Ovarian Cysts and Pelvic Health

Ovarian cysts are fluid-filled sacs that develop on or within an ovary. They are extremely common — most women of reproductive age develop at least one cyst during their lifetime, and the vast majority are harmless and resolve without treatment.

Functional cysts are the most common type and are a normal part of ovulation. A follicular cyst forms when the follicle doesn't rupture to release the egg and continues to grow. A corpus luteum cyst forms after ovulation when the empty follicle fills with fluid instead of shrinking. Both types typically resolve on their own within 1–3 menstrual cycles and rarely grow larger than 5–6 centimeters.

Other types include dermoid cysts (teratomas), which contain tissue like hair, skin, or teeth and develop from embryonic cells; endometriomas ("chocolate cysts"), which form when endometrial tissue grows on the ovary; and cystadenomas, which develop from ovarian surface cells and can become quite large.

Most cysts cause no symptoms and are discovered incidentally during imaging for other reasons. When symptoms occur, they may include pelvic pain or pressure (dull or sharp, on one side), bloating or feeling of fullness, pain during intercourse, and irregular periods.

The primary risks from ovarian cysts are rupture and torsion. A ruptured cyst can cause sudden sharp pain and, rarely, significant internal bleeding. Ovarian torsion occurs when a cyst causes the ovary to twist on its blood supply — this is a surgical emergency requiring immediate treatment to save the ovary.

Ovarian cysts are typically discovered during a routine pelvic exam or incidentally on imaging performed for another reason. Once identified, the approach depends on the cyst's size, appearance, and your symptoms.

Transvaginal ultrasound is the primary diagnostic tool. It can determine the cyst's size, location, and composition — whether it's simple (fluid-filled, thin-walled), complex (containing solid components, thick walls, or septations), or solid. Simple cysts under 5 centimeters in premenopausal women are almost always benign and often don't require follow-up.

For cysts that need monitoring, your doctor will typically recommend a repeat ultrasound in 6–8 weeks to see if the cyst has resolved, grown, or changed in appearance. Functional cysts should resolve within this timeframe — if a cyst persists or grows, further investigation is warranted.

Blood tests may be ordered, particularly CA-125 in postmenopausal women, to help assess cancer risk. In premenopausal women, CA-125 is less useful because it can be elevated by many benign conditions including endometriosis, fibroids, and even menstruation itself.

MRI or CT scans are sometimes used for complex cysts or when ultrasound findings are inconclusive. These provide more detailed information about the cyst's internal structure and relationship to surrounding organs.

The "watch and wait" approach is appropriate for most cysts. If you're told you have a small, simple ovarian cyst, try not to panic — your doctor is likely monitoring it because they expect it to resolve on its own, not because they're worried about something serious.

Ovarian cyst rupture is common and, in most cases, not dangerous — functional cysts rupture routinely during ovulation without causing noticeable symptoms. However, when a larger cyst ruptures, it can cause sudden, intense pain that understandably causes alarm.

A ruptured cyst typically causes sharp, sudden pain on one side of the pelvis that may come on during or after physical activity or intercourse. The pain may initially be severe but often improves over several hours to days. You might also experience mild vaginal spotting, nausea, or bloating. Most ruptured cysts can be managed at home with rest, heat, and over-the-counter pain medication.

However, some ruptures cause significant internal bleeding (hemorrhagic cyst rupture), which requires medical attention. Warning signs include pain that doesn't improve or gets worse over several hours, dizziness, lightheadedness, or fainting, rapid heartbeat, cold and clammy skin, shoulder pain (a sign that blood is irritating the diaphragm), and fever. These symptoms warrant emergency evaluation.

At the ER, you'll typically receive an ultrasound to check for free fluid (blood) in the pelvis, blood tests to check for anemia and rule out ectopic pregnancy, and pain management. Most hemorrhagic ruptures resolve with monitoring and supportive care, but rarely, surgery is needed to stop active bleeding.

If you experience recurrent cyst ruptures, your doctor may recommend hormonal birth control to suppress ovulation and prevent new functional cysts from forming. This doesn't affect existing cysts but can prevent future episodes.

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs — typically the uterus, fallopian tubes, and ovaries. It's most often caused by sexually transmitted bacteria, particularly chlamydia and gonorrhea, but can also result from normal vaginal bacteria that ascend into the upper reproductive tract.

