Treatments for Ovarian Cysts

Overview

Ovarian cysts do no always require treatment. In fact, particularly for women of childbearing years, ovarian cysts may resolve on their own without treatment.

Before a physician recommends a course of treatment, other tests might be needed:
  • Pregnancy test
  • Imaging such as an ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) scan
  • CA-125 (cancer antigen 125). This blood test measures levels of a protein associated with some (but not all) ovarian cancers. CA-125 also may be elevated in certain non-cancerous conditions (uterine fibroids, endometriosis). Sometimes women with an early-onset ovarian cancer may have a normal CA-125. A gynecologist should interpret and explain how the CA-125 test can help discover and understand a particular patient’s condition.
  • Complete blood count. This includes a test of white blood cells, which may be elevated when an infection is present.
A physician might recommend “watchful waiting” for ovarian cysts that cause few or no symptoms or do not appear suspicious for cancer. Watchful waiting involves repeating an ultrasound periodically (usually after six to eight weeks) to see if cysts have resolved on their own or decreased in size.

During this period, patients may be instructed to take pain relievers, which could include over-the-counter medications such as Tylenol or NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen, or prescription narcotics. Some premenopausal women may be instructed to take a birth-control pill to prevent new cysts from forming.

When a cyst is large and causes pain, or appears suspicious for cancer, the physician may recommend its surgical removal (cystectomy) or removal of the entire ovary and, potentially, surrounding tissues. Larger cysts are more likely to require surgical removal, but a cyst’s size does not predict the likelihood that it is cancerous.

Surgery may be performed laparoscopically (using several small incisions) or via a single, larger incision (laparotomy). The surgical approach will depend on the size of the cyst, previous surgeries and the suspicion of cancer.

Surgery may be recommended in the following situations:
  • A cyst is causing severe pain or pressure, and concern exists particularly if there is concern that the cyst has burst (also known as “cyst rupture”) or twisted (also called “ovarian torsion”).
  • A cyst appears suspicious for cancer.
  • A cyst does not decrease in size or resolve on its own after a period of watchful waiting.
  • A cyst is associated with endometriosis and might impact the patient’s fertility.
Treatment may include referral to a specialist called a gynecologic oncologist for the following reasons:

If you have not yet entered menopause and have:
  • CA-125 protein level greater than 200
  • Ascites (fluid in the abdomen)
  • Evidence of cancer outside of the pelvis
  • Family history of breast or ovarian cancer in a first-degree relative
If you have entered menopause and have:
  • Abnormal CA-125 level
  • Ascites (fluid in the abdomen)
  • Nodular or fixed (immobile) pelvic mass
  • Evidence of cancer outside of the pelvis
  • Family history of breast or ovarian cancer in a first-degree relative

Pediatric or Adolescent Concerns

As noted in the “Causes” section, ovarian cysts can occur in females of all ages. The most likely causes of ovarian cysts depend on age.
In children who have not yet reached puberty, physiologic cysts are less common. If present, they may be a sign of early puberty. In young girls, ovarian cysts are more likely to twist. The appearance of a cyst on ultrasound or CT scan will help determine whether it is safe to continue watchful waiting of a cyst or if it should be removed surgically.

Among girls who have started menstruating, the most likely causes of ovarian cysts are the same as those experienced by adult pre-menopausal women.