A Ruptured Ovarian Cyst Can Cause Intense Pain—Here's What You Need to Know
Unless you're ovulating, menstruating, or struggling with fertility issues, you probably don't give much thought to your ovaries—the pair of organs on either side of your uterus that produce eggs and female hormones.
But even though they might not be on the top of your mind at most times, they can be the home to cysts at any time. Ovarian cysts are common, according to the Office on Women's Health. Often, ovarian cysts don't come with symptoms and are usually harmless—but some people can experience what's known as a ruptured ovarian cyst.
The good news: Most of the time, ruptured cysts cause no symptoms or only mild symptoms, according to Johns Hopkins Medicine—and on its own, a ruptured cyst is rarely a medical emergency. But if it's causing extreme pain or severe bleeding, a ruptured cyst could be life-threatening. Here's what you need to know about ruptured cysts, including the most common symptoms and how doctors typically treat them.
What is an ovarian cyst?
An ovarian cyst is a fluid-filled, sac-like structure in the ovary. While these cysts can grow on the outside of an ovary, most of the time they grow inside the ovary, like a yolk is inside an egg, Sawsan As-Sanie, MD, an associate professor and the director of minimally invasive gynecological surgery at Michigan Medicine, tells Health.
There are many types of ovarian cysts, and what's inside your cyst will depend on what type of cyst you have, Ja Hyun Shin, MD, director of minimally invasive gynecological surgery at Weill Cornell Medicine/New York-Presbyterian Hospital, tells Health. According to the Mayo Clinic, cysts can be abnormal, which means they're unrelated to the function of your menstrual cycle; or functional, which occur at different points of your menstrual cycle (these types of cysts are the most common). The types of both functional and abnormal cysts include:
- Follicular cysts: A follicular cyst is a functional cyst that forms when the follicle doesn't rupture or release its egg when it usually would at the midpoint of your cycle, instead continuing to grow.
- Corpus luteum cysts: "When a follicle releases its egg, it begins producing estrogen and progesterone for conception. This follicle is now called the corpus luteum," as the Mayo Clinic explains this type of functional cyst. "Sometimes, fluid accumulates inside the follicle, causing the corpus luteum to grow into a cyst."
- Dermoid cysts: Also known as teratomas, these abnormal cysts can contain tissue, such as hair, skin, or teeth because they form from embryonic cells.
- Cystadenomas: These abnormal cysts can be filled with a watery or a mucous material and develop on the surface of an ovary.
- Endometriomas: These are filled with endometrial tissue and develop as a result of endometriosis, when your uterine endometrial cells grow outside of your uterus.
Cysts typically occur in premenopausal people, with those with polycystic ovary syndrome being at an increased risk for developing cysts, according to Dr. Shin. And again, for the most part, they often go unnoticed. "Cysts are very common, and the majority of times they're actually harmless and women might not even know that they have them," Dr. Shin says.
However, sometimes a cyst makes itself known—either by causing irritation on its own or by rupturing.
What is a ruptured ovarian cyst?
A cyst ruptures when the ovary tissue bursts, opening up the cyst wall, and exposing the fluid that was in the cyst to your abdominal cavity. Smaller cysts are less likely to rupture, but when cysts get larger, and the ovarian tissue surrounding the cyst becomes thinner and thinner, it has a greater likelihood of rupturing, according to Dr. Shin.
Besides its size, another factor that can determine whether a cyst ruptures is if you've done any vigorous activity that affects the pelvis. Many people who have had a ruptured cyst will report having recently had sex or strenuous exercise. But that doesn't mean you should restrict your lifestyle in anyway to avoid rupturing a cyst, Dr. Shin says.
Now, it's actually common for functional cysts to rupture, according to Dr. As-Sanie. In fact, they're the type of cyst that most often ruptures. "A lot of times when patients are seen and say they had pain from a ruptured cyst and you see a small amount of fluid in the pelvis, that often just is normal physiology of the ovaries in a patient who is in reproductive years and is ovulating and has the potential to get pregnant," she explains.
As for the abnormal cysts (again, cysts that don't have a physiologic function), Dr. As-Sanie says those rarely spontaneously rupture. That's because they have a thicker cyst wall, according to Dr. Shin.
What are the symptoms of a ruptured ovarian cyst?
Sudden onset pain in your pelvic area is the hallmark symptom of a ruptured ovarian cyst. That pain can happen before, during, or after the rupture, Dr. Shin says. The pain following the rupture may last several days; that's because the fluid from the cyst can be irritating after it's released into your abdominal cavity and before your body absorbs it.
Usually, most ruptures cause only mild to moderate symptoms, without serious complications, that can be easily managed. When it comes to a functional cyst rupture, specifically, the pain usually lasts just a couple hours to a day and then goes away on its own or with the help of pain medication, according to Dr. As-Sanie.
But other times, "it can be quite painful," Dr. Shin says. "And oftentimes women will come to the emergency room reporting really severe, intense, acute, sharp pain, kind of not knowing exactly what hit them."
The spot you feel the pain could be where the cyst is, but not necessarily. And then once it's ruptured, the pain can be felt pretty much anywhere in the pelvis since the fluid from the cyst can collect in different areas of the abdominal cavity, according to Dr. Shin.
Besides pain, you can also sometimes have more vague symptoms leading up to a rupture, like nausea, vomiting, abdominal fullness, and bloating, Dr. Shin says.
But as Dr. As-Sanie points out, acute pelvic pain can be tied to a number of conditions—including anything from a urinary tract infection to a kidney stone—and doesn't automatically mean you have a ruptured ovarian cyst. "It's not like I would say that you have unremitting pain and the first thing you should think of is you might have a ruptured cyst," she says. Rather, if you have acute pain that is interfering with your ability to do usual activities like walk and use the bathroom and is unrelieved with over-the-counter medications, Dr. As-Sanie recommends that you contact your doctor.
If your pain is severe and accompanied with nausea, vomiting, and fever, you should go to the emergency room. If the only symptom you're experiencing is pain that's not too severe, then you can schedule a trip to your primary care physician or ob-gyn.
If you don't have established care with any doctor, then it'd be appropriate to go to an urgent care or an emergency department, Dr. As-Sanie says.
How is a ruptured ovarian cyst diagnosed and treated?
Again, there are many potential causes of pelvic pain. So when you go to your doctor for your acute pelvic pain, they will need to figure out exactly what the cause of that pain is. Based on your symptoms and exam findings, the doctor will determine what laboratory tests you need, as well as whether any imaging test is needed, according to Dr. As-Sanie.
The imaging might help your doctor make a retrospective diagnosis. "In theory, if someone has a cyst that was ruptured, then the cyst isn't actually potentially visible on imaging anymore. So really all you know is that they had pain," Dr. As-Sanie says. The imaging might show that there's some fluid in your abdominal cavity, but that alone might not be enough to make a diagnosis. It would be the imaging—along with knowing that the pain has resolved over time—that can allow for a doctor to assume a cyst had ruptured. "Patients often get that label [that maybe a cyst ruptured], but there's nothing to actually confirm or exclude that a cyst was ruptured," she says.
Usually, other than keeping track of symptoms, taking pain medication, and possibly scheduling a follow-up ultrasound, there is no treatment necessary for something believed to be a ruptured cyst. An exception would be if after the cyst ruptures, the pain doesn't let up and there are signs of irritation from the cyst's fluid in your abdominal cavity or internal bleeding—emergency surgery might be needed at that point, Dr. As-Sanie says.
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