Treatment of ovarian cysts has two general options. One is surgery to remove the cyst. The other is what is referred to as expectant management. This is simply following the cyst with ultrasounds until it goes away on its own. Which is the right approach has to do with several factors inluding the women’s menopausal status, the size of the cyst, and the quality or type of the cyst. Women who are postmenopausal have different treatment algorithms, see postmenopausal ovarian cysts for a discussion on this issue. The discussion here assumes the women is still having menstrual cycles.
Women with ovarian cysts are often placed on birth control pills to treat the cysts. The data is pretty clear that birth control pills will not increase the chance that a cyst will go away or speed up the regression. Birth control pills actually do not help with cysts that are currently present. They may help prevent future cysts from forming.
Cysts less than 5cm in size can usually be managed expectantly without surgery. There are some exceptions, for example dermoid cysts or very abnormal appearing cysts may require surgery regardless of size. Cysts that are 10 cm or larger always need to be removed and surgery is necessary. Cysts between 5-10 cm are a grey zone. It may be appropriate to manage these expectantly with serial ultrasounds or it may be better to remove them surgically. In the 5-10 cm category a conversation with your physician will be necessary to discuss treatment. Factors including pain, discomfort, anxiety about the cyst or about surgery, the behavior of the cyst over time, and other issues all play a role in the decision making process.
If surgery is necessary there are two ways to do surgery for an ovarian cyst. Cysts can be removed with laparoscopic surgery or with an open procedure. Laparoscopic surgery is performed using a camera in the abdomen. A small incision is made in the belly button and usually two small incisions are made in the lower abdomen. The cyst is removed through these small holes. Laparoscopic surgery is outpatient meaning no hospital stay is required. Recovery is about one week. An open procedure is made with a larger incision in the abdomen. A hospital stay is required for this type of surgery and recovery is about one month.
Because of the quicker recovery, laparoscopic surgery is preferred over an open surgery if it can be done safely. Open surgery may be necessary if there has been a lot of previous surgery and scar tissue is expected or in a case when spillage of the cyst fluid is not acceptable and the ovary is to be preserved. Certain types of cysts, a dermoid for example, can make the patient very sick if the contents are spilled inside the body. Removing these types of cysts laparoscopically increases the risk of spillage. If the entire ovary is to be removed rather than the cyst alone, the laparoscopic approach me be safe in a situation where spillage is a potential problem. Be sure to discuss these issues with your surgeon when the type of surgery is being discussed.