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 associated with endometriosis), dermoid cysts, cystadenomas, and malignant cysts (a type of ovarian cancer). Ovarian cysts are usually asymptomatic, but they can sometimes cause lower abdominal pain and predispose individuals to complications such as cyst rupture or ovarian torsion, which may require surgery. Diagnosis is usually made with pelvic ultrasound. Management and follow-up depend on cyst size and appearance on ultrasound, the patient's menopausal status, and the presence of risk factors for ovarian tumors.
Ovarian cysts are fluid-filled sacs within the ovary.
Functional ovarian cysts
Functional cysts result from a disruption in the development of follicles or the corpus luteum and often resolve on their own.
- Follicular cyst of the ovary (most common ovarian mass in young women)
- Corpus luteum cyst
Theca lutein cysts
- Often multiple cysts that typically develop bilaterally
- Result from exaggerated stimulation of the theca interna cells of the ovarian follicles due to excessive amounts of circulating gonadotropins such as β-hCG
- Strongly associated with multiple gestations and
- Usually resolve once β-hCG levels have normalized
Nonfunctional ovarian cysts
A group of ovarian cysts that do not produce hormones.
- Usually asymptomatic (incidental finding)
- Can cause lower abdominal pain and lead to complications 
- Adnexal mass that is sometimes palpable
- Possibly signs of the underlying cause, such as:
- First-line imaging: pelvic ultrasound 
- For suspected malignancy 
- For acutely symptomatic patients 
Pelvic ultrasound with doppler
- Simple cysts 
Corpus luteum cyst 
- Unilocular cyst with thick walls
- ↑ Peripheral vascularity (ring-of-fire sign)
- Small central lucency
- Intracystic echogenic debris may be present.
Theca lutein cysts 
- Bilateral multilocular cysts with thin walls
- Solid components may be present.
- Potentially malignant cysts 
Additional imaging 
- MRI pelvis with IV contrast
- CT abdomen and pelvis with IV contrast
Management and follow-up are usually determined by cyst appearance and size as well as menopausal status. 
- All patients
- Functional cysts
- Complications, large cysts, persistent painful cysts: Consider surgery.
In most patients with functional cysts, watchful waiting is recommended, as cysts often regress spontaneously.
We list the most important complications. The selection is not exhaustive.
- Rupture is caused by an increase in intracystic pressure.
- Most common type of ruptured cyst: corpus luteum cyst 
- Vigorous physical activity
- Vaginal intercourse
- Large cysts
- Reproductive age
- May be asymptomatic
- Sudden-onset unilateral lower abdominal pain 
- Possible signs of peritonitis 
- Possible nausea and vomiting 
- Minimal vaginal bleeding (spotting) may occur in some cases.
- In case of significant hemorrhage: hypovolemic shock 
- Urine or serum β-hCG: obtain in all patients to exclude intrauterine or ectopic pregnancy
- CBC: may show anemia
- coagulation panel, type and screen :
- POCUS/FAST: Consider in unstable patients to rapidly assess for the presence and extent of free fluid.
- Transabdominal/transvaginal pelvic ultrasound: imaging modality of choice
- CT pelvis with IV contrast: consider in nonpregnant patients if ultrasound findings are inconclusive
- Hemodynamically unstable patients: : emergency exploratory laparoscopy/laparotomy to obtain hemostasis
Hemodynamically stable patients: conservative management with and observation
- Consider outpatient monitoring with close follow-up for patients with:
- Inpatient management if there is evidence of significant and/or ongoing hemorrhage 
- All patients: Consider as needed.
- Ruptured or bleeding ectopic pregnancy
- Tubo-ovarian abscess
- Ovarian torsion
- Acute appendicitis
- See also: “ .”
Acute management checklist for ruptured ovarian cyst
- Urgent OB/GYN consult
- IV fluids (see IV fluid therapy)
- Parenteral analgesics: Opioid analgesics are preferred.
- Order emergency preoperative diagnostics and β-hCG.
- Obtain consent for blood transfusion and give emergent transfusion in suspected hemorrhagic shock.
- Hemodynamically unstable patients: emergency exploratory surgery for hemostasis
- Hemodynamically stable patients: Monitor vitals, Hb, and size of hemoperitoneum on imaging.