Treatments
Ovarian cysts
Has a change been seen on one of your ovaries, or does your doctor want to investigate? Usually this is a cyst. Most cysts are benign.
At Femmecare we find out what it is, and decide together with you whether watchful waiting or treatment suits you best.
What is it?
What is an ovarian cyst?
A change on the ovary is usually a cyst: a sac on the ovary filled with fluid. There are different types of cyst. Most are benign.
A cyst is often found by chance, for example during an ultrasound scan for other symptoms. Sometimes further tests are needed to find out what kind of cyst it is.
Often an incidental findingMost cysts are found on an ultrasound scan carried out for another reason.
In figures
Usually good news
A benign cyst that causes no symptoms often needs no treatment. The figures show:
- Over 80%of women with a benign cyst and no symptoms ultimately need no procedure.
- 1 in 3benign cysts disappear on their own in women who have not yet been through the menopause. After the menopause it is 1 in 13.
- 1 in 1,000is the chance that a cyst which looks benign is in fact malignant, before the menopause. After the menopause it is 7 in 1,000.
- < 1%is the chance that a benign cyst ruptures, or that the ovary twists, during the monitoring period.
Source: Dutch NVOG guideline Het vergrote ovarium, module ‘Chirurgie versus expectatief’ (2021).
Symptoms
Which symptoms can you have?
If you do have symptoms, they may include:
- Abdominal pain
- A swollen abdomen or a feeling of fullness
- Needing to pass urine often or urgently
- Constipation
- Weight loss or nausea
- Pain during sex
Most women with a cyst have no symptoms.
Your visit
What do the tests involve?
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A conversation
The doctor will ask you questions, for example:
- about your age and whether you have been through the menopause
- whether ovarian, breast or bowel cancer runs in your family
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Examination and ultrasound
The doctor then performs an internal examination and an internal ultrasound scan, showing how large the cyst is and what it looks like.
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Sometimes further tests
If the doctor is unsure what kind of cyst it is, a specialist at the hospital performs another ultrasound scan, sometimes followed by an MRI scan. Blood tests are occasionally needed.
Watch and wait, or treat?
A benign cyst without symptoms
What we do depends on your symptoms, the type of cyst, its size and whether you have been through the menopause. For a cyst that looks benign and causes no symptoms, the following usually applies:
Smaller than 5 cm
Monitoring is often unnecessary. After the menopause, some cysts are monitored.
5 to 10 cm
Usually watchful waiting, with ultrasound scans after 3, 6 and 12 months. If the cyst stays the same, monitoring stops. If it grows or you develop symptoms, the doctor will discuss surgery.
10 cm or larger
Surgery is usually needed. For this we refer you to a hospital.
Deciding together. For a benign cyst of 5 to 10 cm without symptoms, you decide together with the doctor: leave the cyst in place, or have it removed. A decision aid helps with this.
- Do you have symptoms? The doctor will discuss with you whether surgery is sensible.
- Any doubt that the cyst is benign? We then refer you to a hospital gynaecologist who specialises in cancer.
Good to know
What we do and do not do
Not at Femmecare
- Surgery on the ovary; for this we refer you to a hospital. It is usually done by keyhole surgery.
- Further tests and treatment where there is doubt whether a cyst is benign; for this we refer you to hospital
Available at Femmecare
- Consultation, internal examination and internal ultrasound
- Ultrasound monitoring during watchful waiting
- Deciding together whether to watch and wait or treat
- Referral to, and liaison with, the hospital where needed
Our approach
What can you expect?
- Careful assessment, with an ultrasound scan at our clinic
- A clear explanation of what has been seen
- Deciding the next step together
For GPs
Referring patients with an adnexal mass
Diagnosis and management of ovarian cysts and adnexal masses in line with the Dutch NVOG guideline Het vergrote ovarium (2023). Surgery is not performed at Femmecare; where there is an indication for surgery we refer on.
ZorgDomein: ‘Femmecare Clinics’
Reasons to refer
- Sonographically abnormal ovary, including as an incidental finding
- Symptoms consistent with an adnexal mass
- Follow-up of a benign-looking ovarian cyst
Acute abdominal pain with a known enlarged ovary (suspected torsion): straight to hospital.
What we offer
- Transvaginal ultrasound, reported using IOTA terminology (Simple Rules)
- Where the nature is uncertain: expert adnexal ultrasound at the hospital, with MRI if needed
- Watchful waiting with ultrasound checks at 3, 6 and 12 months where indicated
- Shared decision-making using the Dutch decision aid Eierstokcystes
- Where malignancy is suspected: referral to a gynaecological oncologist
First, finding out what it is
Has a change been seen on one of your ovaries, or do you have symptoms that could fit? You can discuss a referral to Femmecare with your GP.