Ovarian Cysts: Types, Symptoms, and Treatment Options
Ovarian cysts can sound scary, especially when you’re told you have one without much explanation. What does the finding on your ultrasound actually mean, and what happens next? Dr. Natalie Crawford explains common ovarian cyst types, symptoms, and treatment options so you can better understand the finding and know what questions to ask.
Learn the difference between functional cysts, endometriomas, dermoid cysts, and cystadenomas, and why your symptoms, the cyst’s size, and its appearance matter. Why might you need another ultrasound? When is monitoring appropriate, and when might surgery be considered? How can a cyst affect exercise or fertility treatment, and where does birth control fit in?
IN THIS VIDEO:
00:00 What does an ovarian cyst on ultrasound mean?
01:08 What are ovarian cysts?
02:24 What are functional ovarian cysts?
04:52 Why do I need a repeat ultrasound for an ovarian cyst?
05:10 What is an endometrioma?
06:14 How are ovarian cysts related to PCOS?
06:48 What are dermoid cysts and cystadenomas?
07:44 What is ovarian torsion, and can I exercise with a cyst?
08:45 Can ovarian cysts cause spotting or painful periods?
09:26 When does an ovarian cyst need surgery?
10:04 Can birth control help with ovarian cysts?
What is an ovarian cyst?
A cyst is simply a structure that contains fluid. Ultrasound is commonly used to look at ovarian cysts, but a cyst can also be found on a CT scan performed for another reason, such as an evaluation for abdominal pain.
The words describing the cyst matter. A report may describe its size or appearance, including whether it looks simple or complex. Those details give us more information than the word “cyst” by itself.
If you are ovulating, some cysts are expected. The follicles that hold your eggs are small fluid filled structures, and the changes that happen around ovulation involve cysts, too.
Functional ovarian cysts: follicles and the corpus luteum
Functional cysts have a job: they are involved in your cycle and make hormones. Two important examples are the growing follicle before ovulation and the corpus luteum afterward.
Follicles and follicular cysts
Each egg developing in the ovary is held within a follicle. The small follicles we count during an antral follicle count, or AFC, are technically small cysts. Seeing these follicles is normal and expected, and the count is a marker of ovarian reserve.
Follicle stimulating hormone, or FSH, stimulates follicle growth. As a selected follicle grows and the egg matures, it produces more estrogen. Near maturity, the follicle can be about two centimeters in size.
On ultrasound, the fluid inside can look dark and uniform. This is described as a simple cyst. At the appropriate time in your cycle, that finding may represent a growing follicle rather than a problem.
The corpus luteum after ovulation
A surge of luteinizing hormone, or LH, triggers ovulation. The follicle ruptures and releases the egg, then changes into a structure called the corpus luteum.
The corpus luteum produces progesterone and estrogen. Its ultrasound appearance can be different from that of a simple follicle, often looking more gray or hazy.
If pregnancy does not occur, the corpus luteum lasts about two weeks before it collapses. Progesterone falls, and a period follows.
A follicular cyst and a corpus luteum can both be normal functional cysts. This is why the timing of an ultrasound within your cycle matters when interpreting what we see.
Why might you need a repeat ultrasound for an ovarian cyst?
Sometimes one ultrasound does not give us enough information to confidently identify a cyst.
Your doctor may recommend repeating the ultrasound in one to two months to see whether the finding resolves or changes. Functional cysts change with the cycle, so following a cyst over time can help clarify what it represents.
One example is distinguishing a corpus luteum from an endometrioma. They can sometimes look similar on an initial ultrasound. Seeing whether the same cyst remains in the same location on a later scan can help us tell them apart.
The recommendation to repeat an ultrasound is not automatically a sign that something is wrong. It can be part of understanding the finding.
Endometriomas: ovarian cysts associated with endometriosis
An endometrioma is an endometriosis cyst in the ovary. Unlike a normal corpus luteum that changes with the cycle, an endometrioma can persist and get larger with additional ovulatory cycles.
Endometriomas contain blood and are sometimes called chocolate cysts. On ultrasound, they may have a hazy, ground glass appearance.
These cysts can be inflammatory and painful. Significant pain with your period is another detail that may be relevant when your doctor is considering whether a cyst could be associated with endometriosis.
Because an endometrioma can sometimes resemble a corpus luteum, the ultrasound appearance, cycle timing, symptoms, and follow up findings all contribute to the conversation.
How are ovarian follicles related to PCOS?
Polycystic ovarian syndrome, or PCOS, can involve a high number of ovarian follicles and increased ovarian volume.
These small follicles are different from a single large ovarian cyst. In PCOS, many follicles may be seen around the outside of the ovary.
The follicles are part of the condition’s picture, not simply cysts that are causing the whole problem. Understanding this distinction helps explain why the word “cyst” can refer to very different findings.
Dermoid cysts and cystadenomas
Not every ovarian cyst is related to ovulation or endometriosis. Two other types discussed in the video are dermoid cysts and cystadenomas.
