Here's What You Need to Know About Having an Ovarian Cyst Removed
Ovarian cysts range widely by type and symptoms, as does the required treatment. As a Physician’s Assistant in surgery, I have walked many patients through the discovery of their cyst, planning, surgery, and postoperative recovery. Each case is different, but cysts range from being asymptomatic — found incidentally with routine or unrelated imaging — to very symptomatic. Ovarian cysts can cause pelvic and abdominal pain and cramping, changes in bowel and bladder habits, bloating, discomfort with intercourse, and, if they cause bleeding, might even lead to light-headedness, heart palpitations, pallor, or fainting.
Here’s what you need to know about ovarian cysts and ovarian cyst removal:
How is an ovarian cyst diagnosed?
The provider will take a comprehensive personal and family medical and surgical history of the patient, then complete a thorough pelvic and abdominal exam, followed by imaging and blood work. Pelvic ultrasound is used to identify the size, contents, and probable type of cyst, and can often be done in the office, as well as in imaging centers and hospitals. If the results are unclear, or if a closer look at the surrounding anatomy is required, a CT-scan or MRI might be utilized. Depending on the patient’s age and personal/family history, a blood pregnancy test (Beta-hCG) will help rule out ectopic pregnancy, and cancer markers, like CA-125, can help determine the likeliness that the cyst is malignant. Depending on the severity of the symptoms, these steps all might happen quickly and urgently.
The information collected will help the patient and provider determine the nature of the cyst and the proper management plan. If the cyst is found to be functional, or hormonal/related to ovulation, and is small and likely to resolve on its own, the patient may be asked to monitor symptoms and return for regular checkups. If the cyst is larger, causing mild symptoms, is non-cancerous, and not at high risk of compromising the blood flow to the ovary, elective surgery may be scheduled in the future. If the cyst appears to be a malignant mass, a Gynecological Oncologist will be consulted to make a management plan that will vary significantly from those of benign cysts. If the cyst is determined to be an ectopic pregnancy, multiple factors will determine whether medical or surgical intervention is required. If the cyst is compromising the blood supply to the ovary, causing an ovarian torsion, urgent surgical treatment is warranted.
What else could it be?
According to Board Certified OBGYN and Fellow of the American College of Obstetrics and Gynecology, Dr. Amy Heeringa, out of Rochester, Michigan, “Other things than can mimic an ovarian cyst on ultrasound would include a paratubal cyst (cyst on the fallopian tube), pelvic inclusion cyst, a dilated tube (hydrosalpinx) or GI related (intestinal) cysts.”
What does it mean if the ultrasound shows “free fluid?”
Dr. Heeringa says, “Free fluid is suggestive, but not diagnostic for, a ruptured ovarian cyst. Some amount of free fluid is normal.”
If surgery is required, what is that like? And how will recovery work?
In general, the goal of surgery is to do the most good with the least invasion, and to maintain as much normal anatomy as possible. The effect of having an ovarian cyst removed on menstruation, menopause, and future pregnancy potential is often negligible, but the surgeon will counsel patients on this before surgery, as well as the likelihood of some ovarian tissue/the entire effected ovary having to be removed, and what the long-term effects of that would be.
Dr. Heeringa says, “Typically cysts develop within the ovary, essentially stretching normal ovarian tissue around the cyst. For this reason, when I consent a patient for surgery, I always discuss the risk that a cystectomy may not be possible. Sometimes due to bleeding or size of cyst, an oophorectomy (complete removal of the ovary) is the only safe option.”
How the surgery is performed will be determined by the size and contents of the cyst, as well as any scarring the patient is likely to have internally- from prior surgeries, endometriosis, diverticulitis, or other conditions. The patient and surgeon will discuss the best approach, whether it be laparoscopy (multiple small incisions, surgery is done with a scope and narrow instruments, possibly with the assistance of a da Vinci robot) or laparotomy (one, large incision). Prior to surgery, the patient and provider will consider all options, possible risks, and outcomes.
