For functional cysts <5 cm, watchful waiting is usually sufficient as around 80% will resolve on their own. A repeat scan in 6-12 weeks will usually confirm that the cyst has disappeared. Cysts that are larger than 10 cm, or those that are persistent, or causing symptoms such as pain often require surgery. Surgery can usually be performed using laparoscopy during which, the cyst is separated from the remainder of the ovary and removed through very tiny incisions.
Endometriomas can be separated from the remainder of the ovary and removed using laparoscopy; this is the preferred treatment. They can also be opened and drained, followed by burning of the cyst walls using electrical energy to try to prevent the cyst from recurring.
Ovarian torsion is a medical emergency and requires immediate surgery. This can be performed via laparoscopy which allows the ovary to be untwisted thereby re-establishing blood flow to the ovary. The cyst that caused torsion to occur can then be removed. Laparoscopic untwisting (or detorsion) is effective in salvaging the ovary in around 90% of cases.
In some cases when cysts are very large, or in women who have already entered the menopause, treatment may involve removing the entire ovary along with the contained cyst.
If there is a high suspicion that a cyst may be malignant, urgent referral to a specialist in gynaecological cancer is advisable.