Functional Ovarian Cysts

Topic Overview

What is a functional ovarian cyst?

A functional ovarian cyst is a sac that forms on the surface of a woman's ovary during ovulation. It holds a maturing egg. Usually the sac goes away after the egg is released. If an egg is not released, or if the sac closes up after the egg is released, the sac can swell up with fluid.

Functional ovarian cysts are different than ovarian growths caused by other problems, such as cancer. Most of these cysts are harmless. They do not cause symptoms, and they go away without treatment. But if a cyst becomes large, it can twist, rupture, or bleed and can be very painful.

What causes functional ovarian cysts?

A functional ovarian cyst forms because of slight changes in the way the ovary makes or releases an egg. There are two types of these cysts:

• A follicular cyst occurs when a sac on the ovary does not release an egg, and the sac swells up with fluid.
• A luteal cyst occurs when the sac releases an egg and then reseals and fills with fluid.

What are the symptoms?

Most functional ovarian cysts do not cause symptoms. The larger the cyst is, the more likely it is to cause symptoms. Symptoms can include:

• Pain or aching in your lower belly, usually when you are in the middle of your menstrual cycle.
• A delay in the start of your menstrual period.
• Vaginal bleeding when you are not having your period.

Some functional ovarian cysts can twist or break open (rupture) and bleed. Symptoms include:

• Sudden, severe pain, often with nausea and vomiting (possible sign of a twisted cyst).
• Pain during or after sex (possible sign of a ruptured cyst).

If you have these symptoms, call your doctor right away. Some ruptured cysts bleed enough that treatment is needed to prevent heavy blood loss.

How are functional ovarian cysts diagnosed?

Your doctor may find an ovarian cyst during a routine pelvic exam. He or she may then use a pelvic ultrasound to make sure that the cyst is filled with fluid. In a few months, after you have been through 2 or 3 menstrual cycles, your doctor will recheck you. The cyst is likely to go away on its own during this time.

If you see your doctor for pelvic pain or bleeding, you'll be checked for problems that may be causing your symptoms. Your doctor will ask you about your symptoms and menstrual periods. He or she will do a pelvic exam and may do a pelvic ultrasound.

How are they treated?

Most functional ovarian cysts go away without treatment. Your doctor may suggest using heat and medicine to relieve minor pain.

If a large cyst bleeds or causes severe pain, you can have surgery to remove it.

Your doctor may suggest that you take birth control pills, which stop ovulation. This may prevent new cysts from forming.

Frequently Asked Questions

Cause

A functional ovarian cyst is caused by one or more slight changes in the way the ovary produces or releases an egg. During the normal monthly menstrual cycle, one of two types of functional cysts may develop:

• A follicular, or simple, cyst occurs when the small egg sac (follicle) on the ovary does not release an egg, and it swells with fluid either inside the ovary or on its surface.
• A luteal, or corpus luteum, cyst occurs when the remains of the egg follicle do not dissolve and continue to swell with fluid. This is the most common type of ovarian cyst.

The development of luteal cysts is also common during treatment with clomiphene citrate (such as Clomid or Serophene) for infertility. These cysts go away after treatment is completed, though this can take several months. They do not appear to endanger pregnancy. For more information, see the topic Fertility Problems.

Other ovarian growths

The development of functional cysts is directly related to ovulation. But there are other types of ovarian cysts and growths caused by other conditions. An ovarian growth can be a noncancerous (benign) cystic tumor or related to endometriosis or cancer. In some cases, what seems to be an ovarian mass is actually growing on nearby pelvic tissue. This is why it's important for you to have regular pelvic exams and for your doctor to carefully diagnose any cysts or growths felt on your ovaries.

Symptoms

Functional ovarian cysts usually are harmless, do not cause symptoms, and go away without treatment. Ovarian cysts are often discovered during a routine pelvic exam.

The larger the ovarian cyst is, the more likely it is to cause symptoms. When symptoms occur, they may include:

• Frequent urination, if a large cyst is pressing against your bladder.
• Abdominal pain.
• Menstrual period changes.
• Weight gain.

