Ovarian Cyst: What Is It, Is It Dangerous, and What to Do?

You come in for a routine check-up, and your doctor calmly says, "You have an ovarian cyst." Your heart sinks, and your mind goes straight to 'cancer.' Stop! Let's all take a deep breath: an ovarian cyst is not a death sentence and, in the vast majority of cases, not cancer. It's simply a fluid-filled sac that has formed on the ovary. Most often, it's small, harmless, and resolves on its own. But there are a few things you should know.

What is a cyst and where does it come from?

Imagine the ovary as the size and shape of an almond. A cyst is a blister on it, filled with fluid or semi-fluid material. Usually, it measures 1–3 centimeters, but in rare cases, it can grow to 15–30 centimeters. Where does it come from? Most often, from a slight glitch in the menstrual cycle. For example, the follicle from which an egg should be released doesn't rupture but instead fills with fluid. Or the egg is released, but the follicle heals improperly. These cysts are called functional cysts, and they almost always resolve on their own within a couple of months.

But there are other types. For example, a dermoid cyst—it contains hair, teeth, and even skin. Sounds creepy, but it's actually a congenital anomaly where germ cells 'confuse' their purpose. Many women have these; they're usually found incidentally during an ultrasound for another reason. Or endometrioma—it's called a 'chocolate cyst' due to the dark, old blood inside. It occurs in women with endometriosis and is often accompanied by severe pain—during sex, urination, or in the lower abdomen. There are also cystadenomas—they grow on the surface of the ovary and have watery or mucous contents. They are usually harmless unless they grow to enormous sizes.

Is it cancer? Spoiler: almost never

The word 'tumor' is frightening, but actually, it's just a medical term for any growth. Most cysts are benign, meaning non-cancerous. A cancerous tumor is a solid mass of cells that divide uncontrollably and spread throughout the body. A cyst, on the other hand, is simply a fluid-filled sac. However, there's a nuance: some complex cysts (e.g., dermoid) may contain solid components, making them hard to distinguish from cancer on ultrasound. Therefore, it's important to undergo a full examination. The risk of a cyst transforming into cancer is extremely low—for dermoid cysts, it's only 1–2%, and that's usually after age 45 or when the cyst is large. So don't panic, but don't ignore it either.

What you feel and when to see a doctor

Small cysts usually don't cause any symptoms. You might not even know you have them. But as a cyst grows, symptoms may appear: dull or sharp pain in the lower abdomen (coming and going), a feeling of pressure or fullness, pain during sex, painful or irregular periods, or bloating on one side. If you notice anything like this—don't wait; see a doctor. Also, be alert for symptoms characteristic of ovarian cancer: persistent fatigue, feeling full quickly, urinary issues, constipation, unexplained weight loss with abdominal bloating. It's not necessarily cancer, but you should definitely get checked.

How the diagnosis is made: it's not just an exam

To determine if you have a cyst, the doctor will first perform a physical exam: pressing on your abdomen and doing a gynecological exam. But the most accurate method is an ultrasound. Usually, two types are done: a regular one (transducer moved over the abdomen) and a transvaginal one (a thin transducer inserted into the vagina). The latter might be slightly uncomfortable, but it gives a clearer picture. Blood tests may also be ordered—for example, for the tumor marker CA-125, which can be elevated in ovarian cancer (though it's also elevated in endometriosis and inflammation). Sometimes a CT or MRI is done for further clarification. And yes, they will likely suggest a pregnancy test—it's a standard procedure to rule out pregnancy as a cause of symptoms.

To treat or not to treat? That is the question

The good news: most cysts require no treatment. Functional cysts resolve on their own; doctors just monitor them and do a follow-up ultrasound after a few months. If a cyst is large, causes pain, or is suspicious for cancer, then treatment is needed. Options include hormonal contraceptives (they suppress ovulation, preventing new cysts), pain relievers, and for serious cases, surgery. Small cysts are removed through small incisions (laparoscopy); large or suspicious ones may require a larger incision. The doctor will consider your age, health, and plans for pregnancy. If you want children—be sure to mention it: some cysts (e.g., endometriomas) can interfere with conception, and you'll be given treatment that preserves fertility.

When you need emergency care: signs of dangerous complications

Cysts are not just harmless sacs. They can rupture or cause the ovary to twist (ovarian torsion). This is rare, but it does happen—and requires immediate medical attention. If you experience sudden, severe pain on one side of your lower abdomen, nausea, or vomiting—call an ambulance or go to the hospital. Ovarian torsion is an emergency: if surgery isn't done in time, the ovary may die due to lack of blood flow. So better safe than sorry.

Where to go if you don't have a regular doctor

If you don't have a gynecologist—no problem. You can go to a women's health clinic, a reproductive health center (e.g., family planning clinics), or even a regular polyclinic. In public clinics, you'll be seen for free with your health insurance. If you're uninsured, there are private clinics, but you can also look for non-profit organizations that help with examinations. The key is not to delay the visit out of fear or embarrassment. A cyst is a very common issue, and doctors see such patients every day. They will help you figure it out and choose the right treatment for your case.