Ovarian cysts - diagnosis and treatment at OpenMed Warsaw
At OpenMed Warsaw we see patients with an ovarian cyst found incidentally during an ultrasound scan, as well as women with lower abdominal pain, a feeling of pressure, menstrual disorders or other complaints that call for gynaecological diagnostics. During the visit the doctor may perform an ultrasound and assess, among other things, the size of the lesion, its structure, contents, vascularity and the appearance of the surrounding tissues.
Further management depends on the type of cyst, its appearance on ultrasound, its growth rate, the symptoms present, the patient's age, whether she has been through the menopause and her plans regarding pregnancy. The doctor may recommend a follow-up scan, conservative treatment, additional tests or referral for surgical treatment.
Who we help
We help patients who:
- have an ovarian cyst detected during a gynaecological ultrasound,
- need follow-up of a previously diagnosed lesion,
- feel one-sided pain or pressure in the lower abdomen,
- have painful, irregular or heavy periods,
- experience pain during intercourse,
- have a feeling of fullness, bloating or more frequent urinary urgency,
- have a diagnosed or suspected endometrial cyst,
- are planning a pregnancy and want to assess the effect of the cyst on fertility,
- received an inconclusive ultrasound result and need it interpreted,
- want to establish whether the cyst requires observation, conservative treatment or a surgical consultation.
Doctors diagnosing ovarian cysts in Warsaw
Meet the gynaecologists at OpenMed Warsaw who see patients with a detected or suspected ovarian cyst. During the visit the doctor discusses the symptoms, reviews previous results, may perform an ultrasound and determines whether the lesion requires observation, further tests or treatment.
When to see a gynaecologist about a suspected ovarian cyst
A consultation is advisable both when a cyst has been found incidentally on ultrasound and in the case of recurring lower abdominal complaints. The phrase "ovarian cyst" in a report does not in itself mean that treatment is required. What matters are its dimensions, structure, vascularity, the symptoms present and whether the lesion persists on subsequent scans.
It is particularly worth seeing a gynaecologist in the case of lower abdominal pain, a feeling of pressure, menstrual disorders, pain during intercourse or difficulty conceiving. A consultation is also required for any newly diagnosed ovarian lesion after the menopause, and for a cyst that is growing, has a complex structure or has been described as inconclusive.
Symptoms of an ovarian cyst that should not be ignored
Small cysts often cause no complaints at all and are detected during a routine ultrasound. Symptoms appear more often when the lesion grows larger, presses on neighbouring organs, bleeds, ruptures or when ovarian torsion occurs.
A cyst may cause:
- dull, dragging or one-sided lower abdominal pain,
- a feeling of heaviness, pressure or fullness in the pelvis,
- pain during intercourse,
- painful, irregular or heavier periods,
- bloating and a visible increase in abdominal girth,
- more frequent urination or urinary urgency,
- difficulty with bowel movements,
- pain in the sacral or lumbar region,
- feeling full quickly despite eating only a small meal.
Such symptoms are not specific to cysts alone. They may also occur in endometriosis, fibroids, infections and diseases of the urinary or digestive system, which is why their cause should not be established without a gynaecological consultation.
How we diagnose ovarian cysts at OpenMed
We begin the diagnostic process with a conversation about symptoms, the menstrual cycle, previous illnesses and procedures, medication taken and plans regarding pregnancy. Previous cysts, the menopause and a family history of ovarian or breast cancer also matter.
The basic imaging test is a gynaecological ultrasound. The doctor assesses the lesion, compares it with earlier documentation and determines whether its appearance corresponds to a benign change or requires more detailed diagnostics. The patient receives a discussion of the result together with a plan for further care.
In selected situations the doctor may recommend a follow-up scan, laboratory tests, markers such as CA-125, magnetic resonance imaging, or a consultation at a surgical or gynaecological oncology centre. Markers are not measured routinely for every cyst, and an elevated result does not in itself mean cancer.
Gynaecological ultrasound in the assessment of the ovaries and cysts
For most adult patients the most accurate assessment of the ovaries is provided by a transvaginal ultrasound. In specific situations the scan is performed through the abdominal wall or both methods are combined. Ultrasound not only confirms the presence of a lesion but also allows features relevant to further management to be determined.
During the examination the doctor assesses, among other things:
- the position of the cyst and the ovary it arises from,
- the three dimensions of the lesion,
- the number of chambers and the appearance of its walls,
- the type of contents - fluid, haemorrhagic, fatty or mixed,
- the presence of septa, papillary projections and solid components,
- the vascularity of the walls, septa and solid parts on Doppler examination,
- the appearance of the other ovary, the uterus and the endometrium,
- the presence of free fluid in the pelvis.
