Ovarian Cysts

Ovarian cysts are fluid or semi-solid sacs on or in the ovary. Common in reproductive-age women. Most are asymptomatic and resolve on their own within a few cycles.

Common Types

Functional Cysts

• Follicular cyst — Follicle that didn't rupture. Usually resolves in 1–3 months.
• Corpus luteum cyst — Forms after ovulation. May rupture causing acute pain.

Pathological Cysts

• Endometrioma (chocolate cyst) — From endometriosis, contains old blood
• Dermoid cyst (teratoma) — Contains various tissues including hair and teeth
• Cystadenoma — Benign but can grow very large
• PCOS — Multiple small cysts

Warning Symptoms

• Acute severe pelvic pain (rupture or torsion)
• Chronic pelvic pain, dyspareunia
• Menstrual irregularities
• Bloating, abdominal distension
• Frequent urination from pressure

Diagnosis

• Transvaginal ultrasound — first line
• 3D ultrasound — better characterization
• CA-125, HE4 blood tests — malignancy screening
• MRI — for complex cases

Treatment Decisions

Treatment Options

• Observation with follow-up ultrasound
• Combined oral contraceptives — prevent new functional cysts
• Laparoscopic cystectomy — remove cyst, preserve ovary
• Oophorectomy — for high malignancy risk

Cysts and Fertility

Endometriomas can reduce egg quantity and quality. Balancing surgery vs. moving directly to IVF is a nuanced decision because endometrioma removal may reduce AMH.

PCOS causes irregular ovulation, treatable with ovulation induction or IVF.