Ovarian cyst - Treating ovarian cysts

In most cases, ovarian cysts disappear on their own without the need for treatment.

If you have an ovarian cyst, whether it needs to be treated will depend on:

• its size and appearance 
• whether you have any symptoms
• whether you have had the menopause (post-menopausal women have a slightly higher risk of developing ovarian cancer)

Watchful waiting

In most cases, a policy of "watchful waiting" is recommended, where you receive no immediate treatment. This is because most cysts disappear after a few weeks without the need for treatment. A follow-up ultrasound scan will help confirm whether this is the case.

Because of the slightly increased risk of post-menopausal women developing ovarian cancer, regular ultrasound scans and blood tests are usually recommended until the cyst disappears.

Surgery

Large ovarian cysts or cysts that are causing symptoms will usually need to be removed.

Doctors sometimes recommend removing cysts even when they are not causing symptoms. This is because it is not always possible to tell what type of cyst it is without closely examining it under a microscope. Removing the cyst also significantly reduces the risk of it becoming cancerous later on.

There are two types of surgery that can be used to remove ovarian cysts. They are:

• a laparoscopy
• a laparotomy

Both procedures are usually carried out under general anaesthetic (medication used to provide pain relief during surgery).

Laparoscopy

Smaller cysts can sometimes be removed using a procedure known as a laparoscopy. This is a type of keyhole surgery where small cuts are made in your lower abdomen and gas is blown into the pelvis to lift the wall of your abdomen away from the organs inside.

A laparoscope, which is a small, tube-shaped microscope with a light on the end, will be passed into your abdomen so the surgeon can see your internal organs. Using tiny surgical tools, the surgeon will remove the cyst through the small cut in your skin.

After the cyst has been removed, the cuts will be closed using dissolvable stitches. Depending on the type and size of cyst, the operation usually takes about an hour. Most women are able to go home later on the same day or the following day.

A laparoscopy is the preferred surgical method because it causes less pain and allows you to resume normal activity sooner.

Laparotomy

If there is a chance that your cyst is cancerous, a more invasive procedure called a laparotomy may be recommended.

During a laparotomy, a larger cut will be made to give the surgeon better access to the cyst. Depending on the size of the cyst, this may be along your bikini line or in the midline of your tummy. 

The whole cyst and ovary will be removed so that it can be sent to a laboratory to check whether it is cancerous. Stitches or staples will be used to close the incision.

After the procedure, you will have a catheter (a tube in your bladder to drain urine) and a drip. You may need to stay in hospital for a few days after the procedure.

Your fertility

If only one of your ovaries is removed, your remaining ovary will continue to function normally if you are pre-menopausal. It will release hormones and eggs as usual, which means that your health and fertility should be unaffected, although your fertility may be slightly reduced.

If both of your ovaries need to be removed, this will trigger an early menopause (if you have not already reached the menopause). However, it may still be possible to have a baby by having a donated egg implanted into your womb. This will need to be discussed with specialists at a centre that specialises in assisted reproduction techniques.

Your surgeon will try to preserve as much of your reproductive system as possible. For example, it may be possible to preserve your ovary and fallopian tube (the tube where the egg passes), which will have a minimal effect on your fertility. This procedure is known as an ovarian cystectomy.

Following an ovarian cystectomy, you may be able to return to work within two weeks. However, if the cyst is very large and the whole tube covers the ovary or there are concerns about the nature of the cyst, the whole tube and ovary may need to be removed.

In this case, your recovery may still only be two weeks if the procedure is carried out laparoscopically. If an "open" approach is used, such as a laparotomy, your recovery may take six to eight weeks.

The results may take three to four weeks to come back. A plan for further management will either be sent to you by your consultant through the post or a follow-up hospital appointment may be arranged.

Cancer treatment

If laboratory results show that the cyst is cancerous, both of your ovaries, your womb (uterus) and some of the surrounding tissue may need to be removed.

Again, this would trigger an early menopause and mean that you would be infertile.

Read more about treating ovarian cancer.