Ovarian cysts are a common cause of pelvic pain in pre, peri, and post-menopausal women(1). A typical ovarian follicle is less than 1cm in diameter. However, at the time of ovulation, the dominant follicle grows but normally remains under 2.5cm in diameter(1). If a follicle fails to release an oocyte or does not regress it will enlarge into a follicular cyst(1). Cysts can vary in size and symptoms. A small or functional cyst is asymptomatic and if present in premenopausal women remains a low risk for malignancy. As the cyst grows it can become more hazardous putting pressure on surrounding structures such as the bladder and pelvic region causing symptoms to occur(1,3). Women who have a cyst larger than 5cm are predisposed to ovarian torsion (partial or complete twisting of the ovary or fallopian tube at the vascular pedicles) and requires annual ultrasound for follow up(1).
A large ovarian cyst is likely to cause symptoms whereas a functional or small ovarian cyst tends to stay asymptomatic and is only discovered during a routine pelvic exam(3). Symptoms of a large ovarian cyst could include unexplained weight gain, abdominal pain, menstrual period changes, and frequent urination(3). If sudden, severe abdominal or pelvic pain, nausea, vomiting, vertigo, vaginal bleeding or symptoms of shock occur the patient should see the doctor immediately as these are indicative of a cyst that has ruptured, twisted or is bleeding(3).
Evaluation for detection of an ovarian cyst would include a pelvic exam, a history of symptoms and menstrual periods, a family history and a transvaginal ultrasound(4). Further testing should be completed if the ultrasound was not diagnostic due to the fact pelvic pain overlaps with gastrointestinal and genitourinary pathology, if the patient was not ovulating during the first exam, moderate to severe pain exists, vaginal bleeding is present, the growth is larger than 7.6cm, or there are risk factors for ovarian cancer(4). This further testing includes MRI, CT scan, Laparoscopy, and serum CA-125 (cancer antigen) test(2,4).