- Ovarian Cysts Before Menopause: What You Need to Know
Ovarian cysts are very common in women who have not yet gone through the menopause. Most are harmless, and many disappear on their own without treatment.
The important thing is to work out which cysts are likely to be simple and harmless, and which need closer checks or specialist care.
- What is an ovarian cyst?
An ovarian cyst is a fluid-filled sac that develops in or on the ovary. Many cysts are linked to the normal menstrual cycle. These are called functional cysts and often go away naturally within a few months.
Other ovarian lumps may not be simple cysts. They may contain thicker fluid, blood, solid areas, or other tissue. These are sometimes called complex ovarian masses.
- Are ovarian cysts usually cancer?
In women before the menopause, ovarian cancer is uncommon. Most ovarian cysts in this age group are benign, meaning non-cancerous.
The Royal College of Obstetricians and Gynaecologist (UK)- states that the chance of cancer in a symptomatic ovarian cyst before the menopause is about 1 in 1000. This risk rises slightly with age, reaching about 3 in 1000 by age 50.
Even though cancer is uncommon, doctors still assess ovarian cysts carefully to make sure women get the right care.
- Symptoms that may need checking
Many ovarian cysts cause no symptoms and are found by chance during a scan.
Some women may have:
- Lower tummy or pelvic pain
- Bloating or swelling
- Pain during sex
- Changes in periods
- Pressure symptoms, such as passing urine more often
- A feeling of fullness or reduced appetite
Symptoms such as ongoing bloating, feeling full quickly, pelvic pain, or needing to pass urine more often should be discussed with a healthcare professional, especially if they are new, persistent, or getting worse.
- How are ovarian cysts assessed?
The first step is usually a discussion about symptoms, medical history, menstrual history, and family history. Your doctor may ask whether there is any family history of ovarian or breast cancer.
A pelvic examination may be offered, although a scan is usually much better at seeing the ovaries clearly.
- Ultrasound scan
An ultrasound scan is the main test used to assess an ovarian cyst. A transvaginal ultrasound, where a small probe is placed inside the vagina, usually gives the clearest view of the ovaries.
Sometimes an abdominal ultrasound is also needed, especially if the cyst is large.
The scan looks at the size and appearance of the cyst. Doctors check whether it is simple and fluid-filled, or whether it has more complex features such as solid areas, thick walls, or blood flow.
- Blood tests
A blood test called CA-125 is sometimes used when assessing ovarian cysts. However, it is not needed for every simple cyst in a premenopausal woman.
This is because CA-125 can be raised for many harmless reasons, including:
- Endometriosis
- Fibroids
- Adenomyosis
- Pelvic infection
- Periods
- Pregnancy
Because of this, a raised CA-125 does not automatically mean cancer.
If the CA-125 level is very high, especially above 200 units/ml, doctors may discuss the case with a gynaecological cancer specialist.
In women under 40 with a complex ovarian mass, other blood tests may be done to look for rarer ovarian tumours that are more common in younger women. These may include LDH, alpha-fetoprotein, and hCG.
- What happens if the cyst is simple?
Simple cysts are usually filled with clear fluid and have a smooth appearance on ultrasound.
Management depends mainly on size:
| Size of simple cyst | Usual approach |
|---|---|
| Less than 5 cm | Usually no follow-up needed; many go away on their own. Occasionally a 3-4month follow up reassurance scan is done. |
| 5–7 cm | Usually yearly ultrasound follow-up |
| More than 7 cm | Further imaging, such as MRI, or surgery may be considered |
Most small simple cysts disappear within a few menstrual cycles.
- Can the pill treat ovarian cysts?
The combined oral contraceptive pill does not make existing functional ovarian cysts disappear faster. For this reason, it should not be used as a treatment for a cyst that is already present.
- When is surgery needed?
Surgery may be needed if:
- The cyst is large
- The cyst is growing
- The cyst does not go away
- The cyst has complex or suspicious features
- Symptoms are troublesome
- The diagnosis is uncertain
For cysts that look benign, keyhole surgery, also called laparoscopy, is usually preferred when suitable. It often means less pain, a shorter hospital stay, and a quicker recovery than open surgery.
However, open surgery may be needed for very large cysts or when there is concern about cancer.
- Why are some women referred to a specialist?
Some scan findings can raise concern and may need review by a gynaecological cancer specialist. These include:
- Solid areas within the cyst
- Several internal projections or “papillary” areas
- Fluid in the abdomen, called ascites
- Very strong blood flow in the mass
- Signs that the cyst may not be confined to the ovary
Referral does not always mean cancer. It means the cyst needs expert assessment and careful planning.
- Can an ovarian cyst just be drained?
Routine drainage of ovarian cysts is not usually recommended. This is because cysts often come back after drainage. Removing the cyst properly is usually a better option when treatment is needed.
- Will the ovary need to be removed?
Not always. In many cases, the cyst can be removed while leaving the ovary behind.
However, sometimes removing the ovary may be the safest or most appropriate option. This should be discussed before surgery, especially for women who wish to have children in the future.
- Key message
Most ovarian cysts before the menopause are not cancer. Many small simple cysts go away on their own and do not need treatment.
The most important step is a good-quality ultrasound scan. Blood tests may be helpful in some situations, but they are not needed for every simple cyst.
Women with large, persistent, complex, or suspicious cysts may need specialist review or surgery. The aim is to avoid unnecessary treatment while making sure serious conditions are not missed.
Remember, ALWAYS consult with your GP and/or your gynecologist for your specific treatment options. Every woman is different!