Ovarian cysts are remarkably common. The Office on Women’s Health estimates that most women develop at least one ovarian cyst during their lifetime, with the majority forming during the childbearing years. Despite how frequently they occur, many women are unfamiliar with the symptoms of ovarian cysts and may not recognize when their body is signaling a problem. Understanding what to look for can help you distinguish routine cysts from those that require medical evaluation.
What Are Ovarian Cysts?
Ovarian cysts are fluid-filled sacs that develop on or inside an ovary. Most are functional cysts, meaning they form as a normal part of the menstrual cycle. Follicular cysts occur when a follicle does not release an egg and continues to grow, while corpus luteum cysts form when the follicle seals off after releasing an egg and fills with fluid.
Other types include dermoid cysts (which can contain tissue like hair, skin, or teeth), endometriomas (associated with endometriosis), and cystadenomas (which develop from ovarian tissue and may fill with watery or mucous material). While most ovarian cysts are benign and resolve without treatment, some types can grow large, cause significant symptoms, or, in rare cases, indicate a more serious condition.
The American College of Obstetricians and Gynecologists (ACOG) notes that functional cysts are the most common type and rarely require treatment. However, persistent or atypical cysts may need monitoring, imaging, or surgical evaluation.
Common Symptoms of Ovarian Cysts
Many ovarian cysts produce no symptoms at all and are discovered incidentally during a pelvic exam or imaging study performed for another reason. When symptoms do appear, they often develop gradually and can be mistaken for other conditions.
Pelvic pain is the hallmark symptom. This may present as a dull, persistent ache on one side of the lower abdomen, or it can feel like a sharp, sudden pain if the cyst ruptures or twists. The pain may come and go and often intensifies during menstruation or sexual intercourse. Some women describe it as a heaviness or pressure in the pelvis.
Bloating and abdominal swelling are also frequently reported symptoms of ovarian cysts, particularly when cysts grow large. You may notice your clothes fitting differently around the waist even without weight gain. This bloating can be accompanied by a feeling of fullness or pressure in the lower abdomen that does not improve with dietary changes.
Additional Symptoms to Watch For
Beyond pain and bloating, ovarian cysts can cause a range of other symptoms. Changes in menstrual patterns, including irregular periods, heavier or lighter flow than usual, or spotting between periods, may signal that a cyst is affecting ovarian hormone production.
Frequent urination or difficulty fully emptying your bladder can occur when a large cyst presses on the bladder. Similarly, constipation or changes in bowel habits may develop if a cyst puts pressure on the rectum. Some women also experience lower back pain or thigh pain radiating from the affected side.
Nausea, breast tenderness, and a sensation of pressure during bowel movements are less common but still recognized symptoms of ovarian cysts. If you experience any combination of these symptoms, particularly if they persist for more than a few weeks, scheduling an evaluation with your healthcare provider is a reasonable next step.
Symptoms of a Ruptured Ovarian Cyst
When an ovarian cyst ruptures, it can release fluid into the pelvic cavity, causing sudden and sometimes severe pain. The pain typically begins on the side of the affected ovary and may spread across the lower abdomen. A ruptured cyst can also cause light vaginal bleeding or spotting.
Most ruptured cysts resolve on their own with rest and over-the-counter pain medication. However, in some cases, a ruptured cyst can cause internal bleeding that requires medical attention. Signs of a more serious rupture include intense or worsening pelvic pain, dizziness, lightheadedness, rapid heartbeat, and feeling faint.
When to seek emergency care: Call 911 or go to the nearest emergency room if you experience sudden, severe pelvic pain accompanied by fever, vomiting, dizziness, fainting, rapid breathing, or signs of shock such as cold and clammy skin. These symptoms may indicate internal bleeding, ovarian torsion, or another emergency requiring immediate treatment.
Symptoms of Ovarian Torsion
Ovarian torsion occurs when a cyst causes the ovary to twist on its supporting ligaments, cutting off its blood supply. This is a medical emergency that requires immediate surgical intervention to save the ovary. Torsion is more likely to occur with larger cysts, typically those over 5 centimeters in diameter.
The symptoms of torsion include sudden, intense, one-sided pelvic pain that may come in waves, along with nausea and vomiting. The pain is often severe enough that it is difficult to find a comfortable position. Unlike the dull ache of an uncomplicated cyst, torsion pain is sharp and unrelenting.
