cysts resolve on their own over several menstrual cycles.
Does an ovarian cyst always cause pelvic pain?
No.
Many ovarian cysts cause no symptoms at all. Pelvic pain can also come from the uterus, endometriosis, bladder, bowel, pelvic floor muscles, and other structures.
Finding a cyst does not automatically prove that it is the cause of the pain.
How do you know whether an ovarian cyst is dangerous?
Symptoms alone cannot answer that question.
Evaluation may include:
- Medical history
- Examination
- Pelvic ultrasound
- Comparison with previous imaging
- Follow-up ultrasound
- Blood tests in selected patients
- MRI or specialist evaluation when indicated
Ultrasound features are particularly important in assessing an ovarian or adnexal lesion.
What does a concerning ovarian cyst look like on ultrasound?
There is no single feature that determines the diagnosis.
Radiologists evaluate characteristics such as whether a lesion is simple or complex, its internal structures, solid components, wall characteristics, blood flow, and other findings. The ACR O-RADS system provides standardized descriptions and risk categories for ovarian and adnexal lesions.
Do I need surgery for an ovarian cyst?
Not necessarily.
Many ovarian cysts can be observed safely. Surgery is considered when symptoms, persistence, growth, imaging characteristics, complications, or other risk factors make treatment appropriate.
Can ovarian cysts be treated with medication?
Sometimes, depending on the type of cyst and the treatment goal.
Medication may be used to control pain or treat an underlying condition such as endometriosis. Hormonal suppression may also have a role in selected patients.
However, birth-control pills do not make an existing functional ovarian cyst resolve faster.
Can an ovarian cyst cause sudden severe pain?
Yes.
Cyst rupture and ovarian torsion can cause sudden severe pain. Severe pelvic pain, especially with nausea, vomiting, fainting, marked weakness, or other concerning symptoms, requires prompt medical evaluation.
Can ovarian cysts affect fertility?
Many ovarian cysts do not affect fertility.
However, conditions such as endometriosis may affect fertility, and surgery involving an ovary should be planned carefully when future fertility is important.
Is ultrasound the best test for an ovarian cyst?
Pelvic ultrasound is the primary imaging test for most ovarian and adnexal lesions. It allows evaluation of the ovaries and characterization of many types of cysts and masses.
MRI or other testing may be useful when ultrasound does not provide enough information.
Is an in-office pelvic ultrasound less expensive than hospital imaging?
It can be.
Hospital outpatient services may include facility-related payments in addition to professional services, while physician-office imaging is paid differently. The actual cost to an individual patient depends on insurance coverage, deductible, coinsurance, and site of service.
At Women’s Health Group Chicago, having ultrasound available in the office can provide both clinical convenience and, for many patients, a substantially lower-cost imaging option.
Get the Right Diagnosis Before Choosing the Treatment
An ovarian cyst is a finding.
The next step is figuring out what that finding actually means.
At Women’s Health Group Chicago, we combine:
- A detailed review of your symptoms
- A complete gynecologic evaluation
- High-quality in-office pelvic ultrasound
- Our experienced and compassionate ultrasound technologist, Gabi
- Image review by Dr. Michael Awad
- Interpretation by an expert board-certified radiologist
- Comparison with previous imaging when available
- Medical treatment when appropriate
- Surgical treatment when necessary
- Attention to fertility and long-term goals
And because the pelvis contains many organs and tissues in a small area, we do not assume that every ovarian cyst explains every episode of pelvic pain.
We first make sure we are targeting the correct problem.
Sometimes the right treatment is surgery.
Sometimes it is medication.
Sometimes it is treating endometriosis or another underlying condition.
Sometimes it is repeating an ultrasound.
And sometimes the best treatment is simply leaving a reassuring cyst alone.
The goal is not to treat every cyst.
The goal is to accurately diagnose your symptoms and treat what is actually causing them.
If you have been diagnosed with an ovarian cyst or are experiencing unexplained pelvic pain, bloating, pressure, or pain during intercourse, schedule an evaluation with Women’s Health Group Chicago.