Dermoid cysts
A dermoid, also called a teratoma, can contain different tissue components, including fat, hair, and teeth.
These components can give it a distinct appearance on ultrasound or CT imaging. Dermoid cysts can grow over time.
Cystadenomas
A cystadenoma is a type of ovarian tumor arising from the outer lining of ovarian cells. These tumors are usually benign, but they can become quite large.
Size matters because a very large cyst can affect the surrounding ovarian tissue. Dermoids, cystadenomas, and endometriomas can also cause significant pain or raise concerns about ovarian torsion.
Ovarian torsion: symptoms and exercise considerations
Ovarian torsion occurs when an ovary twists on itself and its blood supply can become restricted. It is a surgical emergency.
Symptoms can include severe pain and vomiting. The pain may come and go if the ovary twists and untwists.
Cyst size is one reason your doctor may discuss activity modifications. In the video, I explain this using a basket and water balloons: the pelvis is the basket, and the ovaries are the water balloons we want to keep inside it.
Running, jumping, and twisting movements may be part of that discussion when a cyst is large enough to raise concern. The question is not simply whether you have a cyst, but what its size and characteristics mean for your situation.
Can ovarian cysts cause spotting or painful periods?
Most ovarian cysts are not associated with changes in bleeding or the menstrual cycle. However, there are important exceptions discussed in the video.
When a functional cyst ruptures during ovulation, estrogen production can be temporarily disrupted. That transient drop in estrogen can contribute to spotting around ovulation.
Endometriosis associated with an endometrioma can cause significant pain with your period. If a cyst is difficult to identify on ultrasound, the presence of very painful periods may be another relevant clue.
When does an ovarian cyst need surgery?
Not every ovarian cyst needs to be removed. We may monitor cysts that look clearly benign and are growing slowly.
This is especially relevant in fertility care. We do not always remove a cyst before IVF or other treatment because surgery can affect the remaining ovarian tissue.
Reasons to consider removal can include:
Uncertainty about whether a cyst is benign or concern that it could be cancerous.
Severe pain.
A situation where diagnosing and treating another condition, such as endometriosis, could be helpful.
A cyst large enough to raise concerns about ovarian torsion, including how that risk affects activity.
The decision depends on the cyst and the person. Monitoring and surgery are not competing rules that apply to every finding; they are options considered in context.
Can birth control help with ovarian cysts?
Birth control pills can sometimes be used in cyst management because they prevent ovulation and can help prevent functional cysts from forming.
Some functional cysts persist rather than resolving as expected and can cause pain. Preventing ovulation can also be helpful when ovulation itself is painful or associated with bleeding, or when endometriosis is part of the problem.
Not all contraceptive methods have the same effect on ovulation. A progesterone IUD does not always prevent ovulation, so it is not interchangeable with the birth control pill for this purpose.
The reason a particular medication is being considered matters. It is worth understanding whether the goal is to prevent ovulation as part of managing the cyst or symptoms.
Questions to ask after an ovarian cyst is found
If an ultrasound report leaves you with more questions than answers, use these topics to guide your conversation:
What type of cyst does this appear to be?
Could it be related to where I am in my menstrual cycle?
How large is it, and what does its appearance tell us?
Why are we repeating the ultrasound, and what changes are we looking for?
Do my pain or bleeding symptoms affect how you interpret the finding?
Does the cyst’s size mean we should discuss exercise modifications?
What would make monitoring or removal appropriate?
If birth control is being considered, what is it intended to help with?
How does this finding affect plans for fertility treatment?
Frequently asked questions about ovarian cysts
Are ovarian cysts always abnormal?
No. Follicles and the corpus luteum are examples of cysts that can be a normal part of ovulation and hormone production. The type of cyst and the timing within your cycle matter.
Can an ovarian cyst go away on its own?
Functional cysts can resolve as the cycle changes. Other cysts, such as endometriomas, can persist. A repeat ultrasound may help distinguish a changing functional cyst from a persistent finding.
Does every ovarian cyst need to be removed before IVF?
No. Some cysts are monitored rather than removed before fertility treatment because surgery can affect the remaining ovarian tissue. Appearance, symptoms, size, and other concerns influence that decision.
Can ovarian cysts cause spotting at ovulation?
A functional cyst rupturing during ovulation can temporarily disrupt estrogen production, which can contribute to spotting.
Is every type of birth control used the same way for cyst management?
No. Preventing ovulation can be part of managing functional cysts and certain symptoms, but not all contraceptive methods consistently prevent ovulation.
Understanding your ultrasound finding
An ovarian cyst finding is the beginning of a conversation, not a complete explanation by itself. Some cysts are expected parts of your cycle. Others require a closer look at their appearance, size, persistence, and symptoms.
The goal is to understand what was seen, why a particular follow up or treatment is being considered, and what questions matter for your care.
For the full explanation, watch the accompanying ovarian cysts video with Dr. Natalie Crawford. For more on hormones, fertility, and understanding your body, explore The Fertility Formula.