Topic Overview

What is a functional ovarian cyst?

A functional
ovarian cyst is a sac that forms on the surface of a woman’s
ovary during
or after ovulation. It holds a maturing egg. Usually the sac
goes away after the egg is released. If an egg is not released, or if the sac
closes up after the egg is released, the sac can swell up with fluid.

Functional ovarian cysts are different from ovarian growths caused by
other problems, such as cancer. Most of these cysts are harmless. They do not
cause symptoms, and they go away without treatment. But if a cyst becomes
large, it can twist, rupture, or bleed and can be very painful.

What causes functional ovarian cysts?

A functional
ovarian cyst forms because of slight changes in the way the ovary makes or
releases an egg. There are two types of these cysts:

  • A follicular cyst occurs when a sac on the
    ovary does not release an egg, and the sac swells up with fluid.
  • A
    luteal cyst occurs when the sac releases an egg and then reseals and fills with
    fluid.

What are the symptoms?

Most functional ovarian
cysts do not cause symptoms. The larger the cyst is, the more likely it is to
cause symptoms. Symptoms can include:

  • Pain or aching in your lower belly, usually
    when you are in the middle of your menstrual cycle.
  • A delay in the
    start of your menstrual period.
  • Vaginal bleeding when you are not
    having your period.

Some functional ovarian cysts can twist or break open
(rupture) and bleed. Symptoms include:

  • Sudden, severe pain, often with nausea and
    vomiting.
  • Pain during or after
    sex.

If you have these symptoms, call your doctor right away.
Some ruptured cysts bleed enough that treatment is needed to prevent heavy
blood loss.

How are functional ovarian cysts diagnosed?

Your
doctor may find an ovarian cyst during a pelvic exam. He or she may then use a pelvic
ultrasound to make sure that the cyst is filled with
fluid.

If you see your doctor for pelvic pain or bleeding,
you’ll be checked for problems that may be causing your symptoms. Your doctor
will ask you about your symptoms and menstrual periods. He or she will do a
pelvic exam and may do a pelvic ultrasound.

How are they treated?

Most functional ovarian
cysts go away without treatment. Your doctor may suggest using heat and
medicine to relieve minor pain.

If a large cyst bleeds or causes
severe pain, you can have surgery to remove it.

Your doctor may
suggest that you take birth control pills, which stop ovulation. This may
prevent new cysts from forming.

Frequently Asked Questions

Learning about ovarian cysts:

Being diagnosed:

Getting treatment:

Living with ovarian cysts:

Cause

A
functional ovarian cyst is caused by one or more
slight changes in the way the ovary produces or releases an egg. During the
normal monthly menstrual cycle, one of two types of functional cysts may
develop:

  • A follicular, or simple, cyst occurs when the
    small egg sac (follicle) on the ovary does not release an egg, and it
    swells with fluid either inside the ovary or on its surface.
  • A
    luteal, or corpus luteum, cyst occurs when the remains of the egg follicle do
    not dissolve and continue to swell with fluid. This is the most common type of
    ovarian cyst.

The development of functional cysts is also common during
treatment with
clomiphene (such as Clomid or Serophene) for
infertility. These cysts go away after treatment is
completed, though this can take several months. They do not appear to endanger
pregnancy.

Other ovarian growths

There are other types of ovarian cysts
and growths caused by other conditions. An ovarian growth can be a noncancerous
(benign) cystic tumor or related to
endometriosis or cancer. In some cases, what seems to
be an ovarian mass is actually growing on nearby pelvic tissue. This is why
it’s important for you to have pelvic exams and for your doctor to
carefully diagnose any cysts or growths felt on your ovaries.

Symptoms

Functional ovarian cysts usually are harmless, do not
cause symptoms, and go away without treatment. Ovarian cysts are often
discovered during a
pelvic exam.

The larger the
ovarian cyst is, the more likely it is to cause symptoms. When symptoms occur,
they may include:

  • Frequent urination, if a large cyst is pressing
    against your bladder.
  • Abdominal (belly) pain.
  • Menstrual period
    changes.
  • Weight gain.

