Ovarian cyst

Disease Description (Causes and Symptoms)

• Definition: An ovarian cyst is a mass in the ovary filled with fluid or semisolid material. Most are benign and are common in women of reproductive age.
• Causes/Pathophysiology: The most common cause is a functional cyst (follicular cyst or corpus luteum cyst), which forms when a follicle produced during ovulation remains or fails to be released. Other possible causes include congenital cysts, endocrine abnormalities, benign ovarian tumors (follicular cysts, mucinous or serous cystadenomas, etc.), and, rarely, malignant tumors.
• Main symptoms: Most are asymptomatic. When symptoms occur, they may include pelvic pain, abdominal bloating/pressure, abnormal vaginal bleeding, pain during sexual intercourse, difficulty urinating or defecating, and acute abdominal pain (when torsion or rupture occurs). Sudden severe pain and hypotension may indicate an emergency.

Treatment Methods

• Initial approach
  • Most functional cysts resolve spontaneously within several weeks to several months → observation (follow-up monitoring) and symptom management are standard.
  • During observation, periodic pelvic ultrasonography (e.g., at 6–12-week intervals) and monitoring for changes in symptoms are performed.
• Medication treatment
  • Pain control: Temporary use of NSAIDs (e.g., ibuprofen).
  • Hormonal treatment: Oral contraceptives do not make existing cysts shrink more quickly, but may be used to prevent recurrence of functional cysts (the effect is limited).
• Procedures/Surgery
  • Indications: Cysts that persist or enlarge; findings suspicious for malignancy on ultrasonography (solid components, septations, papillary tissue, abnormal blood flow, asymmetry); large size (compressing organs); acute abdominal pain (torsion or rupture); newly developed cysts in postmenopausal women; elevated tumor markers; and others.
  • Surgical methods: Laparoscopic ovarian cystectomy (cystectomy that preserves the ovary) is considered first. If necessary, partial or total oophorectomy (ovariectomy) or laparotomy may be performed. If malignancy is suspected, additional surgery for staging is performed.
  • In emergencies: Emergency surgery is necessary in cases of ovarian torsion or bleeding and shock caused by rupture.
• Precautions/Self-management
  • Visit the emergency room immediately if symptoms such as acute pain, fever, fainting, or hypotension occur.
  • Regularly record menstrual cycles, pain, and bleeding patterns. Consult a healthcare provider about contraceptive use and pregnancy plans.
  • Depending on whether the ovaries are preserved after surgery, fertility may be affected — if fertility preservation is important, discuss the surgical method and extent in advance.

Outpatient Visit Checklist (Including Preparation Items and Sample Questions)

• Items and records to prepare
  • List of medications and supplements currently being taken (including doses and administration times).
  • Recent test results (ultrasonography, blood tests, CT/MRI, etc.) and their dates.
  • Menstrual history: date of the first day of the last menstrual period, changes in cycle, duration, or menstrual flow, and whether menstrual pain is present.
  • Pain diary: when the pain started, frequency, intensity (0–10), triggers, and relieving factors.
  • Pregnancy status, obstetric history (including previous pregnancies and surgical history), and family history (breast cancer, ovarian cancer, and BRCA-related conditions).
  • Allergies and underlying conditions (such as blood-clotting disorders).
• Documents/Imaging to bring to the outpatient visit
  • Previous ultrasound images and reports, and CT/MRI reports (if available, bring the originals or a CD).
• Sample questions (to show the doctor)
  • "How should the size and characteristics of the cyst be interpreted based on my recent ultrasound results?"
  • "Is it okay to continue with observation alone for now, and how likely is it that I will need surgery?"

General Sample Questions to Ask the Doctor

• What are the side effects of this medication (or prescription), and how long should I take it?
• What is the prognosis of my cyst (the likelihood of spontaneous resolution and the risk of recurrence)?
• Are there any particular precautions I should take regarding lifestyle habits (exercise, sexual activity, contraception, etc.)?

Disease-Specific Sample Questions

• How can the ultrasound findings distinguish whether this cyst is functional (related to ovulation) or has features suspicious for malignancy? Which findings are warning signs?
• Fertility and pregnancy plans are important to me. If surgery is necessary, can ovarian function be preserved as much as possible? What are the surgical options and expected outcomes?

(Note: Healthcare providers determine diagnostic and treatment decisions by comprehensively considering the individual’s condition, age, imaging findings, tumor markers, and other factors.)