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.
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.
History and exam
Other diagnostic factors
- pelvic pain
- bloating and early satiety
- palpable adnexal mass
- premenopausal age group
- early menarche
- first trimester of pregnancy
- personal history of infertility or polycystic ovary syndrome
- increased intrinsic or extrinsic gonadotropins
- tamoxifen therapy
- personal or family history of endometriosis
1st investigations to order
- transvaginal ultrasonography
Investigations 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
- PET imaging of abdomen/pelvis
- serum biomarkers (ovarian adnexal mass assessment score test system)
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
- 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
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