More severe symptoms may develop if the cyst has twisted
(torsion), is bleeding, or has ruptured. See your doctor immediately if you
have any of the following pain, shock, or bleeding symptoms:

  • Sudden, severe abdominal or pelvic
    pain
  • Nausea and vomiting
  • Sudden faintness, dizziness,
    and weakness
  • Vaginal bleeding or
    symptoms of shock from heavy bleeding
    (hemorrhage)

There are many
other conditions that cause signs or symptoms of a
functional ovarian cyst. This is why it’s important to have any unusual pelvic
symptoms checked and to have a pelvic exam.

What Happens

Most
functional ovarian cysts cause no symptoms and go away
without treatment in 1 to 2 months or after 1 to 2 menstrual periods. Some
cysts grow as large as
4 in. (10.2 cm) in diameter
before they shrink or rupture. A rupturing functional cyst can cause some
temporary discomfort or pain.

What to think about

Functional ovarian cysts do
not cause
ovarian cancer. But your doctor must rule out other
possible types of ovarian cysts or growths before diagnosing a functional cyst.
This may involve another pelvic exam, a pelvic
ultrasound, or possibly a
laparoscopy procedure to closely examine the cyst and
its ovary.

Cysts after menopause. After
menopause, ovarian cancer risk increases. This is why
all postmenopausal ovarian growths are carefully checked for signs of cancer.
Some doctors will recommend removing the ovaries (oophorectomy) when any kind
of cyst develops on an ovary after menopause. But the trend in medicine seems
to be moving away from surgery for small and simple cysts in postmenopausal
women. In the 5 years after menopause, some women will still have functional
ovarian cysts now and then. Some postmenopausal ovarian cysts, called
unilocular cysts, which have thin walls and one
compartment, are rarely linked to cancer.

What Increases Your Risk

A
functional ovarian cyst sometimes develops near the end of the
menstrual cycle, when an egg
follicle fills up with fluid. Factors that may
increase your risk for developing a functional ovarian cyst include:

  • A history of a previous functional ovarian
    cyst.
  • Current use of clomiphene, such as Clomid or
    Serophene, to start
    ovulation.
  • Use of low-dose
    progestin-only contraception (such as some implants, pills, and IUDs).

When To Call a Doctor

Call your doctor immediately if you have:

  • Sudden, severe pelvic pain with nausea or
    vomiting.
  • Severe
    vaginal bleeding.
  • Sudden faintness or
    weakness.
  • Sudden dizziness with abdominal discomfort that persists
    for 2 hours or longer.

Call your doctor for an appointment if:

  • Pain interferes with your daily
    activities.
  • Your periods have changed from relatively pain-free to
    painful during the past 3 to 6 months.
  • Your periods have changed
    from regular to infrequent during the past 3 to 6 months and you are not
    nearing
    menopause.
  • You have pain during sexual
    intercourse.

Watchful waiting

Most
functional ovarian cysts are harmless, do not cause
symptoms, and go away without treatment.
Watchful waiting is usually an appropriate option if
you are diagnosed with a functional ovarian cyst.

Who to see

Ovarian cysts can be diagnosed and treated by any of the
following health professionals:

You may need to see a gynecologist for further testing or
treatment.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

If you see your doctor for pelvic
pain or bleeding, you’ll be checked for a number of conditions, including an
ovarian cyst, that may be causing your symptoms. Your
evaluation will include a
pelvic exam, a history of your symptoms and menstrual
periods, a family history, and a
transvaginal ultrasound (which uses a narrow wand
placed in the vagina). See an image of
ovarian cysts.

If your doctor discovers an ovarian cyst during a pelvic exam, a transvaginal or abdominal ultrasound can help show what
kind of cyst it is.

When is further testing needed?

If an
ultrasound shows that you have a fluid-filled functional ovarian cyst, and it
isn’t causing you severe pain, your doctor will probably suggest a watchful
waiting period. You can then have the cyst checked 1 to 2 months later to see
whether it is changing in size. Most cysts go away in 1 to 2
months without treatment or after 1 or 2 menstrual periods.