More severe symptoms may develop if the cyst has twisted (torsion), is bleeding, or has ruptured. See your doctor immediately if you have any of the following pain, shock, or bleeding symptoms:

• Sudden, severe abdominal or pelvic pain
• Nausea and vomiting
• Sudden faintness, dizziness, and weakness
• Vaginal bleeding or symptoms of shock from heavy bleeding (hemorrhage)

There are many other conditions that cause signs or symptoms of a functional ovarian cyst. This is why it's important to have any unusual pelvic symptoms checked and to have regular annual pelvic exams.

What Happens

Most functional ovarian cysts cause no symptoms and go away without treatment in 1 to 2 months or after 1 to 2 menstrual periods. Some cysts grow as large as 4 in. (10.2 cm) in diameter before they shrink or rupture. A rupturing functional cyst can cause some temporary discomfort or pain.

What to think about

Functional ovarian cysts do not cause ovarian cancer. But your doctor must rule out other possible types of ovarian cysts or growths before diagnosing a functional cyst. This may involve another exam in 6 or 8 weeks, a pelvic ultrasound, or possibly a laparoscopy procedure to closely examine the cyst and its ovary.

Cysts after menopause. After menopause, ovarian cancer risk increases. This is why all postmenopausal ovarian growths are carefully checked for signs of cancer. Some doctors will recommend removing the ovaries (oophorectomy) when any kind of cyst develops on an ovary after menopause. But the trend in medicine seems to be moving away from surgery for small and simple cysts in postmenopausal women. In the five years after menopause, some women will still have functional ovarian cysts now and then. Some postmenopausal ovarian cysts, called unilocular cysts, which have thin walls and one compartment, are rarely linked to cancer.¹

What Increases Your Risk

A functional ovarian cyst sometimes develops during the latter part of the menstrual cycle, when an egg follicle fills up with fluid. Factors that may increase your risk for developing a functional ovarian cyst include:

• A history of a previous functional ovarian cyst.
• Current use of clomiphene citrate, such as Clomid or Serophene, to start ovulation. For more information, see the topic Fertility Problems.
• Use of low dose progestin-only contraception (such as some implants, pills, and IUDs).

Tubal sterilization ("having your tubes tied") may increase the risk of functional ovarian cysts.² Further research is necessary to confirm this link.

When To Call a Doctor

Call your doctor immediately if you have:

• Sudden, severe pelvic pain with nausea or vomiting.
• Severe vaginal bleeding.
• Sudden faintness or weakness.
• Sudden dizziness with abdominal discomfort that persists for 2 hours or longer.

Call your doctor for an appointment if:

• Pain interferes with your daily activities.
• Your periods have changed from relatively pain-free to painful during the past 3 to 6 months.
• Your periods have changed from regular to infrequent during the past 3 to 6 months and you are not nearing menopause.
• You have pain during sexual intercourse.

For more information about other symptoms that concern you, see the following topics:

• Abdominal Pain, Age 12 and Older
• Abnormal Vaginal Bleeding
• Missed or Irregular Periods

Watchful Waiting

Most functional ovarian cysts are harmless, do not cause symptoms, and go away without treatment. Watchful waiting is usually an appropriate option if you are diagnosed with a functional ovarian cyst.

Who To See

Ovarian cysts can be diagnosed and treated by any of the following health professionals:

• Family medicine physician
• Internist
• Gynecologist
• Nurse practitioner
• Physician assistant

You may need to see a gynecologist for further testing or treatment.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

If you see your doctor for pelvic pain or bleeding, you'll be checked for a number of conditions, including an ovarian cyst, that may be causing your symptoms. Your evaluation will include a pelvic exam, a history of your symptoms and menstrual periods, a family history, and a transvaginal ultrasound (which uses a narrow wand placed in the vagina). See a picture of ovarian cysts .

If your doctor discovers an ovarian cyst during a routine pelvic exam, a transvaginal or abdominal ultrasound can help show what kind of cyst it is.

When is further testing necessary?

