“You have a cyst on your ovary.” For many Nigerian women, these words trigger immediate fear; images of surgery, cancer, or infertility. But here is the truth: most ovarian cysts are entirely harmless, resolve on their own without any treatment, and cause no long-term problems. At the same time, some ovarian cysts do require medical attention and knowing the difference is what this article is about.
Ovarian cysts are extremely common. Most women will develop at least one during their lifetime, often without ever knowing it. Understanding what they are, what symptoms to watch for, and when to be concerned is essential knowledge for every Nigerian woman.
What Is an Ovarian Cyst?
An ovarian cyst is a fluid-filled sac that develops on or inside one of the ovaries. The ovaries are two small organs on either side of the uterus that produce eggs and hormones (oestrogen and progesterone).
Cysts vary enormously in size, from a few millimetres (smaller than a pea) to several centimetres (the size of an orange or larger). They can occur on one or both ovaries.
The vast majority of ovarian cysts are functional cysts; a normal part of the menstrual cycle and disappear without treatment within a few weeks to months.
Types of Ovarian Cysts
Understanding the type of cyst matters because it determines the risk level and what management is needed.
Functional Cysts (Most Common – Usually Harmless)
Follicular cysts: Each month, a follicle in the ovary grows and releases an egg during ovulation. If the follicle does not rupture and release the egg, it continues to grow, forming a follicular cyst. These are extremely common, usually cause no symptoms, and almost always resolve within 1-3 menstrual cycles.
Corpus luteum cysts: After ovulation, the empty follicle (now called the corpus luteum) normally breaks down. If it seals off and fills with fluid, a corpus luteum cyst forms. These can grow larger than follicular cysts (up to 10 cm) and may cause some pelvic discomfort. They also typically resolve on their own within a few weeks.
Non-Functional Cysts (May Require Treatment)
Dermoid cysts (teratomas): Develop from cells that can produce hair, skin, teeth, or other tissues. They are not cancerous but can grow large and may cause complications. Surgical removal is usually recommended.
Endometriomas: Cysts formed when endometrial tissue (the lining of the uterus) grows on the ovary and fills with dark, old blood, sometimes called “chocolate cysts.” Strongly associated with endometriosis and can significantly affect fertility.
Cystadenomas: Develop from cells on the outer surface of the ovary. Can grow very large. Two types: serous (filled with watery fluid) and mucinous (filled with thick mucus). Usually benign but require removal.
Polycystic Ovaries (PCOS): In Polycystic Ovary Syndrome, the ovaries contain multiple small follicular cysts and do not release eggs regularly. This is a hormonal condition, not simply a cyst problem; it causes irregular periods, excess androgens, and fertility challenges.
Ovarian Cancer
The most feared concern. Ovarian cancer can present as a cyst, but the vast majority of ovarian cysts, especially in women of reproductive age, are benign. Features that raise concern for malignancy include: solid components, irregular borders, internal blood flow on ultrasound Doppler, large size, multiple internal compartments, and associated fluid in the abdomen (ascites). These features require urgent further investigation.
Symptoms of Ovarian Cysts
Most ovarian cysts cause no symptoms at all and are found incidentally during a pelvic ultrasound done for another reason. When symptoms do occur, they may include:
Pelvic Pain or Discomfort
A dull, aching pain or pressure on one side of the lower abdomen, the side where the cyst is located. The pain may be constant or come and go. It may worsen during periods, during sex, or with certain movements.
Bloating and Abdominal Fullness
A feeling of fullness, bloating, or heaviness in the lower abdomen. Larger cysts can cause visible abdominal swelling.
Irregular Periods
Cysts can disrupt the hormonal cycle, causing irregular, heavier, lighter, or missed periods.
Pain During Sex
Particularly with deeper penetration, if the cyst is in a position where pressure is applied to it.
Frequent Urination or Difficulty Emptying Bladder
Larger cysts pressing on the bladder.
