Finding out you have an ovarian cyst can be worrying, and it’s natural to have a lot of questions. One of the most common is about size — does a bigger cyst mean more danger? While size is an important factor, it’s not the only piece of the puzzle.
This post explains what ovarian cysts are, how their size can relate to risk, the symptoms to watch for, and the different types and treatment options available.
What is an ovarian cyst?
An ovarian cyst is a fluid-filled sac that develops on or inside an ovary. They’re very common (an estimated 10% of women experience ovarian cysts), and many women have no idea they have one until they’re discovered incidentally during a routine pelvic exam or imaging for an unrelated condition.
Most ovarian cysts are benign (non-cancerous) and often go away on their own without causing any symptoms.
Danger Level of Ovarian Cysts
While most ovarian cysts are benign and resolve on their own, sometimes they can grow too large or rupture. Fewer than 1% of ovarian cysts are malignant (cancerous).
A doctor will look at the size, appearance (what it looks like on an ultrasound), and your symptoms to determine if a cyst needs treatment. Here’s a general overview of how size can factor into the clinical management of ovarian cysts.
Small Cysts (Under 4 cm)
Cysts smaller than 4 centimeters are typically considered small. Most of these are functional cysts that form as a normal part of the menstrual cycle. They’re almost always benign and usually resolve on their own within one to three months. Your doctor will likely recommend a “watchful waiting” approach, which may involve a follow-up ultrasound to confirm it has disappeared.
Medium Cysts (4-6 cm)
Cysts in this range still have a very low risk of being cancerous, but your doctor may want to monitor them more closely. Depending on your age, symptoms, and the cyst’s appearance on an ultrasound, your doctor might recommend regular follow-up imaging to monitor its growth or changes.
Large Cysts (Over 6 cm)
Once a cyst grows larger than 6 centimeters, your doctor may recommend further evaluation or treatment. Large cysts have a slightly higher chance of being cancerous, although most are still benign. They’re also more likely to cause symptoms like pain or bloating and carry a risk of ovarian torsion or rupture.
Symptoms to Watch Out for
Most women with ovarian cysts do not experience any symptoms, especially if the cysts are small and physiological.
Be sure to contact your doctor if you experience:
- Pelvic pain or a dull ache in the lower back
- Bloating or a feeling of fullness in the abdomen
- Pain during intercourse
- Changes in your menstrual cycle
- A frequent need to urinate
Call 911 if you have sudden, severe abdominal pain, fever, or vomiting, as these could be signs of a ruptured cyst or ovarian torsion.
Potential Complications
Though it’s rare, some cysts can lead to complications that require immediate medical attention.
Ovarian Torsion
Larger cysts can cause the ovary to twist on itself, which is a condition called ovarian torsion. This is a medical emergency because it can cut off blood flow to the ovary. The main symptom is sudden, severe, and persistent pelvic pain, often accompanied by nausea and vomiting.
Ruptured Cyst
A cyst can sometimes break open (rupture). This might not cause any symptoms, or it could lead to a sudden, sharp pain in the lower abdomen. While many ruptured cysts resolve on their own, some can cause severe pain or internal bleeding and require medical intervention.
Types of Ovarian Cysts
Understanding the type of cyst you have can help determine its potential risk and management.
Functional Ovarian Cysts
These are the most common types and are directly related to the menstrual cycle. Functional cysts only occur in premenopausal women.
- Follicular Cyst: In a normal cycle, a follicle releases an egg. If it fails to do so, the follicle can continue to grow and form a follicular cyst.
- Corpus Luteum Cyst: After releasing an egg, the follicle transforms into the corpus luteum. If fluid accumulates inside, it can form a cyst.
Other Types of Cysts
- Dermoid Cyst: These cysts form from embryonic cells and can contain tissue like hair, skin, or teeth. They’re rarely cancerous but can grow large.
- Endometrioma: These are also known as “chocolate cysts” and form in women with endometriosis when endometrial-like tissue grows on the ovaries.
- Serous Cystadenoma: These are benign tumors that can grow on the surface of an ovary and are filled with a watery fluid.
Who is at risk?
Certain factors can increase your risk of developing ovarian cysts, including:
- Hormonal imbalances: Taking fertility drugs to induce ovulation can increase the risk.
- Pregnancy: Cysts can sometimes form in early pregnancy.
- Endometriosis: This condition can lead to the development of endometriomas. Endometriosis is a chronic, inflammatory condition where endometrial-like tissue grows outside the uterus, causing pain, infertility, and other symptoms.
- Pelvic Inflammatory Disease (PID): Severe pelvic infections can sometimes spread to the ovaries and fallopian tubes, leading to the formation of cysts.
- Previous cysts: If you’ve had one cyst, you may be more likely to develop another.
Important Considerations
- Cysts after menopause: For women who have gone through menopause, any new ovarian cyst is evaluated more carefully. While most of these are still benign, the risk of ovarian cancer does increase with age.
- Recurring cysts: For some women, cysts can be a recurring issue. If you get cysts frequently, your doctor may suggest a proactive plan. This could include hormonal birth control to prevent new functional cysts from forming and regular check-ups.
Treatment Options
The right treatment depends on your age, the cyst’s size and type, and your symptoms.
- Watchful Waiting: For small, simple cysts, your doctor will likely monitor it over a few months to see if it resolves on its own.
- Medication: Hormonal birth control may be prescribed to help prevent new functional cysts from forming.
- Surgical intervention: If a cyst is large, causing persistent pain, or appears suspicious on an ultrasound, your doctor may recommend surgical removal. This can often be done with laparoscopic surgery (a minimally invasive procedure).
Takeaway
Ovarian cysts are extremely common, and most are harmless, especially the smaller ones. While size is an important indicator of potential risk, it’s just one factor your doctor considers alongside the cyst’s appearance and your symptoms.
Cysts smaller than 4 cm are usually not a problem. Cysts larger than 6 cm may need more attention or treatment to avoid rare but serious issues like ovarian torsion. After menopause, doctors evaluate cysts more carefully. It’s important to pay attention to your body and talk to your healthcare team about any ongoing or severe symptoms.
FAQs About Ovarian Cysts
Can ovarian cysts be cancerous?
It’s rare, but possible. Most ovarian cysts are benign, especially in premenopausal women. Your doctor will evaluate the cyst’s characteristics on an ultrasound to assess the risk of malignancy.
Do ovarian cysts affect fertility?
Most cysts, particularly functional cysts, do not affect fertility. However, cysts related to conditions like endometriosis or polycystic ovary syndrome (PCOS) can be associated with challenges in getting pregnant.
How are ovarian cysts diagnosed?
Ovarian cysts are most often found during a routine pelvic exam. To confirm the diagnosis and get more details, your doctor will typically order a transvaginal ultrasound, which provides clear images of the ovaries.
A Word From RMA
Hearing you have an ovarian cyst can be stressful, but getting clear answers can make all the difference. The RMA team is here to listen to your concerns and talk through all of your options — for cysts, fertility, and your overall reproductive health. Reach out to us to schedule a consultation with one of our specialists.
