Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO. Last updated: June 2026.
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
What are the main types of ovarian cysts, and which are most common?
Most ovarian cysts — particularly in women of reproductive age — are functional cysts that arise naturally from the monthly ovulation cycle, are harmless, and resolve spontaneously. Pathological cysts (endometriomas, dermoids, cystadenomas) are less common and are distinguished by their origin, ultrasound appearance, and clinical significance. Understanding the type matters because management, fertility impact, and urgency differ considerably between them.
Functional cysts (by far the most common type)
Functional cysts are not disease — they are a by-product of a normal menstrual cycle and are classified as pathological only when they cause symptoms or fail to resolve.
- Follicular cyst: Each cycle, one or more follicles (fluid-filled sacs each containing an egg) grow on the ovary. Normally, the dominant follicle ruptures at ovulation. If rupture does not occur, the follicle continues filling with fluid, forming a follicular cyst — typically thin-walled, unilocular, and under 5 cm. The vast majority resolve on their own within 1–3 menstrual cycles without any intervention.
- Corpus luteum cyst: After an egg is released, the follicle becomes the corpus luteum (a temporary gland that produces progesterone). Sometimes the corpus luteum fills with fluid or blood rather than dissolving. These usually resolve within a few weeks; occasionally they enlarge, cause one-sided pelvic pain, or rupture.
Neither type is associated with cancer, neither requires intervention unless symptomatic or persistent, and neither has a lasting impact on fertility.
Endometrioma ("chocolate cyst")
An endometrioma is a cyst caused by endometriosis — a condition in which tissue similar to the uterine lining grows on the ovary. The cyst fills with old, dark blood that has a characteristic "chocolate" appearance on ultrasound, which is where the informal name comes from. Endometriomas do not resolve spontaneously. They are directly relevant to fertility because they can reduce ovarian reserve by damaging the adjacent ovarian cortex, and their presence requires specialist evaluation before IVF egg retrieval. Full discussion — including staging, surgical options, and fertility implications — is on the endometriosis page.
Dermoid cyst (mature cystic teratoma)
A dermoid is a benign ovarian tumour (strictly speaking not a cyst, though it presents as one) that develops from germ cells and can contain a surprising variety of tissues — hair, skin, fat, and occasionally teeth. Most are discovered incidentally on ultrasound and are asymptomatic. Dermoids do not resolve on their own. They typically require laparoscopic removal when they are large enough to carry a meaningful torsion risk and because imaging alone cannot always exclude a more concerning growth. Dermoids are not hormonally active and do not directly impair fertility, but surgical removal carries a small risk of reducing ovarian reserve.
Cystadenoma
Cystadenomas are benign tumours arising from ovarian surface tissue. They are filled with watery fluid (serous cystadenoma) or thick mucous fluid (mucinous cystadenoma) and can grow to a significant size. They are managed by surgical removal when symptomatic, enlarging, or when their ultrasound appearance cannot exclude other diagnoses.
Complex or suspicious cysts
A cyst is described as complex when it has internal solid components, thick walls or septae, increased blood flow on Doppler ultrasound, or is rapidly increasing in size. These features warrant specialist assessment, including tumour markers (CA-125 and others — see below) and often surgical evaluation. It is important to note that most complex cysts in premenopausal women are still benign; the investigation pathway is about appropriate risk stratification, not an assumption of malignancy.
"Polycystic ovaries" on scan — not the same as ovarian cysts, and not the same as PCOS
A transvaginal ultrasound may report "polycystic ovaries" or "polycystic ovarian morphology" — meaning the ovaries contain many small follicles arranged around the periphery. This is not the same as having a discrete ovarian cyst. It is also important to understand that polycystic ovarian morphology is only one of three criteria used to diagnose Polycystic Ovary Syndrome (PCOS) — you cannot have a diagnosis of PCOS from an ultrasound finding alone, and many women with polycystic-appearing ovaries do not have PCOS. If you have been told your ovaries appear "polycystic", please see the dedicated PCOS page for a full explanation of the Rotterdam diagnostic criteria, symptoms, and management. The two conditions — a discrete ovarian cyst and PCOS — are distinct and are managed very differently.