Difficulty with Bowel Movements
Cysts pressing on the rectum can cause constipation or a feeling of incomplete emptying.
Nausea and Vomiting
Particularly if a cyst twists (ovarian torsion – see below).
When Ovarian Cysts Become Emergencies
Most ovarian cysts are not emergencies. But two complications require immediate hospital attention:
Ovarian Torsion
When a cyst causes the ovary to twist on its supporting ligaments, cutting off its blood supply. This is a surgical emergency.
Symptoms: Sudden, severe one-sided pelvic pain often described as the worst pain the woman has experienced. May be accompanied by nausea, vomiting, and fever. The pain may come and go initially if the ovary is twisting and untwisting, then become constant.
What to do: Go to a hospital immediately. Delayed surgery can result in loss of the ovary.
Ruptured Cyst
A cyst that bursts, releasing its contents into the abdominal cavity. Most ruptured cysts, particularly small functional cysts, cause temporary sharp pain that resolves within hours and requires only pain management and monitoring.
However, a ruptured cyst with significant internal bleeding is a medical emergency.
Symptoms of serious rupture: Sudden severe abdominal pain, dizziness or fainting, rapid heartbeat, signs of shock. Requires immediate hospital care.
How Ovarian Cysts Are Diagnosed
Pelvic Ultrasound
The primary and most accessible diagnostic tool. Ultrasound clearly visualises ovarian cysts their size, location, internal characteristics (purely fluid-filled vs. solid components), and number. A transvaginal ultrasound (probe inserted gently into the vagina) gives a more detailed view than an abdominal scan and is the preferred method for ovarian assessment.
Blood Tests
CA-125 is a tumour marker in the blood that can be elevated in ovarian cancer. However, it is also elevated in many benign conditions, such as endometriosis, fibroids, pelvic infection, pregnancy, and even menstruation, making it an unreliable standalone test for cancer. It is most useful when interpreted alongside ultrasound findings and clinical context.
Hormonal tests: (LH, FSH, oestradiol, testosterone, AMH) help assess ovarian function, particularly if PCOS is suspected.
Pregnancy test: essential, as an ectopic pregnancy (pregnancy outside the uterus) can mimic an ovarian cyst on examination and is a life-threatening emergency.
MRI or CT Scan
Used when ultrasound findings are unclear or when malignancy needs to be more thoroughly assessed.
At Pretty Healthcare, pelvic ultrasound and relevant blood tests are available. If you have been experiencing one-sided pelvic discomfort, irregular periods, or bloating, an ultrasound is the right first step.
Treatment
Treatment depends entirely on the type, size, and symptoms of the cyst, the woman’s age, and her fertility goals.
Watchful Waiting (Most Common Approach)
For simple, small functional cysts in women of reproductive age, the standard approach is to repeat the ultrasound after 6 -12 weeks to confirm the cyst has resolved. No medication or surgery is needed. The vast majority of functional cysts disappear within 1-3 menstrual cycles.
Pain Management
Over-the-counter pain relief (ibuprofen or paracetamol) manages discomfort during the waiting period.
Hormonal Contraceptives
Combined oral contraceptive pills do not shrink existing cysts but may prevent new functional cysts from forming by suppressing ovulation. Useful for women who develop recurrent functional cysts.
Surgery
Recommended when:
- The cyst is large (typically above 5-6 cm and not resolving)
- It has suspicious features suggesting possible malignancy
- It is causing significant symptoms
- Ovarian torsion or rupture with bleeding has occurred
- It is a dermoid cyst, cystadenoma, or endometrioma
Laparoscopic cystectomy (keyhole surgery to remove the cyst while preserving the ovary) is the preferred approach for most benign cysts. It involves small incisions, shorter recovery time, and better cosmetic outcomes than open surgery.
Oophorectomy (removal of the entire ovary) is reserved for very large cysts, suspected malignancy, or cases where ovary preservation is not possible.
