Are cysts in the pelvis bad? Understanding the risks and treatment

September 28, 2025 •

5 min read

It's estimated that the majority of women will develop at least one ovarian cyst during their lifetime, often without ever knowing. This common occurrence can raise serious concerns, prompting the question: Are cysts in the pelvis bad? The truth is that while most are benign, certain symptoms and cyst characteristics warrant closer attention from a healthcare provider.

Quick Summary

Most pelvic cysts are harmless and resolve on their own, but they can occasionally lead to complications such as rupture or torsion. Regular monitoring and awareness of concerning symptoms, including severe pain or irregular bleeding, are crucial for determining if a cyst requires treatment or further evaluation.

Key Points

Most are harmless: Functional cysts are the most common type, are benign, and typically resolve on their own, especially in premenopausal women.
Size and complexity matter: Larger cysts (over 6 cm) and those with solid components require closer monitoring and may be more likely to cause complications.
Emergency symptoms: Sudden, severe pelvic pain, especially with nausea or fever, can indicate a ruptured cyst or ovarian torsion and requires immediate medical attention.
Diagnosis is key: A healthcare provider will use a pelvic exam, ultrasound, and sometimes other imaging or blood tests to accurately diagnose and characterize a cyst.
Treatment varies: Management can range from watchful waiting to medication or surgical removal, depending on the cyst's type, size, and symptoms.

What are Pelvic Cysts?

A cyst is a fluid-filled sac that can develop in various parts of the body. In the pelvic region, these sacs most commonly form on the ovaries, but they can also appear on or near other structures. While the term "ovarian cyst" is frequently used, not all pelvic cysts are ovarian in origin. These sacs can contain a variety of materials, from thin fluid to blood or other semi-solid matter, and their composition is a key factor in assessing potential risk.

Common Types of Ovarian Cysts

Functional Cysts: These are the most frequent type and are a normal part of the menstrual cycle. They are almost always benign and typically disappear on their own within a few cycles. There are two main kinds:
- Follicular Cysts: Occur when a follicle (the sac that holds an egg) fails to rupture and instead continues to grow.
- Corpus Luteum Cysts: Form when the follicle releases its egg and then reseals itself, causing fluid to accumulate inside.
Dermoid Cysts (Teratomas): These growths are formed from cells present at birth and can contain various types of tissue, such as hair, teeth, or skin. They are rarely cancerous but can grow large and cause problems if they twist.
Cystadenomas: These cysts grow on the surface of an ovary and can become quite large. They are filled with a watery or mucous-like fluid.
Endometriomas: Also known as "chocolate cysts," these are caused by endometriosis, a condition where endometrial-like tissue grows outside the uterus. They can cause significant pain, particularly during menstruation.

When Should You Worry About a Pelvic Cyst?

For many, a pelvic cyst is discovered by chance during a routine exam and requires no intervention. However, certain signs and circumstances indicate that a cyst is more than just a temporary inconvenience. It is vital to be aware of these potential red flags and to contact a healthcare provider immediately if you experience them.

Key indicators of a potentially problematic cyst include:

Sudden, severe pelvic pain: This could signal a ruptured cyst or ovarian torsion, where the ovary twists on its blood supply. Both are medical emergencies.
Pain accompanied by fever, nausea, or vomiting: These symptoms, especially with sudden pain, are strong indicators of a serious complication.
Changes in your menstrual cycle: Unusually heavy or lighter periods, or bleeding between cycles, can sometimes be linked to cysts.
Persistent abdominal bloating or a feeling of fullness: While these are common and often benign symptoms, they can be associated with a growing cyst.
Pain during sex or bowel movements: A large or particular type of cyst can press on surrounding organs, causing discomfort.
Increased size or complex features: Cysts that grow larger than 10cm or have solid components are more likely to require closer observation or removal. This is especially true for women after menopause, who have a slightly elevated risk of ovarian cancer.