If an ultrasound shows that you have a fluid-filled functional ovarian cyst, and it isn't causing you severe pain, your doctor will probably suggest a watchful waiting period. You can then have the cyst checked 6 to 8 weeks later to see whether it is changing in size. Most cysts go away without treatment in 1 to 2 months or after 1 to 2 menstrual periods.³

Your doctor will recommend further testing or treatment if:

• Initial ultrasound doesn't clearly show what kind of cyst or growth is present, or both ovaries are affected.
• You are not ovulating during your initial examination (because you are either a postmenopausal woman or a girl not yet menstruating). Without ovulation, a new functional cyst would be highly unlikely, so other possible conditions are explored.
• You have moderate to severe pain or vaginal bleeding.
• A diagnosed functional ovarian cyst does not get smaller or go away in 2 to 3 months.
• An ovarian growth or cyst (mass) is larger than 3 in. (7.6 cm).
• You have risk factors for ovarian cancer. The higher your risk of ovarian cancer, the more likely aggressive testing will be recommended to find out the cause of an ovarian mass.

Further testing

• Laparoscopy allows a surgeon to look at the ovary through a lighted viewing instrument and take a sample of the growth (biopsy). After testing the sample, the surgeon can decide whether to surgically remove the cyst (cystectomy) or the entire ovary (oophorectomy). If there is concern about ovarian cancer, a laparotomy (instead of a laparoscopy) may be done. Then, if cancer is found, the surgeon can safely remove the ovaries.
• CA-125 (cancer antigen) test is only recommended for women with a very high risk for ovarian cancer. These are women with a significant family history of the disease. This blood test result is combined with ultrasound results, because it doesn't give a highly dependable diagnosis on its own.

Treatment Overview

Most functional ovarian cysts are harmless, do not cause symptoms, and go away without treatment. When treatment is needed, treatment goals include:

• Relieving symptoms of pelvic pain or pressure.
• Preventing more cysts from developing by preventing ovulation (if recurrence is a problem). Treatment with birth control pills prevents ovulation.

Initial treatment

Because functional ovarian cysts typically go away without treatment within 1 to 2 menstrual cycles, your doctor may recommend a period of observation without treatment (watchful waiting) to see whether your ovarian cyst gets better or goes away on its own. Your doctor will do another pelvic exam in 1 to 2 months to see whether the cyst has changed in size.

If an ovarian cyst doesn't improve in 1 to 2 menstrual cycles, your doctor may want to do more tests to be sure that your symptoms are not caused by another type of ovarian growth. Home treatment with heat and pain-relieving medicine can often provide relief of bothersome symptoms during this time.

Ongoing treatment

A functional ovarian cyst that persists through 2 to 3 menstrual cycles, has an unusual appearance on ultrasound, or causes symptoms may require treatment with either medicines or surgery.

• Your doctor may suggest that you try birth control pills for several months to stop more cysts from forming.
• Surgical removal of the cyst (cystectomy) through a small incision (laparoscopy) may be needed if a painful functional ovarian cyst does not go away despite medical treatment. If a cyst has an unusual appearance on ultrasound or if you have other risk factors for ovarian cancer, your doctor may recommend surgical removal through a larger abdominal incision (laparotomy) instead of by using laparoscopy.

What To Think About

Cysts after menopause. After menopause, ovarian cancer risk increases. This is why all postmenopausal ovarian growths are carefully checked for signs of cancer. Some doctors will recommend removing the ovaries (oophorectomy) when any kind of cyst develops on an ovary after menopause. But the trend in medicine seems to be moving away from surgery for small and simple cysts in postmenopausal women. In the five years after menopause, some women will still have functional ovarian cysts now and then. Some postmenopausal ovarian cysts, called unilocular cysts, which have thin walls and one compartment, are rarely linked to cancer.¹

Prevention

Functional ovarian cysts cannot be prevented if you are ovulating. Anything that makes ovulation less frequent reduces your chance of developing an ovarian cyst. Birth control pills, pregnancy, and breast-feeding in the first 6 months following birth prevent ovulation. Ovulation ceases when menopause is complete.

Women who use high-dose birth control pills have a modestly decreased risk of developing functional ovarian cysts. And low-dose birth control pills seem to have a less preventive effect.²

Home Treatment

Home treatment can help relieve the discomfort of functional ovarian cysts.

