Bimpe had right lower abdominal pain for 3 months — and everyone kept suggesting it was period pain. But the pain was mid-cycle, not during her period. A pelvic scan at Mascot Healthcare found a 4.5 cm right ovarian cyst. Managed conservatively — it resolved on its own within 12 weeks.
Software developer, Lekki. Presented with 3-month history of intermittent right-sided lower abdominal pain — occasionally sharp, worst at mid-cycle, associated with bloating and a sense of fullness. Appendix removed age 18. Periods regular. Pregnancy test negative. Referred for pelvic ultrasound.
Pelvic Ultrasound ScanBimpe knew her periods. She was organised, tracked her cycles precisely, and had done so for years. The right-sided pain was different — it came at mid-cycle, not during her period, and had been present for three months. When she mentioned it to a pharmacist, she was given mefenamic acid (period pain tablets). When she mentioned it to a colleague, she was told "women always have that kind of pain." She was frustrated — she knew this was not period pain.
She came to Mascot Healthcare and specifically asked for a pelvic scan. "I know what my period pain feels like," she told the doctor. "This isn't it. It's mid-cycle, it's on the right, and it's been there for three months." The doctor agreed that a pelvic ultrasound was the appropriate investigation and arranged it immediately.
The scan began. The uterus appeared — normal. The left ovary — normal. The right ovary: the sonographer paused and measured. A thin-walled, anechoic, rounded structure — 4.5 × 4.2 cm. A cyst. "There it is," the doctor said, turning the screen toward Bimpe. "Right ovarian cyst. This is what's been causing your pain."
Right lower abdominal pain in a woman has a broad differential: gynaecological (ovarian cyst, endometriosis, ectopic pregnancy), appendicular, or gastrointestinal. In a woman with regular cycles and a negative pregnancy test, a pelvic ultrasound is the first essential investigation — and will identify most gynaecological causes immediately.
Intermittent, sometimes sharp right lower quadrant pain — 3 months' duration, no clear trigger, worsening at mid-cycle.
Pain most severe around Day 14 of the cycle — suggesting ovarian origin (Mittelschmerz from a persistent or enlarging follicle/cyst).
A feeling of right-sided pelvic fullness — consistent with a cystic mass in the right adnexa.
Appendix removed at 18 — removing the most common cause of right lower pain, but not excluding pelvic pathology.
Excludes ectopic pregnancy as the cause of right lower pain — but not ovarian or other pelvic pathology.
Bimpe had googled her symptoms at length. She had gone down the endometriosis path, the ovarian cancer path, and the appendix-related adhesions path. By the time she attended Mascot Healthcare, she had convinced herself it was probably endometriosis — or possibly something worse.
The Mascot Healthcare doctor explained: a simple ovarian cyst (thin-walled, fluid-filled, no internal septations or solid components) is the most common gynaecological finding in a woman her age and is almost always benign. Ovarian cancer in a 26-year-old is extremely rare — and has specific sonographic features (solid components, thick septations, papillary projections) that were entirely absent here.
Right ovary: 4.5 × 4.2 cm simple cyst — unilocular, thin smooth walls, entirely anechoic (no internal echoes, no septations, no solid components). No papillary projections. Doppler: no internal vascularity. Left ovary: normal, 3.2 × 2.1 cm. Uterus: normal size and echo-texture. Endometrium: 9 mm (mid-secretory phase, appropriate). No free fluid.
IOTA classification: simple cyst — almost certainly benign. Size 4.5 cm: below the 5 cm threshold typically considered for surgical intervention in a premenopausal woman. Management: conservative surveillance — repeat scan in 6–8 weeks.
Bimpe was counselled: functional ovarian cysts (which arise from follicles that failed to rupture) are extremely common, typically asymptomatic or cause mid-cycle pain, and resolve spontaneously within 1–3 menstrual cycles in 70–80% of cases. No hormonal treatment was indicated. She was advised to return immediately if she developed sudden severe pain (which would suggest rupture or torsion).
Right ovarian simple cyst — 4.5 cm, unilocular, IOTA benign. Left ovary normal. Uterus normal. No features of torsion, rupture, or malignancy.
Conservative management; repeat pelvic scan in 6–8 weeks; return immediately if sudden severe pain; no surgery at this size in premenopausal woman with simple cyst.
Repeat scan at 8 weeks: cyst reduced to 2.1 cm. Scan at 16 weeks (12 weeks post-initial): cyst no longer identifiable — fully resolved. Pain had resolved by week 6.
Cyst fully resolved without surgery at 12 weeks. Bimpe's pain disappeared by week 6. She now knows what an ovarian cyst feels like — and will come in earlier next time.
Mid-cycle right lower abdominal pain in a woman with regular periods is ovarian, not menstrual. Period pain medications don't treat ovarian cysts. A pelvic scan identifies the cyst and allows a management plan — most small simple cysts resolve without surgery.
Women know their own bodies. When a patient says "this doesn't feel like my period pain" — that clinical observation deserves investigation, not reassurance without evidence.
Right lower pain at mid-cycle is often an ovarian cyst — not period pain. A 15-minute pelvic scan confirms it, and most simple cysts resolve without surgery.
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