In Marathi, ovarian cysts are commonly referred to as गर्भाशयाच्या गाठी or अंडाशयाच्या गाठी — a term your doctor may use during consultation.
What symptoms do ovarian cysts cause — and when is pain a red flag?
Most ovarian cysts — particularly functional cysts — cause no symptoms at all and are discovered incidentally during a routine or fertility-related ultrasound scan. When symptoms do occur, they vary by cyst type, size, and whether a complication has arisen.
Symptoms when present may include:
- Dull pelvic pain or pressure — often one-sided, corresponding to the affected ovary; can be constant or intermittent
- Lower abdominal bloating or fullness — particularly with larger cysts
- Pain during intercourse — especially with posterior or larger cysts
- Irregular or disrupted periods — functional cysts can affect cycle regularity in some women
- A feeling of abdominal heaviness or fullness after small meals — with large or growing cysts
Red-flag symptoms — seek urgent care immediately
Two serious complications — ovarian torsion (twisting of the ovary on its blood supply) and cyst rupture with significant bleeding — are gynaecological emergencies.
Seek urgent assessment if you experience:
- Sudden, severe, one-sided pelvic pain — especially if it comes on without warning, is the worst pain you have experienced, or is associated with nausea and vomiting; this pattern is characteristic of ovarian torsion or significant rupture
- Pain with fever — raises concern for infection or other acute pelvic pathology
- Fainting, dizziness, or signs of significant blood loss — can occur with a large haemorrhagic rupture
- Difficulty urinating or passing stool with acute pain
How are ovarian cysts diagnosed?
Transvaginal ultrasound (TVS) — the primary investigation
A transvaginal ultrasound is the cornerstone of ovarian cyst evaluation. It characterises the cyst by size, wall thickness, internal echogenicity (appearance), number of compartments (unilocular vs. multilocular), presence of solid components, and vascularity on Doppler. In the hands of an experienced operator, most cysts can be reliably classified, and a management recommendation made, on TVS alone. Aansh's in-house diagnostic unit performs TVS as part of the initial fertility workup.
Blood tests (tumour markers)
Tumour markers are not a routine requirement for all ovarian cysts. They are used selectively — primarily for complex cysts or in postmenopausal women:
- CA-125 — elevated in many ovarian cancers but also in endometriosis, fibroids, pelvic inflammatory disease, and benign cysts; not reliable as a screening test in premenopausal women; most useful as part of a structured risk-assessment approach alongside ultrasound findings
- Additional tumour markers — selected markers may be measured in younger women when germ cell tumour components (including dermoid) need to be excluded
- AMH (anti-Müllerian hormone) — not a tumour marker, but routinely measured as part of a fertility assessment to gauge ovarian reserve, particularly relevant before any planned ovarian surgery
MRI (selected cases)
MRI is used when ultrasound findings are ambiguous, to better characterise a suspected dermoid or deep infiltrating endometriosis, or before planning complex surgical management. It is not required for simple functional cysts.
Laparoscopy — for complex or indeterminate cases
For cysts whose ultrasound appearance is indeterminate, or when surgical treatment is already likely, laparoscopic evaluation and treatment in the same procedure is often the most appropriate next step. Direct visualisation confirms the nature of the cyst, allows tissue sampling, and permits treatment (cystectomy or drainage) in a single operation.
How do ovarian cysts affect fertility — and does every cyst need to be removed before IVF?
The answer depends almost entirely on the type of cyst.
Functional cysts and fertility: Simple follicular and corpus luteum cysts have no lasting impact on fertility. A functional cyst found at the baseline ultrasound before an IVF stimulation cycle may prompt a short delay in starting treatment (a few days to a week) or aspiration of the cyst at the time of egg collection planning — but this is a minor, routine management step, not a reason to abandon the treatment cycle.
