Summary
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].
History and exam
Other diagnostic factors
- pelvic pain
- bloating and early satiety
- palpable adnexal mass
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
Diagnostic tests
1st tests to order
- transvaginal ultrasonography
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
Emerging tests
- PET imaging of abdomen/pelvis
- serum biomarkers (ovarian adnexal mass assessment score test system)
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
Assistant Professor
Department of Obstetrics and Gynecology
Northeast Ohio Medical University
Rootstown
OH
Director of Gynecologic Oncology
Aultman Health Foundation
Canton
OH
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
MN
Disclosures
JB declares that he has no competing interests.
David Chelmow, MD
Chair
Department of Obstetrics and Gynecology
Virginia Commonwealth University
Richmond
VA
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
UK
Disclosures
TJC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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 DifferentialsGuidelines
- ACR appropriateness criteria® clinically suspected adnexal mass, no acute symptoms
- Initial investigation and management of benign ovarian masses
More GuidelinesPatient information
Ovarian cyst
Ovarian cancer
More Patient information
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