Functional vs. Complex Cysts: A Comparison

To better understand the differences between typically harmless and potentially concerning cysts, consider the table below:


Feature	Functional Cysts	Complex/Concerning Cysts
Commonness	Very common, part of the menstrual cycle	Less common, may indicate an underlying condition
Cause	Normal hormonal fluctuations during ovulation	Result from specific conditions like endometriosis, genetics, or abnormal growth
Appearance (on ultrasound)	Thin-walled, fluid-filled, uniform	Thick-walled, multiple chambers, solid components
Spontaneous Resolution	Very likely to disappear on their own	Often do not resolve and may grow larger
Risk Level	Very low risk of complications or malignancy	Higher risk of rupture, torsion, or malignancy
Management	Watchful waiting, follow-up imaging	Close monitoring, medication, or surgical removal

How Pelvic Cysts are Diagnosed

If a cyst is suspected based on symptoms or a routine exam, a healthcare provider will recommend further tests. The diagnostic process aims to determine the cyst's size, composition, and potential for complications.

Pelvic Exam: A physical examination can sometimes reveal an enlarged ovary or a mass.
Pelvic Ultrasound: This is the most common and effective tool for evaluating a pelvic mass. It uses sound waves to create an image, allowing the doctor to see the cyst's size, shape, and internal structure.
Blood Tests: A CA-125 test may be ordered. This test measures a protein that can be elevated in some women with ovarian cancer, but it is not a definitive diagnostic tool. It can also be elevated in non-cancerous conditions like endometriosis or fibroids.
Advanced Imaging: In some cases, a CT scan or MRI may be used to provide a more detailed image of the cyst and surrounding pelvic organs.

Management and Treatment Options

Once a diagnosis is made, the course of action depends on the cyst's characteristics, the patient's symptoms, and their overall health profile.

Watchful Waiting: For small, simple, functional cysts, the most common approach is simply monitoring. The provider may schedule a follow-up ultrasound in a few months to ensure the cyst has resolved or hasn't grown.
Medication: Hormonal birth control pills can prevent ovulation, which in turn reduces the risk of new functional cysts from forming. However, they do not shrink existing cysts.
Surgical Intervention: A doctor may recommend surgery to remove a cyst if it is large, persistent, causing significant pain, or if there's any suspicion of cancer. The type of surgery depends on the situation:
- Laparoscopy: A minimally invasive procedure where the surgeon removes the cyst through small incisions using a lighted instrument called a laparoscope. This typically results in a shorter recovery time.
- Laparotomy: An open procedure with a larger incision, which may be necessary for very large cysts or in cases where cancer is a concern.

Final Thoughts

While the thought of having a pelvic cyst can be alarming, it's reassuring to know that the vast majority are benign and pose little risk. The key is to listen to your body and not ignore persistent or severe symptoms. Regular check-ups with a gynecologist are the best way to ensure any changes are caught and addressed early. By understanding the different types of cysts and when to seek medical help, you can approach your health with greater knowledge and peace of mind.

For more information on ovarian health and other gynecological topics, visit the American College of Obstetricians and Gynecologists website.

Frequently Asked Questions

A simple cyst is a thin-walled, fluid-filled sac that is almost always benign. A complex cyst is more concerning, as it may contain solid tissue, thick walls, or multiple chambers, which can indicate a higher risk of complications or malignancy.

Yes, but it is rare. The vast majority of cysts are benign. The risk of cancer increases with age, particularly in postmenopausal women, and with certain cyst characteristics like large size or complexity. A doctor can assess the risk based on imaging and blood tests.

Most functional cysts do not interfere with fertility. However, certain types like endometriomas can be associated with underlying conditions (endometriosis) that may affect fertility. Surgery to remove a cyst is sometimes performed to preserve fertility.

Ovarian torsion is a painful medical emergency where a cyst grows large enough to cause the ovary to twist on its blood supply. This cuts off blood flow, causing sudden and severe pelvic pain, often with nausea and vomiting. It requires immediate surgery.

Many cysts, particularly functional ovarian cysts that form during the menstrual cycle, will disappear on their own within one to three months. Complex cysts or those related to other conditions are less likely to resolve naturally.

For functional cysts, taking hormonal birth control pills can prevent ovulation and reduce the formation of new cysts. Other types of cysts are not preventable. The best approach is regular pelvic exams and prompt consultation with a doctor for concerning symptoms.

Surgery may be recommended if a cyst is very large (e.g., over 10 cm), causes persistent and severe symptoms, appears complex or suspicious on an ultrasound, or does not resolve over time. For functional cysts, surgery is rarely needed.