• Clinical science

Ovarian cysts


Ovarian cysts are fluid-filled sacs within the ovary. The most common types are functional follicular cysts, corpus luteum cysts, and theca lutein cysts, which all develop as part of the menstrual cycle and are usually harmless and resolve on their own. Nonfunctional cysts include chocolate cysts, which are related to endometriosis, dermoid cysts, cystadenomas, and malignant cysts (a type of ovarian cancer). All types can be diagnosed via pelvic ultrasound. While ovarian cysts are usually asymptomatic, complications due to rupture of a cyst can occur and may require treatment. Moreover, individuals with ovarian cysts are at increased risk of ovarian torsion, which requires surgical correction.



Ovarian cysts are fluid-filled sacs within the ovary.


Clinical features




  • In most patients with functional cysts, watchful waiting is recommended, as cysts often regress spontaneously.
  • NSAIDs in the case of painful cysts
  • Surgery in the case of complications, large cysts, or persistent cysts that are painful
  • Treatment of underlying conditions such as PCOS, endometriosis, or ovarian cancer


Ruptured ovarian cyst

  • Etiology: physical activity
  • Clinical features
    • Sudden-onset unilateral lower abdominal pain
    • In the case of a very large cyst: Fluid and blood loss may cause acute abdomen and shock.
  • Diagnosis: Pelvic ultrasound shows free fluid, most commonly in the pouch of Douglas (rectouterine pouch).
  • Treatment
    • Hemodynamically stable patients can be observed and given analgesics.
    • Hemodynamically unstable patients require laparoscopy to control hemorrhaging.


Ovarian torsion

  • Etiology
    • Physical activity
    • The primary risk factor is ovarian enlargement (e.g., due to cysts, ovarian stimulation, pregnancy, tumors).
  • Clinical features
    • Sudden-onset unilateral lower abdominal pain
    • Nausea and vomiting
  • Diagnosis: Pelvic ultrasound with Doppler velocimetry shows enlarged, edematous ovaries with decreased blood flow.
  • Treatment: Detorsion via laparoscopic surgery is recommended as soon as possible to restore blood flow.


last updated 12/05/2019
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