Functional ovarian cysts
Follicular and corpus luteum cysts are the most common ovarian mass in reproductive-age women, arising from a normal ovulatory cycle that fails to complete, and most resolve spontaneously within one to two cycles with observation alone. Management is a size- and age-stratified triage between watchful waiting, repeat ultrasound, and surgical evaluation, reserved for masses that are large, complex, persistent, or symptomatic.
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What this article covers
- Overview
A functional (physiologic) ovarian cyst is a fluid-filled follicular structure from a normal ovulatory cycle that did not complete correctly, not a neoplasm; it is the most common ovarian mass in young, reproductive-age women.
- Epidemiology
Functional cysts are the most common cause of ovarian enlargement and the most common adnexal mass in young, reproductive-age females.
- Risk factors
Reproductive age with ongoing ovulatory cycling is the prerequisite; risk is essentially absent with anovulation, pregnancy-suppressed ovulation, or menopause.
- Pathophysiology
Follicular cyst: normally, a dominant follicle matures and ruptures at the luteinizing hormone (LH) surge, releasing its ovum; when the mature follicle fails to rupture, it persists and enlarges as a…
- Clinical features
Most functional cysts are asymptomatic and are found incidentally on bimanual exam or on imaging obtained for another reason.
- Differential diagnosis
Ectopic pregnancy: positive beta-hCG with an adnexal mass and no intrauterine pregnancy on ultrasound; check a pregnancy test first in any reproductive-age patient with pelvic pain (see ectopic-pregnancy).
- Diagnosis
The diagnosis is established by transvaginal ultrasonography demonstrating a simple cyst (unilocular, anechoic, thin-walled, no septations, no solid component, no internal blood flow) in a…
- Management
First, stratify by age and menopausal status: the same-size cyst is managed differently at each life stage.
- Complications
Rupture with intraperitoneal hemorrhage, most often from a hemorrhagic corpus luteum cyst, presenting as sudden pain after exertion or intercourse (see ruptured-ovarian-cyst).
- Prognosis
Excellent: the great majority of functional cysts resolve spontaneously within one to two menstrual cycles.
- Prevention
A combined oral contraceptive suppresses ovulation and reduces incidence of new functional cysts, an established non-contraceptive benefit for a woman with recurrent cysts; it does not speed resolution of a cyst already present.
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