An ovarian cyst is a fluid-filled sac that develops inside or on the surface of an ovary. Ovarian cysts are very common, particularly during the reproductive years, and most are harmless and resolve naturally without treatment.

However, some cysts can persist, grow larger, or cause symptoms that require medical assessment and treatment. With expert evaluation and appropriate management, most women experience excellent outcomes.

Many ovarian cysts cause no symptoms and are discovered incidentally during routine examinations or scans. When symptoms do occur, they may include:

• Pelvic or lower abdominal pain (may be dull or sharp)
• Irregular or heavy menstrual periods
• Bloating or feeling of fullness in the abdomen
• Frequent urination (when a cyst presses on the bladder)
• Changes in bowel habits
• Pain during intercourse
• Fatigue, dizziness, or feeling light-headed

If you experience persistent pelvic pain, sudden severe abdominal pain, or symptoms that worsen, seek medical assessment promptly. Early evaluation ensures appropriate monitoring and treatment when needed.

While most cysts are benign, some can cause complications:

• Ovarian torsion — A large cyst can cause the ovary to twist, cutting off blood supply. This creates sudden, severe pain with nausea or vomiting and requires emergency surgical treatment
• Ruptured cyst — A cyst may burst, causing sharp pain or internal bleeding that may require medical intervention
• Persistent or growing cysts — Some cysts continue to grow or persist beyond several months and may require surgical removal
• Suspicious features — Cysts appearing after menopause or those with complex features on imaging require careful evaluation to rule out malignancy

Immediate medical attention is essential for severe or sudden pelvic pain, particularly if accompanied by fever, vomiting, or signs of shock.

Diagnosing ovarian cysts typically involves:

• Detailed medical history and symptom assessment
• Pelvic examination to assess for tenderness or masses
• Transvaginal or abdominal ultrasound scan to visualize the cyst and determine its size, type, and characteristics
• Blood tests including CA125 tumour marker assessment when indicated
• MRI or CT scan for complex cysts requiring detailed imaging
• Repeat ultrasound after 6-12 weeks to monitor simple cysts

These investigations help determine whether a cyst is likely to resolve naturally or requires treatment.

Treatment depends on the cyst's size, type, symptoms, and whether you have reached menopause.

Observation and Monitoring:

Many simple cysts resolve naturally within a few menstrual cycles. Your consultant may recommend:

• Watchful waiting with repeat ultrasound in 6-12 weeks
• Monitoring for symptom changes

This approach is suitable for small, simple cysts that cause minimal symptoms.

Surgical Treatment:

Surgery may be recommended if the cyst:

• Is large (typically over 5-10cm)
• Persists beyond several months
• Causes significant symptoms
• Has concerning features on imaging
• Appears after menopause

Surgical Options:

• Laparoscopic ovarian cystectomy (keyhole surgery) — Minimally invasive removal of the cyst through small incisions, preserving healthy ovarian tissue. Offers quick recovery and minimal scarring
• Robotic-assisted surgery — Advanced minimally invasive technique providing enhanced precision for complex cases
• Laparotomy — Used for very large or complex cysts, involving a slightly larger incision to safely remove the mass

Whenever possible, surgery aims to preserve healthy ovarian tissue while completely removing the cyst. Minimally invasive approaches offer faster recovery, less discomfort, and excellent cosmetic results.

Dr Mohamed Otify is a Consultant Gynaecologist and Gynaecological Oncologist with expertise in minimally invasive and robotic surgery for ovarian cysts. He provides comprehensive assessment from routine monitoring to advanced surgical treatment.

His approach prioritizes:

• Thorough diagnostic assessment with expert ultrasound interpretation
• Evidence-based management decisions tailored to individual circumstances
• Minimally invasive and robotic surgical techniques when treatment is needed
• Preservation of healthy ovarian tissue whenever possible
• Clear communication about monitoring plans and treatment options
• Fast recovery with modern surgical approaches

If you have persistent pelvic pain, have been diagnosed with an ovarian cyst, or require specialist assessment, book a consultation for comprehensive evaluation and personalized treatment recommendations.