The ultrasound image allows the nature and risk of the lesion to be estimated, but it does not always make a definitive diagnosis possible. If a cyst is removed, its type is confirmed by histopathological examination, which is also available at OpenMed.
Types of ovarian cysts and what they mean for treatment
Ovarian cysts differ in origin, appearance on ultrasound and the way they are managed. The most commonly diagnosed are:
- Functional cysts - these include follicular and corpus luteum cysts. They arise in connection with ovulation and often disappear on their own within one or several cycles.
- Haemorrhagic cysts - these contain blood that has entered the lesion. They may cause pain, but typical haemorrhagic lesions are often gradually absorbed.
- Endometrial cysts - these are associated with endometriosis and contain thick, dark content, which is why they are also called chocolate cysts. They usually do not disappear the way functional cysts do.
- Dermoid cysts - mature teratomas may contain fatty tissue, hair, or fragments of bone or teeth. They are most often benign, but they can grow and increase the risk of ovarian torsion.
- Cystadenomas - serous or mucinous lesions arising from the ovarian epithelium. They can reach considerable size despite being benign.
- Complex lesions - these have septa, solid components, papillary projections or irregular walls. This does not automatically mean cancer, but it does require more detailed assessment.
Not every lesion visible near the ovary is an ovarian cyst. A similar picture may be produced by paraovarian cysts, a dilated fallopian tube or lesions arising from other pelvic structures.
When can an ovarian cyst be observed and when does it require treatment?
Observation is often sufficient for a simple, single-chamber cyst that causes no complaints and has a typically benign appearance. This applies especially to functional lesions in menstruating women. A follow-up scan may be performed after one or several cycles, often after around 6-12 weeks, to check whether the cyst has shrunk or disappeared.
There is no single size above which every cyst must be removed. A simple 3 cm lesion in a young patient without symptoms is assessed differently from an 8 cm cyst containing septa, solid parts (containing tissue rather than fluid alone) or papillary projections. Further management is decided by a combination of:
- the size and structure of the lesion,
- the growth rate,
- whether the cyst persists on subsequent scans,
- the severity of symptoms,
- the patient's age and whether she has been through the menopause,
- reproductive plans,
- the risk of torsion, rupture or bleeding,
- the presence of features that require cancer to be excluded.
Treatment is considered more often for lesions that are large, growing, symptomatic, complex or persistent despite observation. After the menopause the threshold for more detailed diagnostics is lower than in menstruating women.
Treatment of ovarian cysts - matching the method to the diagnostic result
Treatment is matched to the type of lesion, not to its diameter alone. Functional cysts often require no active treatment, only follow-up. For pain the doctor may recommend symptomatic treatment, while in endometriosis - hormonal therapy that limits disease activity and the associated pain. Hormonal treatment is not, however, a universal way of removing every cyst.
If the lesion is large, growing, causing severe symptoms, persisting on subsequent scans or has a worrying appearance, surgical treatment may be needed. Most often laparoscopic cyst enucleation is performed, leaving the healthy part of the ovary in place. For very large lesions, suspected cancer or difficult surgical conditions a laparotomy may be necessary, that is opening the abdominal cavity through an incision in the abdominal wall.
In patients of reproductive age the aim is to preserve as much normal ovarian tissue as possible. The extent of surgery does, however, depend on the type of lesion, its size, the condition of the ovary and the patient's safety. Material removed during the procedure should be sent for histopathological examination.
Endometrial cysts, endometriosis and the effect on fertility
An endometrial cyst forms in the ovary in the course of endometriosis. It may coexist with painful periods, pain during intercourse, chronic pelvic pain, adhesions and deep endometriosis lesions. At OpenMed a specialist ultrasound for endometriosis is available, during which not only the ovaries are assessed but also the uterus, the pouch of Douglas, the bladder, the bowel wall and other potential locations of the disease.
Endometriosis may make conception more difficult by distorting pelvic anatomy, causing adhesions and affecting ovarian function. At the same time, not every endometrial cyst requires surgery. The procedure may reduce the amount of healthy ovarian tissue and lower the ovarian reserve, especially with bilateral lesions or repeat surgery on the same ovary.
In patients planning a pregnancy the decision should take into account age, the severity of pain, the size and position of the cyst, previous surgery and the current ovarian reserve. In selected cases the doctor may recommend measuring AMH and assessing the antral follicle count on ultrasound. These results help in planning treatment, but they are not a standalone fertility test.
