An ovarian cyst diagnosis can be alarming — but in most cases, the cyst is benign, causes no symptoms, and resolves on its own. The challenge is identifying which cysts require surveillance only, which need medical management, and which genuinely need surgical removal. Dr. Shweta Mendiratta, laparoscopic and robotic gynaecological surgeon in Faridabad, guides you through the decision-making process.
What Are Ovarian Cysts?
An ovarian cyst is a fluid-filled sac that develops on or within an ovary. They are extraordinarily common — most women will have at least one ovarian cyst during their lifetime, often without knowing it.
There are several types of ovarian cysts:
- Functional cysts: Follicular cysts (from an egg-containing follicle that doesn’t rupture) and corpus luteum cysts (from the structure left after ovulation). These are by far the most common and almost always resolve within 1–3 menstrual cycles without treatment.
- Endometriomas (chocolate cysts): Cysts caused by endometriosis, filled with old blood. These do not resolve spontaneously and can impair ovarian reserve.
- Dermoid cysts (mature teratomas): Contain a variety of tissue types (skin, hair, teeth). Generally benign but require surgical removal due to the risk of complications.
- Cystadenomas: Serous or mucinous cysts arising from the ovarian surface. Can grow large; require surgical removal.
- Polycystic ovaries: Multiple small follicles in PCOS — not ‘cysts’ in the traditional sense.
When to Watch and Wait
Not all ovarian cysts require surgery. Expectant management (watching and waiting) is appropriate when:
- The cyst is less than 5 cm in a premenopausal woman
- The ultrasound features are reassuringly simple (thin-walled, no solid components, no septae, no blood flow within the cyst)
- The woman is asymptomatic
- Tumour markers (CA-125, AFP, inhibin) are normal
- The cyst is consistent with a functional cyst
In these cases, Dr. Mendiratta typically recommends a repeat ultrasound after 6–12 weeks to confirm resolution.
When Surgery Is Required
Surgical removal (ovarian cystectomy) is recommended when:
- The cyst is large (generally over 5–6 cm and not decreasing in size)
- Ultrasound features are suspicious: thick walls, internal septations, solid components, papillary projections, or abnormal blood flow
- CA-125 or other tumour markers are elevated
- The cyst persists beyond 3 menstrual cycles
- The cyst is causing significant pain, pressure, or other symptoms
- Torsion (twisting of the ovary) is suspected — a gynaecological emergency
- The cyst has ruptured and is causing internal bleeding
- The woman is postmenopausal (any new cyst requires careful evaluation)
- The cyst is an endometrioma (particularly if affecting fertility or growing)
- The cyst is a dermoid or cystadenoma (which do not resolve spontaneously)
Ovarian Cystectomy: The Surgical Procedure
Ovarian cystectomy — removal of the cyst while preserving the ovary — is the preferred approach for most benign cysts in women of reproductive age. Dr. Mendiratta performs this laparoscopically or robotically:
- 3–4 small port incisions (5–10 mm)
- The cyst wall is carefully dissected from the ovarian tissue and removed intact
- Ovarian tissue is meticulously preserved
- The ovary is repaired (no sutures needed in small defects; careful suturing for larger ones)
Preservation of healthy ovarian tissue is critically important, particularly for women who wish to conceive. Dr. Mendiratta uses technique specifically designed to minimise damage to the surrounding follicles.
Endometrioma Surgery — Special Considerations
Ovarian endometriomas (chocolate cysts) require particularly careful surgical technique because the cyst wall is adherent to normal ovarian cortex and indiscriminate removal damages the healthy tissue beneath. Evidence suggests that stripping endometriomas significantly reduces ovarian reserve (AMH levels). Dr. Mendiratta uses a conservative, minimal-damage technique and discusses the risks and benefits of surgery versus expectant management thoroughly with patients planning IVF.
Frequently Asked Questions (FAQs)
Q1. Can ovarian cysts cause infertility?
Functional cysts do not cause infertility and resolve on their own. Endometriomas and large cysts that damage ovarian tissue can impair fertility. The decision to operate should carefully weigh the potential damage from surgery against the damage from leaving the cyst in place.
Q2. Is ovarian cyst surgery safe?
Laparoscopic ovarian cystectomy is a safe, well-established procedure. As with all surgery, there are small risks of bleeding, infection, and injury to adjacent structures, which are minimised by the experience of the surgeon.
Q3. How quickly do ovarian cysts regrow after surgery?
Simple functional cysts do not recur. Endometriomas have a recurrence rate of approximately 20–30% over 5 years. Medical treatment (OCPs, dienogest) after surgery reduces recurrence risk.
Q4. Can an ovarian cyst be cancerous?
The vast majority of ovarian cysts in women under 50 are benign. However, certain ultrasound features (solid components, internal blood flow, papillary projections) and elevated tumour markers raise the suspicion of malignancy and require urgent specialist evaluation.
Q5. My doctor said my cyst is 4 cm — should I be worried?
A 4 cm cyst in a premenopausal woman with benign ultrasound features is unlikely to be serious. A repeat scan in 6–8 weeks is typically advised. If it persists or grows, further evaluation is warranted.
Get In Touch With Dr. Shweta Mendiratta
Phone: +91-8130048652 | +91-9999093503
Email: shwetasmendiratta@gmail.com
Yatharth Super Speciality Hospital
Plot No 9, Sector-20, Krishna Nagar, New Industrial Township, Faridabad, Haryana 121007
Phone: +91 8178-939442
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