Most ovarian cysts are harmless, resolve on their own within a few months, and require nothing more than a follow-up ultrasound. If you’ve just been told you have one, the next steps depend on the type of cyst, its size, and whether it’s causing symptoms. Here’s what you need to know to understand your situation and manage it effectively.
Why the Type of Cyst Matters
The most common ovarian cysts are functional cysts, meaning they form as a normal part of your menstrual cycle. There are two kinds. A follicular cyst develops when a follicle (the small sac that holds a developing egg) doesn’t release its egg and instead keeps growing. A corpus luteum cyst forms after an egg is released, when the opening seals off and fluid accumulates inside the empty follicle. Both types are usually small, painless, and disappear within one to three menstrual cycles without treatment.
Other types behave differently. Endometriomas form when tissue similar to the uterine lining attaches to an ovary, and they’re linked to endometriosis. Dermoid cysts contain a mix of tissue types (skin cells, hair, even teeth) and grow slowly but can become large enough to shift the ovary out of position. Cystadenomas, filled with watery or mucous fluid, can also grow substantially. These types rarely resolve on their own and are more likely to need monitoring or removal.
What to Expect During Diagnosis
Ultrasound is the primary tool for evaluating an ovarian cyst. Your doctor will look at the cyst’s size, whether it’s filled with fluid or has solid areas, the smoothness of its walls, and whether there’s blood flow inside it. A simple, fluid-filled cyst with smooth walls and no solid components is almost always benign. Features that raise concern include irregular walls, solid areas, multiple internal structures, or strong blood flow within the cyst.
You may also have a blood test for a marker called CA-125. The standard threshold is 35 U/mL, but this test is far more useful in postmenopausal women. In premenopausal women, CA-125 levels are naturally higher and can be elevated by many benign conditions, including endometriosis, fibroids, and even menstruation itself. For this reason, the American College of Obstetrics and Gynecology recommends a much higher cutoff of 200 U/mL for premenopausal women with pelvic masses. If your doctor orders this test, keep in mind that a mildly elevated result before menopause does not mean cancer.
When Watchful Waiting Is the Right Approach
If your cyst is small, fluid-filled, and not causing symptoms, the standard recommendation is watchful waiting. This applies regardless of your age. You’ll typically have one or more follow-up ultrasounds over several months to check whether the cyst has changed in size or appearance. Most functional cysts shrink and disappear during this window. If the cyst stays the same or gets smaller, no further action is needed.
Managing Pain at Home
Cysts that cause mild to moderate discomfort can often be managed while you wait for them to resolve. Over-the-counter anti-inflammatory medications like ibuprofen or naproxen work well for cyst-related pain because they reduce both inflammation and cramping. Acetaminophen is another option if you can’t take anti-inflammatories. Placing a heating pad or warm rice bag on your lower abdomen can relax the surrounding muscles and ease aching. Warm baths offer similar relief. Some people also find that massage therapy helps by reducing tension in the pelvic and lower back muscles.
Birth Control Pills Won’t Shrink an Existing Cyst
This is one of the most common misconceptions. Early, higher-dose oral contraceptives were associated with fewer functional cysts, and many doctors assumed the pills could also treat cysts that had already formed. A Cochrane review of randomized controlled trials found this isn’t the case. In none of the trials did oral contraceptives help cysts resolve faster than doing nothing. Birth control pills may help prevent new functional cysts from forming in the future, but they should not be prescribed to shrink a cyst you already have.
When Surgery Becomes Necessary
Size is one of the key factors. Cysts larger than 5 to 6 centimeters carry a higher risk of ovarian torsion, a painful twisting of the ovary that cuts off its blood supply and requires emergency surgery. Cysts that persist through multiple menstrual cycles, keep growing, have concerning features on ultrasound, or cause significant symptoms are also candidates for removal.
Most surgical removals are done laparoscopically, through small incisions, with a relatively quick recovery. For cysts larger than about 10 to 12 centimeters, a traditional open incision (laparotomy) may be necessary simply because of the cyst’s size. In younger women, surgeons typically aim to remove only the cyst and preserve the ovary. In postmenopausal women, or when multiple cysts affect the same ovary, removing the entire ovary may be recommended.
How Cysts Affect Fertility
Simple functional cysts generally have no impact on your ability to get pregnant. They’re a sign that your ovaries are cycling normally, and they resolve without lasting effects.
Endometriomas are the type most associated with fertility concerns. Between 30 and 50 percent of women with endometriosis experience difficulty conceiving, and endometriomas are frequently discovered during infertility workups. The concern centers on whether these cysts reduce ovarian reserve, the pool of eggs available in the ovary. Interestingly, research involving over 1,000 menstrual cycles found that ovulation rates were similar in ovaries with endometriomas compared to unaffected ovaries, regardless of cyst size. Studies on the fluid surrounding eggs near endometriomas have also found only slight differences in oxidative stress levels compared to healthy ovaries, suggesting the impact on egg quality may be modest. Still, if you have an endometrioma and are planning pregnancy, it’s worth discussing your ovarian reserve with a fertility specialist.
Surgical removal of endometriomas can itself reduce ovarian reserve by removing some healthy ovarian tissue along with the cyst. This creates a balancing act: leaving a large endometrioma may affect the ovary over time, but removing it carries its own risks to fertility. The decision depends on the cyst’s size, your symptoms, and your reproductive plans.
Signs That Need Immediate Attention
Most cysts cause no emergencies, but two complications require urgent care: rupture and torsion. A ruptured cyst typically causes sudden, sharp pain in the lower abdomen or back, sometimes with vaginal spotting or bloating. This pain can be intense but often resolves as the fluid is reabsorbed by the body.
Seek emergency care if you experience severe nausea and vomiting alongside abdominal pain, which can signal ovarian torsion. Fever suggests a possible infection. Heavy vaginal bleeding, or feeling faint and dizzy, can indicate significant internal bleeding from a ruptured cyst. These situations require imaging and possibly surgery, and waiting them out at home is not safe.