• Use heat, such as a hot water bottle, heating pad, or warm bath, to relax tense muscles and relieve cramping. Be careful not to burn yourself.
• Use pain relievers you can get over-the-counter. Acetaminophen (such as Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) (such as Advil or Aleve), and aspirin (such as Bayer) are all pain medicines you can buy without a prescription.
• Herbal teas, such as chamomile, mint, raspberry, and blackberry, may help soothe tense muscles and anxious moods.
• Empty your bladder as soon as you have the urge to urinate.
• Avoid constipation. Constipation does not cause or treat ovarian cysts but may further increase your pelvic discomfort. For more information, see the topic Constipation, Age 12 and Older.

Medications

Treatment with medicine may be useful if you have recurrent, painful functional ovarian cysts.

• Birth control pills (oral contraceptives) are used to prevent ovulation. Without ovulation, the chance that ovarian cysts will form is reduced and your symptoms may be relieved.
• Although birth control pills do not make ovarian cysts go away any faster, their use may prevent new cysts from forming.

Medication Choices

Birth control pills (oral contraceptives) to stop ovulation by controlling hormone levels in the body

What To Think About

Birth control pills have not been shown to get rid of or shrink ovarian cysts that have already formed. Some studies show that the cysts shrink at the same rate with or without birth control pill use.⁴

Surgery

Surgery may be needed to confirm the diagnosis of an ovarian cyst or to evaluate ovarian growths when ovarian cancer is possible. Surgery does not prevent ovarian cysts from coming back unless the ovaries are removed (oophorectomy).

Surgery may be needed in the following situations:

• An ovary and cyst have twisted (torsion) or ruptured.
• You have severe pain or bleeding.
• A cyst is larger than 3 in. (7.6 cm) or is pressing on other abdominal organs.
• A cyst has not gone away after 2 to 3 months of observation without treatment (watchful waiting), especially if you have had 1 or 2 menstrual periods during this time.
• Ovarian cancer is suspected based on your risk factors for ovarian cancer or an unusual appearance of the cyst on ultrasound.

Goals of surgical treatment for an ovarian cyst are to:

• Confirm a diagnosis of an ovarian cyst.
• Rule out the diagnosis of ovarian cancer.
• Remove cysts that are causing pain.
• Relieve the pressure that cysts larger than 3 in. (7.6 cm) may cause on the bladder and other pelvic organs.

Surgery Choices

Surgery for an ovarian cyst or growth can be done through a small incision using laparoscopy or through a larger incision (laparotomy). The cut is made in your stomach area.

Laparoscopy may be used to confirm the diagnosis of an ovarian cyst in a woman of childbearing age. Persistent, large, or painful ovarian cysts that have no signs of cancer risk can be removed during laparoscopy, leaving the ovary intact.

Laparotomy is used when an ovarian cyst is very large, ovarian cancer is suspected, or other problems with the abdominal or pelvic organs are present. If cancer is found, the larger incision lets the surgeon closely examine the entire area and more safely remove all cancerous growth.

What To Think About

For the most part, functional ovarian cysts stop forming when menopause occurs (in rare cases, a functional ovarian cyst will occur or persist within 5 years of menopause). Relieving symptoms with medicine until menopause is complete may be an option.

Some women prefer the risks of surgery to symptoms that reduce their quality of life. If your doctor recommends surgery, ask whether laparoscopic surgery or laparotomy would be the best choice for you.

Unless the ovaries are removed, surgery does not prevent the formation of new functional ovarian cysts.

Other Treatment

No other treatment for functional ovarian cysts is available at this time.

Other Places To Get Help

Organizations

References

Citations

1. Modesitt SC, et al. (2003). Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstetrics and Gynecology, 102(3): 594-599.

2. Holt VL, et al. (2003). Oral contraceptives, tubal sterilization, and functional ovarian cyst risk. Obstetrics and Gynecology, 102(2): 252-258.

3. Katz VL (2007). Benign gynecologic lesions. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 452-557. Philadelphia: Mosby Elsevier.

4. Grimes DA, et al. (2006). Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

Other Works Consulted

• Tzadik M, et al. (2007). Functional cysts section of Benign disorders of the ovaries and oviducts. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 654-661. New York: McGraw-Hill.

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