🫧 Men's Health
Ovarian Cysts — When to Worry
Understanding ovarian cysts — most are harmless, but some need treatment
An ovarian cyst is a fluid-filled sac that develops on or within an ovary. The vast majority of ovarian cysts are benign (non-cancerous) and are related to the normal menstrual cycle — these functional cysts resolve spontaneously within 1–3 menstrual cycles. In Nigeria, ovarian cysts are commonly detected incidentally on pelvic ultrasound done for other reasons, causing significant anxiety. Understanding which cysts are truly concerning and which can safely be observed requires clinical and ultrasound assessment. Ovarian cancer does exist — but it is far less common than benign cysts — and specific features help distinguish them.
Signs and Symptoms
✓ Most ovarian cysts cause NO symptoms and are detected incidentally on ultrasound
✓ Lower abdominal or pelvic pain or discomfort — often dull, on one side
✓ Bloating or sense of pelvic fullness
✓ Irregular or painful periods
✓ Pain during intercourse
✓ Urinary frequency or difficulty emptying bladder (if large cyst pressing on bladder)
✓ Ovarian cyst accident — sudden severe pain: torsion (twisted ovary) or rupture
When to Seek Help
EMERGENCY — sudden severe pelvic pain + nausea/vomitingOvarian torsion (twisting) — the ovary's blood supply is cut off. Requires emergency surgery within hours to save the ovary. DO NOT wait
Severe pain with collapseRuptured ovarian cyst (especially corpus luteum) — haemorrhage into abdomen. Emergency
Cyst > 5cm on ultrasoundNeeds gynaecological assessment — most still benign but warrants formal evaluation and CA-125 blood test
Post-menopausal woman with any ovarian cystRisk of malignancy is higher after menopause — any cyst needs specialist assessment
Cyst with complex features on ultrasound (solid areas, septations, blood flow)More concerning features — specialist evaluation urgently
Tests & Diagnosis
🧪 Transvaginal pelvic ultrasound
The primary investigation — assesses cyst size, characteristics (simple vs. complex), content (clear fluid, blood, mixed), septa, solid components, and blood flow. Simple thin-walled unilocular cyst = almost certainly benign
🧪 CA-125 blood test
Tumour marker — elevated in ovarian cancer but also in endometriosis, fibroids, PID, and many other conditions. Not reliable for cancer screening in premenopausal women. More useful in post-menopausal women and for monitoring known ovarian cancer
🧪 HE4 and ROMA score
Better cancer biomarker than CA-125 alone — available at some centres in Nigeria. Helps stratify risk of malignancy
🧪 Beta-hCG (pregnancy test)
Ectopic pregnancy can look like an ovarian cyst — exclude in all women of reproductive age with pelvic pain
🧪 MRI pelvis
When ultrasound is inconclusive — better characterises complex cysts and helps plan surgery
🧪 Laparoscopy
Surgical evaluation and treatment — for cysts that do not resolve or are suspicious on imaging
Frequently Asked Questions
My ultrasound showed an 'ovarian cyst' — do I have ovarian cancer?
Very unlikely. The vast majority of ovarian cysts — especially in premenopausal women — are benign. A simple, thin-walled cyst containing only clear fluid is almost always benign. The risk of malignancy is higher if the cyst is complex (solid areas, multiple compartments), you are post-menopausal, or if CA-125 is significantly elevated. Discuss the specific features of your cyst with your doctor.
Will an ovarian cyst affect my fertility?
Most functional cysts do not affect fertility. Endometriomas (chocolate cysts) do affect fertility and ovarian reserve — they require specific management if you are trying to conceive. Large dermoids or cystadenomas may need surgery before fertility treatment. A specialist fertility and gynaecology assessment is needed if you have an ovarian cyst and are trying to conceive.
Should I have my ovarian cyst removed immediately?
For most simple cysts in premenopausal women, observation is appropriate — many resolve without surgery. Immediate surgery is indicated for ovarian torsion (emergency), large symptomatic cysts, or concerning features suggesting malignancy. Unnecessary surgery on benign cysts carries risks (anaesthetic, infection, reduced ovarian reserve). Wait-and-watch is appropriate for most simple cysts.
Does PCOS mean I have ovarian cysts?
Not exactly. PCOS (polycystic ovary syndrome) involves multiple small follicles visible on ultrasound — these are not true 'cysts' but small undeveloped follicles (< 9mm) that line the ovary in a 'string of pearls' appearance. Despite the name, PCOS is primarily a hormonal disorder (excess androgens, insulin resistance) rather than a cyst disease. Individual follicles in PCOS are small and do not need surgical treatment.