Ovarian cysts are fluid-filled or partly solid changes of the ovary and can occur at any age. Particularly before menopause, many cysts develop as part of the normal menstrual cycle and often resolve spontaneously.

Not every ovarian cyst requires treatment. Careful assessment of the size, appearance, and development of the cyst, as well as symptoms, age, and menopausal status is essential in determining the appropriate approach.

Possible Symptoms

Many ovarian cysts cause no symptoms and are discovered incidentally during an ultrasound examination. Depending on their size and type, however, they may cause:

• lower abdominal or pelvic pain
• a feeling of pressure or fullness
• pain during sexual intercourse
• menstrual or bleeding irregularities
• pressure on the bladder or bowel
• sudden severe pain, for example, due to ovarian torsion or rupture of a cyst

Sudden, severe lower abdominal or pelvic pain should be assessed promptly by a medical professional.

Ultrasound & Diagnosis

The most important examination for assessing an ovarian cyst is transvaginal ultrasound. This allows detailed evaluation of the size, shape, internal structure, margins, and blood flow of the lesion.

These characteristics often make it possible to determine whether a cyst has typical benign features or requires further investigation.

For unclear or suspicious findings, additional investigations such as tumor markers, MRI, or CT may be appropriate depending on the individual situation.

Through his specialization in gynecological oncology, Dr. Arsenakis has particular expertise in the assessment of complex or suspicious ovarian findings.

Monitoring or Treatment?

Many cysts with benign features can initially be monitored with follow-up ultrasound examinations. Surgical treatment may be appropriate if a cyst:

• causes symptoms
• increases in size or persists over time
• carries an increased risk of complications because of its size
• shows complex or suspicious features on ultrasound
• occurs after menopause and requires further evaluation
• cannot be confidently classified as benign

Minimally Invasive Surgical Treatment

When surgery is required and the findings suggest a benign condition, the procedure can often be performed using minimally invasive laparoscopy.

Particularly in younger patients and those wishing to preserve fertility, the aim – whenever medically appropriate – is to remove the cyst while preserving as much healthy ovarian tissue as possible.

If findings are suspicious for malignancy, the surgical strategy is planned according to gynecological oncology principles. In these situations, careful preoperative assessment is particularly important in order to select the appropriate surgical approach from the outset.

Not every ovarian cyst requires surgery. The key is to identify benign changes reliably, investigate suspicious findings carefully, and treat only when medically appropriate.