When 22‑year‑old Ria walked into her gynaecologist’s clinic clutching her ultrasound report, she looked terrified. The scan had shown a “3.5 cm ovarian cyst”, and she had already imagined the worst. Cancer. Infertility. Surgery. Her doctor smiled gently and said, “Take a breath. This is one of the most common findings in young women — and most cysts disappear on their own.” Within three months, Ananya’s cyst had quietly melted away, just as expected.
Stories like hers are far more common than the panic that surrounds the word cyst. For women who have not yet reached menopause, ovarian cysts are usually harmless, often temporary, and rarely a sign of cancer. Understanding them can replace fear with confidence — and help you make informed decisions about your health.
What exactly is an ovarian cyst?
An ovary is a small, powerful organ that releases an egg each month and produces essential hormones. Every cycle, a tiny fluid‑filled sac called a follicle grows to about 2–3 cm before releasing the egg. Sometimes, this sac doesn’t shrink back. It keeps growing — and becomes what we call a simple ovarian cyst.
A cyst is simply a larger fluid‑filled sac, usually more than 3 cm. Some are thin‑walled and filled with clear fluid, while others may contain blood, thick fluid, or even solid areas. Most are benign.
Common types include:
• Simple cyst — the most frequent type; usually disappears naturally.
• Endometrioma — caused by endometriosis, often linked with pelvic pain.
• Dermoid cyst — formed from egg‑producing cells; may contain hair or fat.
Cancerous cysts in premenopausal women are rare.
How common are they?
Very common. Most women will have an ovarian cyst at some point without ever knowing it. They often cause no symptoms and vanish on their own. About one in ten women may need surgery for a cyst at some stage in life — usually because it is large, persistent, or causing discomfort.
Symptoms: When does a cyst make its presence felt?
Many cysts are silent passengers, discovered only during routine scans. But some may cause:
• Pelvic pain or lower abdominal discomfort
• Painful periods or changes in menstrual patterns
• Pain during sex
• Bowel‑related discomfort
• Frequent urination
• Feeling full quickly
• Abdominal bloating
• Difficulty conceiving (often linked to endometriosis)
These symptoms don’t automatically mean a cyst is dangerous — but they do deserve a conversation with your doctor.
What happens at the doctor’s office?
Your doctor will ask about your health, periods, pain patterns, sexual health, and family history of ovarian or breast cancer. A physical examination — including a vaginal exam — is common.
The key test is an ultrasound scan, usually both abdominal and vaginal. This helps determine:
• Whether the cyst is truly in the ovary
• Its size
• Its appearance (simple or complex)
• Whether the other ovary looks normal
If the cyst looks complex, you may be offered blood tests to understand its nature. Simple cysts do not require blood tests.
After the scan: What next?
If the scan is reassuring and you have no symptoms, you may not need any treatment. Many cysts simply fade away.
If the cyst is large, complex, or causing symptoms, or in the rare situation where cancer is suspected, you will be guided to a specialist gynaecologist for further evaluation or surgery
Treatment options
Your choices depend on symptoms, size, appearance, and test results. Doctors often recommend:
Watchful waiting
This is the most common approach for simple cysts.
• Less than 5 cm: No treatment needed; usually disappears naturally.
• 5–7 cm: A follow‑up scan after a year.
• More than 7 cm: MRI or surgery may be advised.
Surgery
If needed, surgery is usually laparoscopic (keyhole) — meaning smaller cuts, less pain, and quicker recovery. Open surgery is reserved for very large cysts or rare cases where cancer is suspected.
Will my ovary be removed?
In most cases, no. Doctors aim to remove only the cyst, preserving the ovary because it produces vital hormones before menopause.
An ovary may need removal only if:
• The cyst is extremely large
• The cyst has replaced the entire ovary
• The ovary has twisted (cutting off blood supply)
• Cancer is suspected
Your doctor will discuss the pros and cons before any surgery.
What if you are pregnant?
Simple cysts are commonly seen during pregnancy and usually disappear as the pregnancy progresses. Large or complex cysts may need monitoring. Surgery during pregnancy is rare and recommended only if the cyst causes significant pain or raises concern for cancer.
What you need to remember:
• The combined oral contraceptive pill does not shrink existing cysts, but it may prevent new ones from forming.
• Draining a cyst (aspiration) is not very helpful because it usually fills up again.
• Most cysts in young and premenopausal women are benign and temporary.
• An ultrasound is your best reassurance.
Ovarian cysts often trigger fear, especially in young women who worry about fertility or cancer. But the truth is far more reassuring: most cysts are harmless, manageable, and part of the natural rhythm of the ovaries.
Understanding them helps you stay calm, make informed choices, and avoid unnecessary interventions. Like Ria, many women discover that what seemed frightening at first is simply a normal, temporary blip in their reproductive journey.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