Your doctor will recommend further testing or treatment if:

  • Initial ultrasound doesn’t clearly show what
    kind of cyst or growth is present, or both ovaries are
    affected.
  • You are not ovulating during your initial examination
    (because you are either a
    postmenopausal woman or a girl not yet menstruating).
    Without ovulation, a new functional cyst would be highly unlikely, so other
    possible conditions are explored.
  • You have moderate to severe pain
    or vaginal bleeding.
  • A diagnosed functional ovarian cyst does not
    get smaller or go away as expected.
  • An ovarian growth or cyst
    (mass) is larger than
    3 in. (7.6 cm).
  • You have
    risk factors for ovarian cancer, such as a strong family history of the disease or gene changes. The higher your risk of ovarian cancer, the
    more likely aggressive testing will be recommended to find out the cause of an
    ovarian mass.

Further testing

  • Laparoscopy allows a surgeon to look
    at the ovary through a lighted viewing instrument and take a sample of the
    growth (biopsy). After testing the sample, the surgeon can decide whether to
    surgically remove the cyst (cystectomy) or the entire ovary (oophorectomy). If
    there is concern about ovarian cancer, a laparotomy (instead of a laparoscopy)
    may be done. Then, if cancer is found, the surgeon can safely remove the
    ovaries.
  • CA-125 (cancer antigen) test is only
    recommended for women with a very high risk for ovarian cancer. These are women
    with a significant family history of the disease. This blood test result is
    combined with ultrasound results, because it doesn’t give a highly dependable
    diagnosis on its own.

Treatment Overview

Most
functional ovarian cysts are harmless, do not cause
symptoms, and go away without treatment. When treatment is needed, treatment
goals include:

  • Relieving symptoms of pelvic pain or
    pressure.
  • Preventing more cysts from developing by preventing
    ovulation (if recurrence is a problem). Treatment with
    birth control pills prevents ovulation.

Initial treatment

Because
functional ovarian cysts typically go away without
treatment, your doctor may recommend a period of
observation without treatment (watchful waiting) to see whether your
ovarian cyst gets better or goes away on its own. Your doctor will do another
pelvic exam in 1 to 2 months to see whether the cyst has changed in
size.

If an ovarian cyst doesn’t go away, your doctor may want to do more tests to be sure that your symptoms are
not caused by another type of ovarian growth. Home treatment with heat and
pain-relieving medicine can often provide relief of bothersome symptoms during
this time.

Ongoing treatment

A
functional ovarian cyst that doesn’t go away, has an unusual appearance on
ultrasound, or causes symptoms may require treatment
with either medicines or surgery.

  • Your doctor may suggest that you try
    birth control pills for several months to stop more cysts from
    forming.
  • Surgical removal of the cyst (cystectomy) through a small
    incision (laparoscopy) may be needed if a painful functional
    ovarian cyst does not go away despite medical treatment. If a cyst has an
    unusual appearance on ultrasound or if you have other risk factors for
    ovarian cancer, your doctor may recommend surgical
    removal through a larger abdominal incision (laparotomy)
    instead of by using laparoscopy.

What to think about

Cysts after menopause. After
menopause, ovarian cancer risk increases. This is why
all postmenopausal ovarian growths are carefully checked for signs of cancer.
Some doctors will recommend removing the ovaries (oophorectomy) when any kind
of cyst develops on an ovary after menopause. But the trend in medicine seems
to be moving away from surgery for small and simple cysts in postmenopausal
women. In the 5 years after menopause, some women will still have functional
ovarian cysts now and then. Some postmenopausal ovarian cysts, called
unilocular cysts, which have thin walls and one
compartment, are rarely linked to cancer.

Prevention

Functional ovarian cysts cannot be prevented if you
are
ovulating. Anything that makes ovulation less frequent
reduces your chance of developing an ovarian cyst.
Birth control pills, pregnancy, and
breastfeeding in the first 6 months following birth
prevent ovulation. Ovulation ceases when
menopause is complete.

Home Treatment

Home treatment can help relieve the
discomfort of
functional ovarian cysts.

