An ovarian cyst is a fluid-filled sac in the ovarian tissue. The cyst may be unilocular or multilocular. The causes may be physiological, infectious, benign neoplastic, malignant neoplastic, or metastatic.
The most important step in management is assessing the risk of malignancy.
Oral contraceptives do not hasten or influence regression of benign ovarian cysts.
Asymptomatic post-menopausal women with simple unilocular ovarian cysts <10 cm in diameter and cancer antigen (CA)-125 <35 U/mL can be managed conservatively with serial ultrasonography.
Ultrasonography can provide a morphology index score that is useful in determining likelihood of malignancy.
Ovarian cyst is a surgical, imaging, or examination finding of an enlarged, fluid-filled ovary or portion of ovarian tissue. Ovarian cysts imply a pathophysiological process involving the ovary itself.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- pelvic pain
- bloating and early satiety
- palpable adnexal mass
- pre-menopausal age group
- early menarche
- first trimester of pregnancy
- personal history of infertility or polycystic ovary syndrome
- increased intrinsic or extrinsic gonadotrophins
- tamoxifen therapy
- personal or family history of endometriosis
1st investigations to order
- transvaginal ultrasonography
Investigations to consider
- serum cancer antigen (CA)-125
- colour power Doppler ultrasonography of abdomen/pelvis
- MRI of abdomen/pelvis
- CT imaging of abdomen/pelvis
- karyotype analysis
- laparoscopy/laparotomy and histopathology
- PET imaging of abdomen/pelvis
- serum biomarkers (ovarian adnexal mass assessment score test system)
non-pregnant: pre-menopausal with simple ovarian cyst
non-pregnant: pre-menopausal with complex ovarian cyst
non-pregnant: pre-menopausal with solid ovarian cyst
post-menopausal with simple ovarian cyst
post-menopausal with complex ovarian cyst
post-menopausal with solid ovarian cyst
- Ovarian cancer
- Ovarian torsion
- Polycystic ovary syndrome
- Initial investigation and management of benign ovarian masses
- Simple adnexal cysts: SRU consensus conference update on follow-up and reporting
Ovarian cancerMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer