Understanding ovarian cysts

An ovarian cyst can develop for different reasons. Most are harmless. Treatment depends on whether it's regular or complex. A regular cyst is a simple fluid-filled sac. A complex cyst may have solid areas, bumps on the surface, or several areas filled with fluid.

A cyst that ruptures may cause no symptoms or only mild symptoms such as pain. Ruptured cysts that cause mild symptoms can often be managed with pain medicines.

In some cases, a ruptured cyst can cause more severe symptoms. These can include pain in the lower belly (abdomen) and bleeding. Symptoms like these need treatment right away.

Diagnosing a ruptured ovarian cyst

Your healthcare provider or an obstetrics and gynecology (ob-gyn) doctor will diagnose the condition. Your healthcare provider will ask about your health history and your symptoms. Be sure to tell the provider if you know that you have an ovarian cyst. You will also have a physical exam. This will likely include a pelvic exam.

If your healthcare provider thinks you may have a ruptured cyst, you may need tests. These tests can help rule out other possible causes of your symptoms, such as an ectopic pregnancy, appendicitis, or a kidney stone. These tests may include:

• Ultrasound. This test uses sound waves to view the size, shape, and location of the cyst.

• Pregnancy test. This is done to check if pregnancy may be the cause of the cyst.

• Blood tests. These check for low iron in the blood (anemia). They also check for infection.

• Urine test. This looks for other possible causes of your pain.

• Vaginal culture. This is done to check for a pelvic infection.

• CT scan. This uses a series of X-rays and a computer to create a detailed picture of the area.

You may need more tests to rule out other possible causes of your symptoms.

Treating a ruptured ovarian cyst

Many women have ovarian cysts that are not complex. A ruptured cyst that is not complex can be treated with pain medicine. You may be told to watch your symptoms over time. In some cases, you may need to have follow-up ultrasound tests. You may not need any other treatment.

If the cyst is complex, you may need different care. This type of cyst may cause:

• Blood loss that causes low blood pressure or fast heart rate

• Fever

• Signs of possible cancer

If you have a complex ruptured ovarian cyst, you may need care in the hospital. Your treatment may include:

• IV (intravenous) fluids to replace lost fluid

• Careful monitoring of your heart rate and other vital signs

• Monitoring of your red blood cell level (hematocrit) to check the blood’s ability to carry oxygen

• Repeated ultrasounds to check for bleeding into your belly (abdomen)

• Surgery for a worsening medical condition or to check for cancer

If you need surgery, your healthcare provider may use a minimally invasive method. This is also known as laparoscopy. The provider makes small incisions in your abdomen while you are under anesthesia. A tiny lighted camera and other small tools are put through these incisions. The provider controls the bleeding and removes any blood clots or fluid. They may then remove the cyst or your entire ovary. The tools are then removed. The incisions are closed and bandaged. If the provider does not use laparoscopy, the surgery will be done with larger incisions.

Talk with your healthcare provider about what type of treatment will work best for you.

Follow-up care

You and your medical team will make a follow-up plan that makes the most sense for you.

If your ruptured ovarian cyst is not complex, you will likely continue your care at home. You can use pain medicines as needed. Your pain should go away in a few days. Let your healthcare provider know right away if your pain gets worse, you feel dizzy, or you have new symptoms. Follow up with your healthcare provider if you need imaging or blood tests.

If you have a complex ruptured ovarian cyst, you may need to stay in the hospital for 1 or more days. If your cyst is no longer bleeding, you may be able to go home. You can use pain medicines as needed. You may need follow-up imaging tests to make sure that your bleeding has stopped.

In rare cases, a ruptured ovarian cyst is caused by cancer. This will need careful follow-up treatment from a healthcare provider who specializes in cancer care. You may need surgery and other treatments.

Some women have more than 1 ovarian cyst. You can work with your healthcare provider to plan treatment for multiple cysts. A cyst that has not ruptured may need to be watched over time. In other cases, you may need to have the cyst removed with surgery.

If you need surgery for your cyst, your healthcare provider will tell you how to get ready for it.

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

• Sudden, sharp abdominal or pelvic pain

• Pain along with nausea and vomiting