Ovarian cysts

Last updated: November 8, 2022

Summarytoggle arrow icon

Ovarian cysts are fluid-filled sacs within the ovary. The most common types are functional follicular cysts, corpus luteum cysts, and theca lutein cysts, which all develop as part of the menstrual cycle and are usually harmless and resolve on their own. Nonfunctional cysts include chocolate cysts (which are associated with endometriosis), dermoid cysts, cystadenomas, and malignant cysts (a type of ovarian cancer). Ovarian cysts are usually asymptomatic, but they can sometimes cause lower abdominal pain and predispose individuals to complications such as cyst rupture or ovarian torsion, which may require surgery. Diagnosis is usually made with pelvic ultrasound. Management and follow-up depend on cyst size and appearance on ultrasound, the patient's menopausal status, and the presence of risk factors for ovarian tumors.

Overviewtoggle arrow icon


Ovarian cysts are fluid-filled sacs within the ovary.


Functional ovarian cysts

Functional cysts result from a disruption in the development of follicles or the corpus luteum and often resolve on their own.

Nonfunctional ovarian cysts

A group of ovarian cysts that do not produce hormones.

Clinical featurestoggle arrow icon

Ovarian cancer must be ruled out in premenarchal and postmenopausal patients with a palpable ovarian mass.

Diagnosticstoggle arrow icon


Exclude pregnancy in all patients of childbearing age with pelvic pain or a pelvic mass. [5]

Laboratory studies [5]


Pelvic ultrasound with doppler

Transvaginal or transabdominal pelvic ultrasound with doppler is the first-line imaging modality for symptomatic and asymptomatic patients with a suspected adnexal mass.

Additional imaging [5]

  • MRI pelvis with IV contrast
  • CT abdomen and pelvis with IV contrast
    • Alternative to MRI for potentially malignant cysts
    • Consider in patients with acute pelvic pain to rule out nongynecologic etiologies.

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Managementtoggle arrow icon

Management and follow-up are usually determined by cyst appearance and size as well as menopausal status. [5][6]

In most patients with functional cysts, watchful waiting is recommended, as cysts often regress spontaneously.

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Ruptured ovarian cysttoggle arrow icon

Etiology [11]

  • Rupture is caused by an increase in intracystic pressure.
  • Most common type of ruptured cyst: corpus luteum cyst [12]
  • Risk factors
    • Vigorous physical activity
    • Vaginal intercourse
    • Large cysts
    • Reproductive age

Clinical features

Diagnostics [10]

Laboratory studies


Free fluid in the pouch of Douglas in a pregnant patient should raise concern for ruptured ectopic pregnancy.

Treatment [10][14][15]

Differential diagnoses

Acute management checklist for ruptured ovarian cyst

Referencestoggle arrow icon

  1. Shiner A, Burbos N. Ovarian Cysts and Ovarian Cancer. InnovAiT. 2012; 5 (9): p.547-557.doi: 10.1093/innovait/ins130 . | Open in Read by QxMD
  2. Hertzberg BS et al.. Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis. Abdom Imaging. 1999; 24 (3): p.304-308.doi: 10.1007/s002619900502 . | Open in Read by QxMD
  3. Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. 2009; 23 (5): p.711-724.doi: 10.1016/j.bpobgyn.2009.02.001 . | Open in Read by QxMD
  4. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  5. Bhosale PR et al.. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group. Ultrasound Q. 2016; 32 (2): p.108-115.doi: 10.1097/ruq.0000000000000200 . | Open in Read by QxMD
  6. Roche O, Chavan N, Aquilina J, Rockall A. Radiological appearances of gynaecological emergencies. Insights Imaging. 2012; 3 (3): p.265-75.doi: 10.1007/s13244-012-0157-0 . | Open in Read by QxMD
  7. Lee JK, Bodur S, Guido R. The management of gynecological hemoperitoneum found to be associated with a ruptured corpus luteum cyst. Gynecol Surg. 2016; 13 (4): p.305-311.doi: 10.1007/s10397-016-0951-7 . | Open in Read by QxMD
  8. Kim JH, Lee SM, Lee J-H, et al. Successful Conservative Management of Ruptured Ovarian Cysts with Hemoperitoneum in Healthy Women. PLoS ONE. 2014; 9 (3): p.e91171.doi: 10.1371/journal.pone.0091171 . | Open in Read by QxMD
  9. Mohamed M, Al-Ramahi G, McCann M. Postcoital hemoperitoneum caused by ruptured corpus luteal cyst: a hidden etiology. J Surg Case Rep. 2015; 2015 (10): p.rjv120.doi: 10.1093/jscr/rjv120 . | Open in Read by QxMD
  10. Patel MD, Ascher SM, Horrow MM, et al. Management of Incidental Adnexal Findings on CT and MRI: A White Paper of the ACR Incidental Findings Committee.. J Am Coll Radiol. 2020; 17 (2): p.248-254.doi: 10.1016/j.jacr.2019.10.008 . | Open in Read by QxMD
  11. Atri M, Alabousi A, Reinhold C, et al. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms. J Am Coll Radiol. 2019; 16 (5): p.S77-S93.doi: 10.1016/j.jacr.2019.02.011 . | Open in Read by QxMD
  12. Andreotti RF, Timmerman D, Strachowski LM, et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020; 294 (1): p.168-185.doi: 10.1148/radiol.2019191150 . | Open in Read by QxMD
  13. Levine D, Patel MD, Suh-Burgmann EJ, et al. Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting. Radiology. 2019; 293 (2): p.359-371.doi: 10.1148/radiol.2019191354 . | Open in Read by QxMD
  14. Bonde AA, Korngold EK, Foster BR, et al. Radiological appearances of corpus luteum cysts and their imaging mimics. Abdom Radiol. 2016; 41 (11): p.2270-2282.doi: 10.1007/s00261-016-0780-1 . | Open in Read by QxMD
  15. Jung SI. Ultrasonography of ovarian masses using a pattern recognition approach. Ultrasonography. 2015; 34 (3): p.173-182.doi: 10.14366/usg.15003 . | Open in Read by QxMD
  16. Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev. 2014.doi: 10.1002/14651858.cd006134.pub5 . | Open in Read by QxMD

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