  • Use heat, such as a hot water bottle, heating
    pad, or warm bath, to relax tense muscles and relieve cramping. Be careful not
    to burn yourself.
  • Use pain relievers you can get over-the-counter.
    Acetaminophen (such as Tylenol),
    nonsteroidal anti-inflammatory drugs (NSAIDs) (such as
    Advil or Aleve), and
    aspirin (such as Bayer) are all pain medicines you can
    buy without a prescription.
  • Herbal teas, such as chamomile, mint,
    raspberry, and blackberry, may help soothe tense muscles and anxious
    moods.
  • Empty your bladder as soon as you have the urge to
    urinate.
  • Avoid constipation. Constipation does not cause or treat
    ovarian cysts but may further increase your pelvic discomfort. For more
    information, see the topic
    Constipation, Age 12 and Older.

Medications

Treatment with medicine may be useful if
you have recurrent, painful
functional ovarian cysts.

Birth control pills (oral contraceptives) are
used to prevent
ovulation. Without ovulation, the chance that ovarian
cysts will form is reduced and your symptoms may be
relieved. Although birth control pills do not make ovarian cysts go
away any faster, their use may prevent new cysts from forming.

What to think about

Birth control pills have not
been shown to get rid of or shrink ovarian cysts that have already formed. Some
studies show that the cysts shrink at the same rate with or without birth
control pill use.footnote 1

Surgery

Surgery may be needed to confirm the
diagnosis of an
ovarian cyst or to evaluate ovarian growths when
ovarian cancer is possible. Surgery does not prevent
ovarian cysts from coming back unless the ovaries are removed
(oophorectomy).

Surgery may be needed in the following
situations:

  • An ovary and cyst have twisted (torsion) or ruptured.
  • You have severe pain
    or bleeding.
  • A cyst is larger than
    3 in. (7.6 cm) or is pressing
    on other abdominal organs.
  • A cyst has not gone away after a period of
    observation (watchful waiting).
  • Ovarian cancer is suspected based on your
    risk factors for ovarian cancer or an unusual appearance of the cyst on
    ultrasound.

Goals of surgical treatment for an ovarian cyst are
to:

  • Confirm a diagnosis of an ovarian cyst.
  • Rule out the diagnosis of ovarian cancer.
  • Remove cysts
    that are causing pain.
  • Relieve the pressure that cysts larger than
    3 in. (7.6 cm) may cause on the
    bladder and other pelvic organs.

Surgery choices

Surgery for an ovarian cyst or growth
can be done through a small incision using
laparoscopy
or through a larger incision (laparotomy). The cut is made in your
stomach area.

Laparoscopy may be used to confirm the diagnosis of
an ovarian cyst in a woman of childbearing age. Persistent, large, or painful
ovarian cysts that have no signs of cancer risk can be removed during
laparoscopy, leaving the ovary intact.

Laparotomy is used when an
ovarian cyst is very large, ovarian cancer is suspected, or other problems with
the abdominal or pelvic organs are present. If cancer is found, the larger
incision lets the surgeon closely examine the entire area and more safely
remove all cancerous growth.

What to think about

For the most part, functional
ovarian cysts stop forming when
menopause occurs (in rare cases, a functional ovarian
cyst will occur or persist within 5 years of menopause). Relieving symptoms
with medicine until menopause is complete may be an option.

Some
women prefer the risks of surgery to symptoms that reduce their quality of
life. If your doctor recommends surgery, ask whether
laparoscopic surgery or laparotomy would be the best
choice for you.

Unless the ovaries are removed, surgery does not
prevent the formation of new functional ovarian cysts.

Other Treatment

No other treatment for
functional ovarian cysts is available at this
time.

Other Places To Get Help

Organizations

American Congress of Obstetricians and Gynecologists
(ACOG)
www.acog.org

U.S. Department of Health and Human Services: Women’s Health
www.hrsa.gov/womenshealth/index.html

References

Citations

  1. Grimes DA, et al. (2011). Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews (9).

Other Works Consulted

  • Tzadik M, et al. (2007). Benign disorders of the ovaries and oviducts. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 654-661. New York: McGraw-Hill.

Credits

ByHealthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD – Obstetrics and Gynecology

Current as ofOctober 6, 2017