Noncancerous (benign) ovarian growths include functional cysts and tumors.

• Most noncancerous cysts and tumors do not cause any symptoms, but some cause pain or a feeling of heaviness in the pelvis.
• Doctors may detect growths during a pelvic examination, then use ultrasonography to confirm the diagnosis.
• Some cysts disappear on their own.
• Cysts or tumors may be removed through an incision in the abdomen, and sometimes the affected ovary must also be removed.

Functional Cysts: Functional cysts form from the fluid-filled cavities (follicles) in the ovaries. Each follicle contains one egg. Usually, during each menstrual cycle, one follicle releases one egg. About one third of women who are menstruating have cysts. Functional cysts seldom develop after menopause.

There are two types of functional cysts:

• Follicular cysts: These cysts form as the egg is developing in the follicle.
• Corpus luteum cysts: These cysts develop from the structure that forms after the follicle ruptures and releases its egg. This structure is called the corpus luteum. Corpus luteum cysts may bleed, causing the ovary to bulge or to rupture. If the cyst ruptures, fluids escape into spaces in the abdomen (the abdominal cavity) and may cause severe pain.

Most functional cysts are less than about 2/3 inch (1.5 centimeters) in diameter. A few reach or exceed about 2 inches (5 centimeters). Functional cysts usually disappear on their own after a few days or weeks.

Benign Tumors: Noncancerous (benign) ovarian tumors usually grow slowly and rarely become cancerous. The most common include the following:

• Benign cystic teratomas (dermoid cysts): These tumors usually develop from all three layers of tissue in the embryo (called germ cell layers). All organs form from these tissues. Thus, teratomas may contain tissues from other structures, such as nerve, glandular, and skin tissues.
• Fibromas: These tumors are solid masses composed of connective tissue (the tissues that hold structures together). Fibromas are slow-growing and are usually less than 3 inches (about 7 centimeters) in diameter. They usually occur on only one side.
• Cystadenomas: These fluid-filled cysts develop from the surface of the ovary and contain some tissue from glands in the ovaries.

Symptoms

Most functional cysts and noncancerous tumors do not cause any symptoms. Sometimes women have irregular periods and spotting. If corpus luteum cysts bleed, they may cause pain or tenderness in the pelvic area. If women have a fever, feel nauseated, and vomit, the spaces in the abdomen (abdominal cavity) and the tissues lining it may be infected (a disorder called peritonitis). Occasionally, sudden, severe abdominal pain occurs because a large cyst or mass causes the ovary to twist (a disorder called adnexal torsion).

Accumulation of fluid in the abdomen (ascites) can occur with fibromas and ovarian cancer. Ascites may cause a feeling of pressure or heaviness in the abdomen.

Diagnosis

Doctors usually detect cysts or tumors during a routine pelvic examination. But sometimes doctors suspect them based on symptoms.

A pregnancy test is done to rule out pregnancy, including pregnancy located outside the uterus (ectopic pregnancy). Ultrasonography using an ultrasound device inserted into the vagina (transvaginal ultrasonography) is done to confirm the diagnosis. If the diagnosis is still unclear, magnetic resonance imaging (MRI) or computed tomography (CT) may be done. If these tests suggest that the growth could be cancerous, doctors remove it and examine it under a microscope. They may also do blood tests to check for substances called markers, which may appear in the blood or may increase when some cancers are present.

Treatment

If ovarian cysts are less than 3 inches (about 7 centimeters) in diameter, they usually disappear without treatment. Ultrasonography is done periodically to check.

If a cyst or tumor needs to be removed, laparoscopy or laparotomy is done if possible. Laparoscopy requires two or three small incisions in the abdomen. It is done in a hospital and usually requires a general anesthetic. However, women do not have to stay overnight. Laparotomy is similar but requires a larger incision and an overnight stay in the hospital. Which procedure is used depends on how large the growth is and whether other organs are affected. Cystectomy (removal of the cyst) can usually be done for the following conditions:

• Most cysts that are larger than 3 inches and that persist for more than three menstrual cycles
• Cystic teratomas that are smaller than 4 inches (about 10 centimeters)
• Corpus luteum cysts if peritonitis develops

Removal of the affected ovary (oophorectomy) is necessary for the following:

• Fibromas and solid ovarian tumors
• Cystadenomas
• Cystic teratomas that are larger than 4 inches
• Cysts that cannot be surgically separated from the ovary
• Most cysts that are detected in postmenopausal women and are > 2 inches

Last full review/revision December 2008 by S. Gene McNeeley, MD