Laparoscopic ovarian cystectomies for benign ovarian cysts are generally out-patient and are typically fairly quick, depending on the nature of the cyst and that of the surrounding anatomy. The patient will undergo general anesthesia and must fast the day of surgery. Almost always, a catheter will be placed in the patient’s urethra once a patient is asleep, to drain the bladder during surgery. It is then removed before the patient awakes and she should be able to empty her bladder soon after surgery. Postoperatively, a patient will stay in the recovery room to make sure their pain is controlled, their bladder is functioning, and they are awake enough to eat and drink. The patient will then heal at home and is expected to be up and walking and eating normally the day of surgery. She can generally return to work and to normal activities within a week or two and can drive once off the pain medications and reflexes are back to normal. There may be additional heavy lifting, exercise, and pelvic rest restrictions (like no intercourse or tampons), depending on the surgeon’s preferences and the extent of the surgery. Typically, narcotic pain medication is used in conjunction with non-steroidal anti-inflammatories like Ibuprofen for the first few days, until the patient can wean down to Acetaminophen (Tylenol) and Ibuprofen products. Stool softeners or laxatives are encouraged to prevent constipation postoperatively. All tissue that is removed will be sent for pathological assessment and typically results are available within one week. Generally, sutures are used under the skin and a sterile glue, tape, or staples will be over the skin. There may be bandages that need to be removed in the first day or two of surgery and any wound care instructions will be provided before discharge. A follow-up visit with the surgeon usually takes place within several weeks of surgery.
If the patient requires a laparotomy to have the cyst removed, the surgery and recovery will be more involved. If possible, the incision is done horizontally and low on the pelvis, like a cesarean section incision, but depending on the location and size of the cyst, some patients will require vertical scars that may span from the pelvis up the abdomen. The cyst itself, or the patient’s anatomy or medical/surgical history may be more complicated, and often these surgeries take more time and come with greater risks. Typically, patients spend a night or two in the hospital postoperatively. Again, the incision will be closed with suture underneath the skin and then tape, staples, or glue will be placed over top, with bandages that will be changed by the hospital staff during the stay. An abdominal binder, like a support garment, may be used. Pain medications will likely be needed more frequently and for longer than after laparoscopic surgery. Initially some patients may be on a liquid diet and pain medications may be IV-administered by staff or available on a pain pump that is controlled by the patient. As bowel activity returns and the patient recovers, this will be transitioned to a regular diet and oral pain medication. Medications for bowel support, as well as fiber and plenty of fluids, are especially important to prevent constipation. Patients may initially have a catheter draining their bladders the first day or two of surgery. Walking and sitting up is encouraged early and often after laparotomy.
After surgery, most patients recover and go back to their normal lives without any issues, but it is important to keep an eye out for potential postoperative problems. Surgeons should be notified with fever, unremitting nausea, worsening pain, difficulty emptying bladder or bowels, and any redness, oozing, or odor from the incisions. Difficulty breathing, chest pain, or any other severe symptoms will require a trip to the emergency room. Menstruation may be irregular for a cycle or two after surgery.
What if ovarian cysts come back?
Once a patient has had an ovarian cyst that required removal, her odds of having another increase, especially if the pathology revealed that it was something affected by hormones. Dr. Heeringa says that “For patients with recurrent functional cysts, it is reasonable to offer suppression of ovulation with medications, such as birth control pills. This will not resolve an existing cyst, but will prevent future cysts.” For those patients will other types of recurrent ovarian cysts, like those with Polycystic Ovarian Syndrome or endometriosis, hormonal management may also be recommended, as well as regular surveillance by a trusted provider.
Sarah Zimmerman is a freelance writer in Northern California and is working on her first novel. In past lives,, she has been a Physician Assistant in Women's Health and the owner of a vegan ice cream business. Sarah writes about marriage, sex, parenting, infertility, pregnancy loss, social justice, and women's mental and physical health, always with honesty and humor. She has written for Ravishly, Cafe Mom, Pregnant Chicken, and more and can be found at sarahzwriter.com and on Medium, Twitter, Facebook, Instagram and TikTok at @sarahzwriter.