Xiao Li, who had just joined the workforce, was found to have a 2.5 cm cyst on her left ovary during her physical examination. The doctor reminded her that she should come for a review in 3 months and the cyst may disappear on its own or it may continue to grow. If the cyst does not disappear and grows, surgery may have to be considered! Xiao Li was a bit scared at that time and followed the doctor’s advice to have regular checkups, unfortunately the cyst grew to 5 cm in the following 3 years. Xiao Li began to hesitate, she was just 25 years old and not yet married, should she have surgery or not? This is actually a problem for many patients, and today we will talk about this topic. Cysts that will disappear on their own within 3 months No special treatment is needed Let’s first explain why Xiao Li’s doctor mentioned that the cysts may disappear on their own after 3 months of review. Ovarian cysts that disappear as mentioned here are usually closely related to the menstrual cycle and are also called physiological ovarian cysts, of which follicular cysts and luteal cysts are the most common. Follicular cysts are mostly formed when follicular fluid is not absorbed or increases and collects in the follicle after the follicle does not ovulate for various reasons; luteal cysts are formed when the corpus luteum persists after ovulation with bleeding and blood accumulates inside the corpus luteum, making it larger. They are usually 1 to 3 cm in diameter and most of them disappear on their own within 3 months with the menstrual cycle and hormonal changes in the body and do not require special treatment. Cysts that do not disappear can be risky if not operated Then if the cysts do not disappear within 6 months of review and follow up and have a tendency to grow, pathological cysts should be suspected. Pathological ovarian cysts include plasmacytic cystadenoma, mucinous cystadenoma, benign cystic teratoma, and chocolate cyst. But as long as the ovarian cysts are pathological, do they have to be operated? Can I skip surgery now that I don’t have any symptoms? If the cyst is less than 5 cm in diameter and has not grown on review, you can continue to review it regularly. However, if the cyst is larger than 5 cm, not having surgery means that you are carrying a “time bomb” and may be at risk of: 1) torsion, rupture and infection: 10% of ovarian cysts may have torsion. What is torsion? A normal ovary is held in place by the surrounding ligaments and does not swing around, but when a cyst grows on the ovary, it increases in size and weight (see below). If you suddenly change position, the cyst can twist taking the ovary, the fallopian tubes and the ligaments used to hold the ovary together. As you can imagine after torsion, the blood cannot flow and the cyst starts to fill with blood and grow rapidly, even undergoing necrosis and turning purple-black, which may then rupture or induce infection. The corresponding symptoms of the patient are severe pain in the lower abdomen, nausea and vomiting or even shock. Even if there is no torsion, because many cysts are filled with liquid and the outer membrane is very thin, abdominal impact, childbirth, sexual intercourse, gynecological examination and puncture may cause cyst rupture, which may also cause the above symptoms. 2. Infertility: large cysts can destroy ovarian tissues, causing ovarian dysfunction, non-ovulation, adhesion to surrounding tissues and obstruction of fallopian tubes, etc. All these conditions can cause infertility. 3. Compression symptoms: Larger ovarian cysts may also compress surrounding organs, such as the bladder and large intestine, resulting in difficulty urinating, frequent urination, urgency or poor bowel movement. 4. Malignancy: Although the majority of ovarian cysts are benign, there is still a 2-4% deterioration rate. Malignant ovarian cysts can have no obvious symptoms in the early stages and are easily overlooked. When patients have cysts on both sides and the tumors are found to be growing rapidly, or ultrasound reveals solid components or blood flow signals inside the cysts, they all indicate the possibility of malignancy and need timely surgical treatment. Therefore, we should not take a chance, especially for patients with fertility needs, it is better to listen to the doctor’s advice and do not delay when it is time to operate. Finally, to summarize: (1) after the discovery of ovarian cysts, if the diameter of <5 cm, suspected physiological cysts can be observed for 3 months, the tumor shrinks or disappears without much attention; (2) half a year cysts do not disappear, the diameter of <5 cm, the examination considered benign cysts, and the review process did not grow, you can choose temporary observation; (3) if half a year does not disappear, the diameter of >5 cm, and there is a tendency to continue to grow (3) if the cyst does not disappear in six months, has a diameter > 5 cm, and has a tendency to continue to grow, and is considered benign after examination, the surgery should be elective (elective surgery means that the date of surgery is selected at a time convenient to the patient in consultation with the hospital); (4) if malignancy is suspected, the surgery should be performed immediately. So how can you know if a cyst is benign or malignant before surgery? Let’s talk about it in the next article.