Most ovarian cysts require no treatment at all. The majority are functional cysts, meaning they form as a normal part of your menstrual cycle, and they typically resolve on their own within a few weeks to a few months. What you need to do depends on the cyst’s size, whether it’s causing symptoms, and what it looks like on ultrasound.
Why Most Cysts Just Need Time
Functional cysts are fluid-filled sacs with no solid features. They come in two varieties: follicular cysts, which form when the sac holding an egg doesn’t release it and keeps expanding, and corpus luteum cysts, which form after the egg is released and the empty sac fills with fluid. Both types usually disappear without any intervention.
Simple cysts smaller than 5 cm (about 2 inches) in premenopausal women typically don’t even need a follow-up appointment. Cysts between 5 and 7 cm generally warrant a repeat ultrasound about a year later to confirm they’ve shrunk or resolved. It’s rare for a simple cyst to be associated with cancer.
Your doctor may call this approach “watchful waiting,” which just means periodic ultrasounds to check whether the cyst has changed in size or appearance. The ultrasound can also show whether the cyst is entirely fluid-filled (reassuring) or has solid components (worth investigating further).
Managing Pain at Home
If a cyst is causing discomfort while you wait for it to resolve, over-the-counter pain relievers like ibuprofen, naproxen, or acetaminophen can help. You can start taking them as soon as you feel discomfort, for up to two or three days at a time.
A heating pad or hot water bottle placed on your lower abdomen works surprisingly well for cyst pain and may be as effective as over-the-counter medication. A warm bath with about two cups of Epsom salts dissolved in the water can also ease the aching. Soak for around 20 minutes to get the most benefit.
What Birth Control Can and Can’t Do
There’s a common belief that hormonal birth control will shrink an existing cyst. The evidence doesn’t support this. A 2024 review from the American Society for Reproductive Medicine found no benefit of hormonal contraception over simply waiting. Most functional cysts resolved on their own within four to six weeks regardless of whether birth control was used. The cysts that persisted were often not functional at all but rather other types (endometriomas, dermoid cysts) that wouldn’t respond to hormones anyway.
What birth control can do is prevent new functional cysts from forming. If you’re prone to recurring cysts, hormonal contraception suppresses ovulation and reduces the chance of new cysts developing. So birth control is a preventive tool, not a treatment for a cyst you already have.
When Surgery Becomes Necessary
Surgery typically enters the conversation when a cyst reaches about 10 cm (4 inches) or larger, keeps growing, doesn’t resolve after several menstrual cycles, causes significant pain, or looks abnormal on ultrasound. Your age, family history of ovarian or breast cancer, and whether you want to have children in the future all factor into the decision.
After menopause, doctors take cysts more seriously. An elevated CA 125 blood marker combined with concerning ultrasound features raises the possibility of ovarian cancer, and surgical evaluation becomes more likely.
If you’re concerned about fertility, it’s worth knowing that cyst removal (cystectomy) can reduce your ovarian reserve, which is essentially the number of eggs your ovaries have available. Research published in Fertility and Sterility found that the effects of surgical treatment are often more harmful to ovarian reserve than the cyst itself. Surgery to remove a cyst does not appear to improve pregnancy rates. This doesn’t mean surgery is never the right call, but it’s a conversation worth having with your doctor if future pregnancy is important to you.
Signs That Need Immediate Attention
Most cysts are harmless, but two complications require emergency care: rupture and torsion.
A ruptured cyst can cause sudden, sharp pain. Most ruptured cysts are managed with observation and pain medication, but if there’s heavy or ongoing internal bleeding, signs of infection, or unstable vital signs, surgery may be needed. If you experience sudden severe pelvic pain that doesn’t ease up, get evaluated promptly.
Ovarian torsion happens when a cyst makes the ovary heavy enough to twist on its blood supply. The hallmark is sudden, severe abdominal pain, often accompanied by nausea and vomiting. The pain is usually sharp and stabbing, located in your lower belly (more commonly on the right side), and it can radiate to your thighs, sides, or lower back. Fever or abnormal vaginal bleeding can signal that the ovarian tissue is starting to lose blood flow. There’s no established safe window for how long the ovary can survive once it twists, which is why speed matters. If you experience these symptoms, treat it as an emergency.
What to Expect Going Forward
For the vast majority of people, an ovarian cyst is a one-time finding that resolves quietly. If your doctor recommends watchful waiting, that’s not a brush-off. It’s the evidence-based approach for small, simple, symptom-free cysts. Keep your follow-up ultrasound appointments, manage any discomfort with heat and over-the-counter pain relief, and know the warning signs of rupture and torsion so you can act quickly if something changes.