Op. Dr. Volkan AktemurObstetrician & Gynecologist

Ovarian Cysts

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Representative image for Ovarian Cysts
Representative image

In any surgical or interventional procedure, results may vary from person to person. You are advised to obtain a detailed opinion from your physician before the procedure.

Ovarian cysts

Ovarian cysts are sacs that develop in the ovary and are filled with fluid or other tissue. The most common are functional cysts, which form as part of ovulation; they often disappear on their own within a few menstrual cycles. Types of cyst that may require surgery include:

  • Endometrioma (chocolate cyst): develops in connection with endometriosis.
  • Dermoid cyst: a usually benign cyst that may contain different tissues such as fat and hair.
  • Cystadenoma: a benign cyst that develops from the surface tissue of the ovary. Some similar-looking masses can be borderline or malignant; the definite distinction is made by pathological examination.

The small follicles seen in polycystic ovary syndrome are not cysts that require surgery.

Monitoring or surgery?

The decision takes into account the cyst’s appearance and size on ultrasound, age, menopausal status, complaints and, if necessary, blood tests. Simple-looking cysts that cause no complaints are mostly monitored with ultrasound. Surgery is considered if the cyst is growing, does not go away, causes complaints or looks suspicious. For masses that may be malignant, planning is different and an assessment by gynecologic oncology may be needed.

Laparoscopic approach

Cystectomy is usually performed laparoscopically (keyhole surgery): a camera and special instruments are introduced through small incisions in the abdomen. Open surgery may be needed because of the size or appearance of the cyst or adhesions from previous surgery. The removed tissue is sent for pathological examination.

Preserving ovarian tissue

The aim of the operation is to remove the cyst while preserving as much healthy ovarian tissue as possible. Ovarian tissue maintains the egg reserve and hormone production. Even so, surgery may reduce the ovarian reserve to some extent; this effect can be more marked in endometrioma surgery. For this reason, ovarian reserve tests such as AMH may be requested before surgery in people planning a pregnancy. After menopause, or when ovarian tissue cannot be preserved, removal of the whole ovary may be discussed.

Recovery and possible risks

After laparoscopic cystectomy, most people can return to daily activities within a short time; gas-related pain in the abdomen and shoulders may last a few days. Possible risks include bleeding, infection, blood clots, injury to the bowel or bladder, problems related to anesthesia, a reduction in ovarian reserve and recurrence of the cyst. If ovarian tissue cannot be preserved during the operation, removal of the ovary may rarely be necessary; this possibility is discussed before surgery.

Frequently asked questions about Ovarian Cysts

Does every ovarian cyst need surgery?

No. Functional cysts that form as part of ovulation often disappear on their own within a few menstrual cycles. These cysts are usually monitored with ultrasound. The decision to operate depends on the type and size of the cyst and the complaints.

Does cyst surgery affect fertility?

The operation aims to preserve healthy ovarian tissue. Even so, the ovarian reserve may decrease, particularly after surgery for an endometrioma (chocolate cyst). In people planning a pregnancy, the timing and extent of surgery are decided with this in mind.

Can a cyst come back after surgery?

Some types of cyst, particularly endometriomas, can form again after surgery. The likelihood of recurrence depends on the type of cyst, so check-ups are recommended after surgery as well. For endometriomas, in people not planning a pregnancy in the near future, hormonal treatment after surgery may be discussed to reduce recurrence.

Which symptoms need emergency assessment?

Sudden severe pelvic pain, nausea and vomiting, fever or dizziness may be signs of an emergency such as twisting of the ovary (torsion) or rupture of a cyst. With these symptoms, the nearest emergency department should be contacted without delay.

The information on this page is for general information only and does not replace a medical examination, diagnosis or treatment. The suitability, scope and possible risks of any procedure vary from person to person and are assessed during a consultation.

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