Ovarian Cysts and Fertility
Most ovarian cysts, particularly functional cysts, do not affect fertility. However:
- Endometriomas (chocolate cysts) can damage ovarian tissue and significantly reduce egg reserves and fertility. Treatment before attempting conception is often recommended.
- PCOS is a leading cause of infertility in Nigerian women due to irregular or absent ovulation. It is highly manageable with lifestyle changes and medication.
- Large cysts pressing on the fallopian tubes or distorting the ovary may interfere with egg release or fertilisation.
If you have been diagnosed with an ovarian cyst and are trying to conceive or plan to in the future, discuss the specific implications with a gynaecologist.
Ovarian Cysts vs. Ovarian Cancer: Understanding the Risk
This is the fear that hangs over every ovarian cyst diagnosis, and it deserves a direct answer.
The vast majority of ovarian cysts are benign, especially in women under 50 of reproductive age. The risk of malignancy increases with:
- Age: postmenopausal women have a higher risk; any new cyst after menopause requires more thorough evaluation
- Family history of ovarian or breast cancer
- Cyst characteristics on ultrasound: solid areas, irregular borders, multiple internal dividers, Doppler blood flow within the cyst
- Rising CA-125 levels combined with concerning ultrasound features
- Presence of fluid around the abdominal organs (ascites)
A simple, smooth-walled, purely fluid-filled cyst in a woman of reproductive age is very unlikely to be cancer. A complex cyst with solid components in a postmenopausal woman requires urgent specialist evaluation.
Nigeria-Specific Context
- Ovarian cysts are frequently discovered incidentally during pelvic ultrasounds for other reasons, highlighting why routine gynaecological health checks matter
- Many Nigerian women with symptomatic ovarian cysts manage pain with self-medication for months or years before seeking care, delaying diagnosis of endometriomas or other conditions that worsen over time
- PCOS is significantly underdiagnosed in Nigeria; many women with irregular periods and difficulty conceiving have never been assessed for it
- Fear of surgery leads some Nigerian women to avoid recommended treatment; laparoscopic surgery for ovarian cysts is safe, minimally invasive, and widely performed in Lagos
- Herbal treatments marketed for “dissolving cysts” have no scientific evidence and can delay access to appropriate care
When to See a Clinician
See a gynaecologist if you have:
- One-sided pelvic pain lasting more than a few days
- Bloating or abdominal fullness that is new and unexplained
- Irregular periods alongside pelvic symptoms
- Been told you have an ovarian cyst and have not had a follow-up scan
- Difficulty conceiving and have not been assessed for PCOS or endometriosis
- Sudden severe pelvic pain with nausea and vomiting: go to a hospital immediately
Quick Summary
| What is it? | Fluid-filled sac on or in the ovary |
| Most common type | Functional cyst: normal, harmless, resolves on its own |
| Most common symptom | Often none discovered on ultrasound |
| Emergency signs | Sudden severe pain possible torsion or rupture |
| Best diagnostic test | Pelvic/transvaginal ultrasound |
| Does it always need treatment? | No, most resolve on their own |
| Does it affect fertility? | Usually no; endometriomas and PCOS are exceptions |
| Is it cancer? | Rarely; most cysts in reproductive-age women are benign. |
Bottom Line
Ovarian cysts are a normal part of female reproductive biology; most women will have one at some point and never know it. The vast majority are harmless and self-resolving. What matters is getting the right diagnosis through a pelvic ultrasound, understanding what type of cyst you have, and following up appropriately. Do not let fear of a diagnosis delay you from finding out, and do not let a cyst diagnosis spiral into unnecessary anxiety without proper medical guidance. Know what you have, understand what it means, and make informed decisions about your care.
Book a pelvic ultrasound or gynaecology consultation at Pretty Healthcare, Ikeja, Lagos – prettyhealthcare.com.ng/diagnostics or chat with our health advisor on WhatsApp. Monday – Friday: 8 am – 5 pm | Saturday: 9 am – 4 pm.
