Most ovarian cysts go away on their own within one to two menstrual cycles without any treatment. These are functional cysts, the most common type, and they form as a normal part of ovulation. The approach to getting rid of a cyst depends entirely on what kind it is, how large it is, and whether it’s causing symptoms. Some cysts just need time. Others need surgery.
Why Most Cysts Resolve on Their Own
Every month, a small sac called a follicle releases an egg from your ovary. A functional cyst forms when that follicle doesn’t release the egg as expected and instead fills with fluid. This sounds alarming, but these cysts are extremely common and typically shrink and disappear within one to two menstrual cycles. Your body reabsorbs the fluid, and the cyst is gone before you ever knew it was there.
If a functional cyst is found on an ultrasound, your doctor will likely suggest a “watchful waiting” approach. That means a follow-up ultrasound in a few weeks or months to check whether the cyst is shrinking, growing, or changing. In most cases, it will have resolved by the time you come back.
Cysts That Won’t Go Away Without Help
Not all ovarian cysts are functional. Some types grow over time and don’t resolve on their own:
- Dermoid cysts (teratomas) contain cells similar to skin, hair, or teeth tissue. They’re noncancerous but can keep growing.
- Endometriomas are filled with old menstrual blood and typically signal endometriosis.
- Cystadenomas develop on the outer surface of the ovary and can become quite large.
These cysts generally require surgical removal, especially if they’re getting bigger or causing pain. Waiting them out won’t work the way it does with functional cysts.
Can Birth Control Shrink a Cyst?
This is one of the most common questions, and the answer is nuanced. Hormonal birth control does not shrink existing cysts. A 2014 Cochrane Review evaluated eight randomized controlled trials and found no benefit of hormonal contraception over simply waiting. Cysts resolved on their own within four to six weeks at the same rate regardless of whether the person took birth control.
What birth control can do is prevent new cysts from forming. One study found that women using hormonal contraception for at least three months had a cyst incidence of 2.4%, compared to 9.5% in women not using hormonal contraception. So if you’re prone to recurring functional cysts, birth control may be worth discussing with your provider as a preventive measure, not a treatment for a cyst you already have.
Managing Pain at Home
While you’re waiting for a functional cyst to resolve, the discomfort can range from a dull ache to sharp pelvic pressure. A few things help:
Over-the-counter pain relievers like ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol) can be taken as soon as you feel discomfort, typically for up to two or three days at a time. Heat is also effective. A heating pad on a low setting, a warm water bottle, or a warm bath can relax the tense pelvic muscles that tighten around the cyst and contribute to cramping. These won’t make the cyst disappear faster, but they make the waiting period more manageable.
How Doctors Decide If Surgery Is Needed
When your doctor evaluates a cyst on ultrasound, they’re looking at specific features to determine whether it’s likely benign or potentially concerning. A thin-walled cyst with smooth, regular borders that contains only fluid and measures under 10 cm has a malignancy rate of 0 to 1 percent, regardless of whether you’ve gone through menopause. A cyst that has thicker walls, irregular borders, or internal structures (called a “complex” cyst) gets evaluated more aggressively.
Size matters too. General guidelines suggest surgical consideration for simple cysts larger than 7 cm in premenopausal women and larger than 5 cm in postmenopausal women. But size isn’t the only factor. A cyst that’s causing significant symptoms, growing between scans, or showing complex features on imaging may be recommended for removal even if it’s smaller than those thresholds.
What Cyst Removal Surgery Looks Like
The procedure to remove a cyst while preserving the ovary is called an ovarian cystectomy, and it’s done one of two ways.
Laparoscopic (Minimally Invasive)
This is the more common approach. Your surgeon makes two or three small incisions, each less than half an inch long, and uses a tiny camera and specialized instruments to remove the cyst. Recovery takes about one to three weeks, and most people return to work and light activities within two weeks.
Open Surgery (Laparotomy)
When a cyst is very large, complex, or potentially cancerous, a single larger abdominal incision is needed. This is more invasive, with a longer recovery. You can expect six to eight weeks of activity modifications, and full recovery can take up to 12 weeks. Your surgeon will choose this route only when the laparoscopic approach isn’t safe or practical.
In both cases, the goal is usually to remove only the cyst and keep the ovary intact. If the ovary is too damaged or there’s concern about cancer, the entire ovary may need to be removed, but that’s a separate conversation your surgeon would have with you beforehand.
When a Cyst Becomes an Emergency
Two complications require immediate medical attention: rupture and torsion.
A ruptured cyst bursts open, causing sudden, severe pelvic pain and potentially significant internal bleeding. Torsion happens when a large cyst causes the ovary to twist on itself, cutting off its blood supply. Torsion typically comes with sudden, intense pelvic pain along with nausea and vomiting. Both of these can develop quickly in someone who previously had only mild symptoms or none at all.
Get emergency care if you experience sudden, severe abdominal or pelvic pain, pain accompanied by fever or vomiting, or signs of shock like cold and clammy skin, rapid breathing, lightheadedness, or weakness. Torsion in particular is time-sensitive because the ovary can be permanently damaged if blood flow isn’t restored.