Warning signs with an ovarian cyst
Sudden, very severe lower abdominal pain may indicate ovarian torsion, cyst rupture or bleeding into the abdominal cavity. These situations require urgent medical assessment rather than waiting for a scheduled consultation.
Urgent help should be sought when the following occur:
- sudden, severe and usually one-sided lower abdominal pain,
- pain combined with nausea or vomiting,
- fainting, dizziness, marked weakness or pallor,
- rapidly worsening pain or a hard, very painful abdomen,
- fever accompanying the pain,
- heavy bleeding from the genital tract,
- pain and bleeding with a positive pregnancy test or suspected pregnancy.
With severe symptoms you should go to a hospital emergency department or call 112. In ovarian torsion in particular, acting quickly may matter for preserving the normal blood supply to the ovary.
How to prepare for the consultation and ultrasound
It is worth bringing previous ultrasound reports and images, MRI or CT results, hospital discharge summaries and documentation of earlier surgery to the consultation. A list of medication taken, including contraception and other hormonal preparations, will also be helpful.
Before the visit, prepare information on:
- the date of your last period and the typical length of your cycle,
- how long the symptoms have lasted and how severe they are,
- previous cysts and how they were treated,
- gynaecological surgery you have had,
- your plans regarding pregnancy,
- ovarian or breast cancer in your immediate family.
A transvaginal ultrasound is usually performed after emptying the bladder and you do not need to fast. For a scan through the abdominal wall a full bladder may be required - it is worth confirming the exact instructions when booking at OpenMed. A period usually does not prevent an ultrasound from being performed, but in some cases the doctor may schedule the scan to fit a particular phase of the cycle.
Why have an ovarian cyst assessed at OpenMed Warsaw?
At OpenMed the patient can have a gynaecological consultation and an ultrasound that allows assessment of the uterus, ovaries, endometrium and the remaining structures of the reproductive organs. Depending on the indications we perform a transvaginal or transabdominal ultrasound and, where an endometrial cyst is suspected, also a specialist ultrasound for endometriosis.
After the examination the patient receives the result together with a discussion of it and recommendations for further care. This may include observation, conservative treatment, extended diagnostics or referral for surgical treatment. The OpenMed Gynaecology and Obstetrics clinic is located at ul. Wschowska 8 in Warsaw Wola.
Frequently asked questions about the diagnosis and treatment of ovarian cysts
Most cysts, especially in women before the menopause, are benign. Risk is assessed on the basis of her age, the symptoms and the structure of the lesion on ultrasound. Irregular solid parts, papillary projections, thick septa, marked vascularity and the presence of free fluid are among the concerning features, but the definitive diagnosis of a surgically removed lesion is given by histopathological examination.
No. A large cyst more often causes symptoms and may increase the risk of torsion, but the decision does not depend on the number of centimetres alone. A small lesion with an inconclusive structure may require more detailed diagnostics than a larger but simple cyst without suspicious features.
Functional cysts and some haemorrhagic cysts may be absorbed within several weeks or months. Endometrial cysts, dermoid cysts and cystadenomas usually do not behave this way, which is why they require individually planned follow-up or treatment.
No. CA-125 may also be elevated during menstruation, in endometriosis, fibroids, inflammatory conditions and other benign diseases. The result is interpreted together with her age, the symptoms and the ultrasound image. A normal level also does not exclude all ovarian cancers.
Not in the everyday sense of the word. In PCOS the structures visible in the ovaries are numerous small follicles, not cysts requiring enucleation. A diagnosis of PCOS is not made on the basis of ultrasound alone - menstrual cycles and symptoms of hormonal disorders are also taken into account.
A small, simple and asymptomatic cyst usually does not mean an automatic ban on activity. With a large lesion or with pain the doctor may recommend limiting intense exercise, sudden movements or intercourse, because of the possibility of worsening symptoms and the risk of torsion or rupture of the cyst.
The timing depends on the type of lesion and her individual situation. A cyst with a functional appearance may be checked after around 6-12 weeks, while other lesions require a different schedule. If the cyst grows, changes structure or starts to cause symptoms, the consultation should take place sooner.
No. In patients before the menopause the aim is most often to remove the cyst alone and preserve healthy ovarian tissue. Removal of the ovary may be necessary when the lesion occupies almost the whole organ, when its blood supply has been permanently damaged or when cancer is suspected.
Ovarian cyst diagnosis and treatment price list
Service available at the following clinics:
- Warsaw Wola - price list
Have questions? Contact us - 22 100 45 20.