PID is a significant health concern because it can cause lasting damage even after treatment. The infection triggers inflammation and scarring in the fallopian tubes and pelvic structures, which can lead to chronic pelvic pain (in about 30% of women who've had PID), infertility (1 in 8 women with PID has difficulty getting pregnant), and increased risk of ectopic pregnancy (6–10 times higher risk after PID).

Symptoms range from subtle to severe. Many women with PID have mild symptoms that are easy to miss or attribute to other causes. Common signs include lower abdominal or pelvic pain (the most common symptom), unusual vaginal discharge (may be yellow or green with an odor), pain or bleeding during or after intercourse, burning with urination, irregular menstrual bleeding, and fever and chills (in more severe cases).

PID is diagnosed through a combination of clinical symptoms, pelvic exam findings (cervical motion tenderness is a hallmark), lab tests for STIs, and sometimes ultrasound to check for tubo-ovarian abscess.

Treatment is antibiotics — typically a combination to cover both chlamydia and gonorrhea plus anaerobic bacteria. Sexual partners must also be tested and treated to prevent reinfection. Early treatment is critical: the sooner PID is treated, the less likely it is to cause permanent damage. If you have symptoms suggestive of PID, don't wait — even a few days of delay can affect outcomes.

Sexually transmitted infections can have direct and indirect effects on your menstrual cycle and pelvic health — and many of these effects fly under the radar because the most impactful STIs are often asymptomatic in women.

Chlamydia and gonorrhea are the most concerning STIs for pelvic health. Both can cause PID if they ascend from the cervix to the upper reproductive tract. Up to 70% of chlamydia infections and 50% of gonorrhea infections in women produce no noticeable symptoms, which is why regular screening is so critical. When symptoms do occur, they may include abnormal vaginal discharge, bleeding between periods or after sex, painful urination, and pelvic pain.

These infections can alter your menstrual pattern by causing intermenstrual bleeding (spotting between periods), heavier or more painful periods, and post-coital bleeding. If you notice a new pattern of spotting or unexplained changes in your cycle alongside new vaginal discharge or pelvic discomfort, STI testing should be part of the workup.

HPV (human papillomavirus) doesn't typically affect menstrual symptoms directly but is the leading cause of cervical cancer. Regular Pap smears and HPV vaccination are essential preventive measures.

Herpes simplex virus (HSV) can cause painful genital lesions that may worsen around menstruation, as hormonal fluctuations can trigger outbreaks. Trichomoniasis can cause vaginal inflammation and discharge that may be confused with other causes of menstrual-related symptoms.

The CDC recommends annual chlamydia and gonorrhea screening for all sexually active women under 25, and for women 25 and older with risk factors (new or multiple partners, or a partner with an STI). Don't skip these screenings — silent infections cause silent damage.

Ovarian torsion is a gynecological emergency in which the ovary (and sometimes the fallopian tube) twists on its vascular pedicle — the stalk of blood vessels that supplies it. This twisting cuts off blood flow, and without prompt treatment, the ovary can lose its blood supply permanently.

Torsion most commonly occurs when a cyst or mass on the ovary increases its weight and makes it more likely to rotate. Cysts larger than 5 centimeters increase torsion risk significantly. It can also occur during pregnancy, after fertility treatments that stimulate the ovaries, or occasionally in normal ovaries — especially in adolescents whose ligaments are longer and more flexible.

The hallmark symptom is sudden, severe, one-sided pelvic pain that often comes on during physical activity, exercise, or intercourse. The pain may be intermittent (as the ovary twists and partially untwists) and is frequently accompanied by nausea and vomiting — up to 70% of women with torsion experience nausea, which helps distinguish it from other causes of acute pelvic pain.

Other symptoms include lower abdominal tenderness on one side, an inability to get comfortable, and sometimes a low-grade fever. The pain is typically not associated with your menstrual cycle timing.

If you suspect torsion — sudden severe one-sided pelvic pain with nausea — go to the emergency room immediately. Diagnosis involves pelvic ultrasound with Doppler flow to assess blood supply to the ovary. Treatment is emergency laparoscopic surgery to untwist the ovary (and remove any causative cyst). When treated within 6 hours, the ovary can usually be saved. Delays beyond this window increase the risk of permanent damage or ovarian loss.