Ovarian cyst


  • Most common are functional or follicular cysts
  • Less common include PCOS, cystadenomas, and dermoid cysts
  • Cysts are generally >1cm in size
  • Cysts are at risk of torsion when >4cm
  • Cysts <2cm are virtually risk free from torsion
Relative incidences of different types of ovarian cysts.[1]

Clinical Features

  • Most tend to be asymptomatic
  • Can cause:
    • Dull pelvic pain or fullness; they can be significantly painful if ruptured
    • Dyspareunia
    • Pressure on the bladder
  • If there is bleeding into the cyst and it ruptures, it can be life threatening, with signs of peritonitis, shock

Differential Diagnosis

RLQ Pain

LLQ Pain


Ultrasound demonstrates a simple ovarian cyst greater than 3 cm in size consistent with a follicular cyst.
Transvaginal ultrasound showing ovarian cyst[2]
Ruptured hemorrhagic cyst. (a) CT with bilateral low-density cystic lesions (white arrows). There is extensive hyperdense free pelvic fluid representing hemorrhagic ascites (black arrow). (b) Trans-abdominal ultrasound shows free fluid containing low level echoes in the pelvis (black arrow). There is an adnexal cyst in the pelvis representing the right hemorrhagic ovarian cyst (white arrow).



  • Typically diagnosed on ultrasound, with same side of pain and absence of other concerning etiologies (e.g. negative UA, not pregnant)
  • Check hemoglobin level to assess for blood loss


  • NSAIDs
  • Oral contraceptives
    • No benefit has been found though gynecology may suggest them[3]
  • Ensure that patient does not have significant anemia/free fluid in pelvis
    • Consider repeat hemoglobin of observation period if concern for ruptured cyst with significant bleeding


  • Home, unlessed ruptured with concern for significant blood loss
  • Follow up with OBGyn

See Also

External Links


  1. Abduljabbar, Hassan S.; Bukhari, Yasir A.; Hachim, Estabrq G. Al; Ashour, Ghazal S.; Amer, Afnan A.; Shaikhoon, Mohammed M.; Khojah, Mohammed I. (July 2015). "Review of 244 cases of ovarian cysts". Saudi Medical Journal. 36 (7): 834–838. doi:10.15537/smj.2015.7.11690. PMC 4503903. PMID 26108588.
  2. http://www.thepocusatlas.com/obgyn/
  3. Cochrane Database Syst Rev 2011. Sep 7;(9):CD006134.