Endometriomas and fertility: Endometriomas are the type of ovarian cyst with the most significant fertility implications. They reduce ovarian reserve by directly damaging the ovarian cortex adjacent to the cyst. AMH levels are measurably lower in women with ovarian endometriomas, and antral follicle counts are reduced on the affected ovary. Surgical removal of an endometrioma (cystectomy) can itself cause further ovarian tissue loss — which is why the decision to operate before IVF is made on a case-by-case basis, weighing the risk of reduced reserve from surgery against the benefit of a cleaner ovarian environment for stimulation. The full management pathway for endometriomas, including the relationship to IVF and the preservation of ovarian reserve, is discussed on the endometriosis page.
Dermoids and fertility: A dermoid cyst does not directly impair fertility unless it is very large or causes torsion. However, surgical removal — which is generally required for dermoids above a certain size — carries a risk of reducing ovarian reserve. If you have been diagnosed with a dermoid and are planning a family, discussing the timing and approach to surgery with a specialist is important.
Large cysts (any type) and IVF: Any large cyst, regardless of type, can physically displace or compress normal ovarian tissue, potentially reducing the follicular response to stimulation. Assessment at the IVF baseline scan is routine, and management of any significant cyst identified at that point is part of the standard pre-treatment protocol.
A fertility assessment including AMH measurement, antral follicle count, and TVS is the right starting point for anyone with a known ovarian cyst who is planning pregnancy or IVF.
What are the management options for ovarian cysts?
Management is tailored to cyst type, size, symptoms, ultrasound characteristics, and the individual's fertility goals. Not all cysts require treatment.
Watchful waiting with repeat ultrasound
For simple, thin-walled functional cysts under 5–7 cm that are asymptomatic, observation with a repeat TVS in 6–12 weeks is the appropriate first step. The majority will have resolved spontaneously on the follow-up scan. This approach avoids unnecessary intervention and preserves ovarian tissue.
Medical management
Oral contraceptive pills (OCPs) do not shrink existing ovarian cysts and are not a treatment for established cysts. They may reduce the likelihood of new functional cysts forming in women who are prone to recurrent functional cysts and who are not currently trying to conceive. No medication causes endometriomas, dermoids, or cystadenomas to resolve.
Surgical removal — laparoscopic ovarian cystectomy
Laparoscopic cystectomy (surgical removal of the cyst with preservation of the surrounding ovarian tissue) is the standard surgical approach. It is indicated when:
- The cyst is large and carries a risk of torsion (particularly dermoids above 5–6 cm)
- The cyst is symptomatic (persistent pain, pressure, impact on daily life)
- Ultrasound features are complex or suspicious
- The cyst is an endometrioma being managed before planned IVF (with careful, ovarian-tissue-preserving technique)
- The cyst has persisted on repeat ultrasound at 3 months without resolution
- There is diagnostic uncertainty that requires histological assessment
Ovarian tissue preservation is a priority in every case. The aim of cystectomy is to remove the cyst while causing minimum damage to the surrounding normal ovarian cortex — because every ovarian procedure carries some risk of reducing ovarian reserve, and this risk is cumulative with repeat procedures. For women with already-reduced ovarian reserve or those planning IVF, this consideration is discussed explicitly before any surgical recommendation is made.
Cost of laparoscopic cystectomy is typically in the range of ₹10,000 – ₹15,000, depending on the clinical approach and individual factors. 0% EMI options (3–24 months) are available. See IVF cost & 0% EMI for indicative ranges. Final cost depends on individual clinical evaluation.
When should I seek an evaluation for an ovarian cyst?
You should consult Dr. Shweta Agarwal if:
- You have been told you have an ovarian cyst on ultrasound that has not resolved after 2–3 menstrual cycles
- You are experiencing persistent one-sided pelvic pain or pressure that interferes with daily activities
- You are trying to conceive and have been told you have an ovarian cyst — regardless of type or size
- Your cyst has been described as "complex," "suspicious," or "needs follow-up"
- You are starting an IVF cycle and have a known cyst
- You have been diagnosed with endometriosis and are concerned about your ovarian reserve
Early evaluation protects both your quality of life and your fertility options. A fertility assessment at Aansh provides an AMH measurement, antral follicle count, TVS characterisation of the cyst, and a clinical recommendation — all in-house, without referral to another centre.