According to the Mayo Clinic, ovarian torsion accounts for approximately 3% of gynecologic emergencies. If you suspect torsion based on sudden severe pain, seek emergency care immediately. Early surgery offers the best chance of preserving the affected ovary.
When to See a Doctor
Not every ovarian cyst requires medical intervention, but certain symptoms warrant a visit to your healthcare provider. Schedule an appointment if you experience persistent pelvic pain lasting more than a few days, bloating that does not improve, noticeable changes in your menstrual cycle, or pain during intercourse that is new or worsening.
Your doctor will likely perform a pelvic exam and order an ultrasound to evaluate the size, type, and characteristics of the cyst. Blood tests, including a CA-125 level in certain populations, may be ordered to help characterize the cyst further. Most cysts are monitored with watchful waiting and repeat imaging in 6 to 8 weeks.
Women who are postmenopausal should take ovarian cysts more seriously, as the risk of malignancy increases after menopause. Any new ovarian cyst discovered after menopause should be evaluated by a gynecologist, and your doctor may refer you to a gynecologic oncologist if the cyst has concerning features on imaging. For more information on related conditions, see our medical conditions guide.
Diagnosis and Treatment Options
Transvaginal ultrasound is the primary imaging tool for evaluating ovarian cysts. It can determine cyst size, whether the cyst is simple (fluid-filled) or complex (containing solid components), and whether it appears benign or warrants further workup. MRI may be used for cysts that are difficult to characterize on ultrasound.
Treatment depends on the type, size, and symptoms of the cyst, as well as the patient’s age and reproductive goals. Small, asymptomatic functional cysts often resolve within one to three menstrual cycles and require only monitoring. Hormonal birth control may be recommended to prevent new functional cysts from forming, though it does not shrink existing cysts.
Surgical removal is considered for cysts that are large (typically over 5 to 10 centimeters), persistent, symptomatic, or have concerning features on imaging. Laparoscopic cystectomy is the preferred surgical approach for benign cysts, as it removes the cyst while preserving the ovary. In rare cases where cancer is suspected, a more extensive surgical approach may be necessary.
If you experience symptoms that might indicate another condition, learning about what a hernia feels like or when to worry about swollen lymph nodes can help you differentiate between overlapping symptoms.
Frequently Asked Questions
Can ovarian cysts go away on their own?
Yes, most functional ovarian cysts resolve on their own within one to three menstrual cycles without treatment. Your doctor may recommend a follow-up ultrasound to confirm the cyst has resolved. Non-functional cysts, such as endometriomas or dermoid cysts, are less likely to resolve spontaneously and may require ongoing monitoring or surgical removal.
Can you feel an ovarian cyst by pressing on your abdomen?
Small cysts are not typically palpable from the outside. Large cysts, particularly those over 10 centimeters, may cause visible or palpable abdominal swelling. However, a doctor can sometimes detect a cyst during a pelvic exam by feeling the ovary. Do not attempt to self-diagnose by pressing on your abdomen, as this could potentially cause a cyst to rupture.
Do ovarian cysts affect fertility?
Most ovarian cysts do not affect fertility. Functional cysts are a normal part of ovulation and typically do not interfere with conception. However, endometriomas associated with endometriosis can impair fertility, and polycystic ovary syndrome (PCOS), a condition characterized by multiple small cysts, is a leading cause of ovulatory infertility. Talk to your doctor if you have concerns about how ovarian cysts may affect your ability to conceive.
What is the difference between an ovarian cyst and ovarian cancer?
The vast majority of ovarian cysts are benign. Ovarian cancer is relatively uncommon, affecting about 1 in 78 women over a lifetime, according to the American Cancer Society. Features that raise concern for malignancy include solid components within the cyst, irregular borders, associated ascites (fluid in the abdomen), and elevated tumor markers. Your doctor will evaluate these factors when determining the appropriate management plan.
The Bottom Line
The symptoms of ovarian cysts range from entirely absent to severely painful, depending on the type, size, and any complications that develop. Pelvic pain, bloating, menstrual changes, and urinary frequency are the most common signs. While most cysts are harmless and resolve on their own, sudden severe pain, dizziness, or signs of shock require emergency medical attention. Regular pelvic exams and prompt evaluation of persistent symptoms give you the best chance of catching any problems early and maintaining your reproductive health.