Ovarian cysts

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 3 Apr 2025

Last updated: 05 Mar 2025

An ovarian cyst is a fluid-filled sac in the ovarian tissue. The cyst may be unilocular or multilocular. The causes may be physiologic, 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 postmenopausal 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.

Guidelines by the American College of Obstetricians provide validated criteria for referral to gynecologic oncology.

Definition

Ovarian cyst is a surgical, imaging, or exam finding of an enlarged, fluid-filled ovary or portion of ovarian tissue. Ovarian cysts imply a pathophysiologic process involving the ovary itself.[Figure caption and citation for the preceding image starts]: Laparoscopic view of ovarian cyst in vivoFrom the collection of Professor Michael Hopkins [Citation ends]. com.bmj.content.model.Caption@3873915d

History and exam

Other diagnostic factors

pelvic pain
bloating and early satiety
palpable adnexal mass

Full details

Risk factors

premenopausal age group
early menarche
first trimester of pregnancy
personal history of infertility or polycystic ovary syndrome
increased intrinsic or extrinsic gonadotropins
tamoxifen therapy
smoking
personal or family history of endometriosis

Full details

Diagnostic tests

1st tests to order

transvaginal ultrasonography

Full details

Tests to consider

serum cancer antigen (CA)-125
color power Doppler ultrasonography of abdomen/pelvis
MRI of abdomen/pelvis
CT imaging of abdomen/pelvis
karyotype analysis
laparoscopy/laparotomy and histopathology

Full details

Emerging tests

PET imaging of abdomen/pelvis
serum biomarkers (ovarian adnexal mass assessment score test system)

Treatment algorithm

ACUTE

acutely ill

ONGOING

nonpregnant: premenopausal with simple ovarian cyst

nonpregnant: premenopausal with complex ovarian cyst

nonpregnant: premenopausal with solid ovarian cyst

postmenopausal with simple ovarian cyst

postmenopausal with complex ovarian cyst

postmenopausal with solid ovarian cyst

pregnant

Contributors

Authors

Sareena Singh, MD

Assistant Professor

Department of Obstetrics and Gynecology

Northeast Ohio Medical University

Rootstown

Director of Gynecologic Oncology

Aultman Health Foundation

Canton

Disclosures

SS declares that she has no competing interests

Acknowledgements

Dr Sareena Singh would like to gratefully acknowledge Dr Michael P. Hopkins, Dr Christina N. Kufel, Dr Lauren M. Blue, Dr Jay R. Patibandla, and Dr Laura K. Randolph, previous contributors to this topic.

Disclosures

MPH, CNK, LMB, JRP, and LKR declare that they have no competing interests.

Peer reviewers

John Bachman, MD

Consultant in Family Medicine

Parker D Sanders and Isabella Sanders Professor of Primary Care

Rochester

Disclosures

JB declares that he has no competing interests.

David Chelmow, MD

Chair

Department of Obstetrics and Gynecology

Virginia Commonwealth University

Richmond

Disclosures

DC declares that he has no competing interests.

T. Justin Clark, MD (Hons), MRCOG

Consultant Obstetrician and Gynaecologist

Birmingham Women's Hospital

Obstetrics and Gynaecology

Birmingham

Disclosures

TJC declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice bulletin no. 174: evaluation and management of adnexal masses. Obstet Gynecol. 2016 Nov;128(5):e210-6. Abstract

DePriest PD, Shenson D, Fried A, et al. A morphology index based on sonographic findings in ovarian cancer. Gynecol Oncol. 1993 Oct;51(1):7-11. Abstract

American College of Obstetricians and Gynecologists. Committee opinion no. 716: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer in women at average risk. Sep 2017 (reaffirmed 2024) [internet publication].Full text

US Preventive Services Task Force; Grossman DC, Curry SJ, Owens DK, et al. Screening for ovarian cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018 Feb 13;319(6):588-94. Abstract

Levine D, Patel MD, Suh-Burgmann EJ, et al. Simple adnexal cysts: SRU consensus conference update on follow-up and reporting. Radiology. 2019 Nov;293(2):359-71.Full text Abstract

Grimes DA, Jones LB, Lopez LM, et al. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev. 2014 Apr 29;(4):CD006134.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Ovarian cancer
- Ovarian torsion
- Polycystic ovary syndrome
More Differentials
Guidelines
- ACR appropriateness criteria® clinically suspected adnexal mass, no acute symptoms
- Initial investigation and management of benign ovarian masses
More Guidelines
Patient information
Ovarian cyst
Ovarian cancer
More Patient information
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Ovarian cysts

Summary

Definition

History and exam

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

acutely ill

nonpregnant: premenopausal with simple ovarian cyst

nonpregnant: premenopausal with complex ovarian cyst

nonpregnant: premenopausal with solid ovarian cyst

postmenopausal with simple ovarian cyst

postmenopausal with complex ovarian cyst

postmenopausal with solid ovarian cyst

pregnant

Contributors

Authors

Sareena Singh, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

John Bachman, MD

Disclosures

David Chelmow, MD

Disclosures

T. Justin Clark, MD (Hons), MRCOG

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice