How Are Ovarian Cysts Removed?

Ovarian cysts are fluid-filled sacs that form on or inside an ovary. Most of them are benign and go away on their own without any treatment. When a cyst does need to be removed, it is typically done through surgery — either laparoscopy (small incisions) or laparotomy (a larger incision), depending on the cyst’s size, type, and whether cancer is suspected. In some cases, a doctor may first drain the cyst using a thin needle guided by ultrasound.

What Are Ovarian Cysts and Why Do They Form?

The ovaries normally produce cysts as part of the menstrual cycle. These are called functional cysts, and they are the most common type.

During a typical cycle, an egg grows inside a small sac called a follicle. When the egg is ready, the follicle breaks open and releases it. Sometimes the follicle doesn’t rupture — the fluid stays inside and forms a follicular cyst. Other times, the follicle releases the egg but then seals back up and fills with fluid, creating a corpus luteum cyst. Both types usually shrink and disappear within a few menstrual cycles.

Other cysts are not related to the normal cycle. These include:

• Dermoid cysts (also called mature teratomas) — contain tissue like hair, skin, or teeth. They are almost always benign but can grow large.
• Endometriomas — form when endometrial tissue grows on the ovary, often linked to endometriosis.
• Cystadenomas — develop from ovarian surface cells and can become quite large.
• Pathological cysts — these are not part of the normal cycle and may need removal.

Most ovarian cysts cause no symptoms. When they do, the most common complaints are pelvic pain, bloating, or a feeling of fullness. A cyst can also twist (torsion) or rupture, which causes sudden severe pain and requires immediate medical attention.

When Does an Ovarian Cyst Need to Be Removed?

Not every cyst needs surgery. In fact, many doctors recommend watchful waiting — repeating an ultrasound in a few weeks or months to see if the cyst shrinks on its own. This is especially common for functional cysts in premenopausal women.

Surgery is generally considered when:

• The cyst is large — often larger than 5 to 10 centimeters, though size alone isn’t the only factor.
• The cyst doesn’t go away or keeps growing after several cycles of monitoring.
• Imaging shows features that raise concern for cancer.
• The cyst causes persistent pain or other symptoms.
• The cyst has twisted or ruptured (this is a medical emergency).
• The woman is postmenopausal — the risk of ovarian cancer rises after menopause, so doctors tend to be more cautious.

Blood tests like CA-125 can help assess cancer risk in some women, but this test is not reliable for all situations. It can be elevated for reasons other than cancer, and it can be normal when cancer is present. Doctors use it alongside imaging and clinical judgment, not as a standalone test.

How Are Ovarian Cysts Removed?

There are three main approaches to removing an ovarian cyst. The choice depends on the cyst’s size, its appearance on imaging, the woman’s age, and whether cancer is suspected.

Laparoscopy

This is the most common method for removing benign-appearing cysts. The surgeon makes a few small incisions in the abdomen — usually less than a centimeter each. A thin tube with a camera (laparoscope) is inserted through one incision. Surgical instruments go through the others.

The surgeon then removes the cyst while preserving as much healthy ovarian tissue as possible. This procedure is called a cystectomy. In some cases, the entire ovary may need to be removed (oophorectomy) if the cyst is large or the ovary is damaged.

Laparoscopy usually means less pain after surgery, smaller scars, and a faster recovery compared to open surgery. Most women go home the same day or the next day.

Laparotomy

If the cyst is very large, if cancer is suspected, or if the surgeon needs a wider view, an open procedure called a laparotomy may be used. This involves a larger incision — typically several inches — in the lower abdomen.

Laparotomy allows the surgeon to remove the cyst or ovary and, if needed, take tissue samples for biopsy. Recovery takes longer than with laparoscopy. Hospital stays of a few days are common.

Ultrasound-Guided Drainage

In some situations, a doctor may drain a cyst using a needle guided by ultrasound. This is less invasive than surgery, but it is not appropriate for all cysts. Drainage alone does not remove the cyst wall, so the cyst can come back. It is sometimes used for women who are not good candidates for surgery or as a temporary measure.

If cancer is confirmed or strongly suspected, the surgical plan changes. The surgeon may need to remove the ovary, the fallopian tube, and possibly other tissue. This is a different situation from removing a benign cyst, and it involves a separate discussion with a gynecologic oncologist.

What Happens During Recovery?

Recovery depends on which type of surgery was done and the woman’s overall health.

After laparoscopy, many women return to normal activities within one to two weeks. Some soreness around the incisions is normal. Shoulder pain can occur because gas used during surgery can irritate the diaphragm — this usually goes away within a few days.

After laparotomy, recovery typically takes four to six weeks. Lifting heavy objects and strenuous exercise should be avoided during this time to allow the incision to heal.

In both cases, doctors usually recommend:

• Keeping incisions clean and dry.
• Taking pain medication as prescribed.
• Walking gently to help prevent blood clots.
• Watching for signs of infection — fever, increasing redness, or discharge from the incision.

Most women recover fully. If only the cyst was removed and the ovary was preserved, fertility is usually not affected. If an ovary was removed, the other ovary can still produce eggs and hormones in most cases.

Can Ovarian Cysts Be Prevented?

Most ovarian cysts cannot be prevented because they are part of normal ovarian function. However, hormonal birth control — pills, patches, or rings — can reduce the formation of functional cysts. This is because these methods stop ovulation, and without ovulation, functional cysts are less likely to form.

That said, hormonal birth control does not prevent all types of cysts, such as dermoid cysts or cystadenomas. And it is not typically prescribed for the sole purpose of preventing cysts unless a woman has a history of problematic cysts or a condition like polycystic ovary syndrome (PCOS).

Regular pelvic exams and ultrasounds can help monitor cysts that have been found. If you have a known cyst, your doctor will likely recommend follow-up imaging to see whether it changes over time.

What Are the Risks of Cyst Removal Surgery?

Any surgery carries some risk. For ovarian cyst removal, potential complications include:

• Infection at the incision site.
• Bleeding.
• Damage to nearby organs, such as the bladder or bowel — this is uncommon but possible.
• Adhesions (scar tissue) that can form after surgery and sometimes cause pain later.
• Loss of ovarian function if a large portion of the ovary must be removed.

The risk of these complications is generally low, especially with laparoscopy. But it is not zero. Talking with your surgeon about their experience and your specific situation is important.

One thing to keep in mind: removing a cyst does not guarantee it won’t come back. New cysts can form later. This is especially true if you have a condition like endometriosis or PCOS that makes cysts more likely.

When Should You See a Doctor?

See a doctor if you have pelvic pain that is severe, sudden, or accompanied by fever or vomiting. These can be signs of a twisted or ruptured cyst, which is a medical emergency.

Also see a doctor if you notice bloating, pressure, or fullness in your abdomen that doesn’t go away. These symptoms can have many causes, but they are worth checking — especially if they are new and persistent.

If you have a known ovarian cyst, follow your doctor’s recommendations for monitoring. Most cysts are harmless. But regular check-ups help ensure that any changes are caught early.