Should I treat ovarian cysts found on my first ultrasound? What is the problem with ovarian cysts that “disappear”? At the end of the year, many organizations organize medical checkups for their employees, and then consult with doctors with the medical reports. The more common ones are ovarian cysts, ranging from 1 to 2 cm in size to 4 to 5 cm in size. Do you need surgery? Usually I would ask her: Have you ever had an ultrasound before to find an ovarian mass? Was this ultrasound done before or after the menstrual period? Let me start by telling you about a patient I once saw, which is still fresh in my mind. She was referred to the hospital by an acquaintance and was diagnosed with an ovarian cyst of about 6cm x 5cm, and she had her period during her hospitalization before she could have surgery, so she was discharged and instructed to review the ultrasound after her period. A few days later, an acquaintance called me and told me that the ovarian cysts were gone on the ultrasound and she would not be hospitalized. I was happy for her and a little scared. The question is, why did such a large ovarian cyst suddenly “disappear”? It turns out that these “disappearing” ovarian cysts are physiological cysts, not real ovarian cysts. They are likely to occur in women of childbearing age and are caused by an excessive physiological response of the ovaries themselves or by drug stimulation. Among them, follicular cysts and corpus luteum cysts are the most common, mostly unilateral, thin-walled, ≤6 cm in diameter, usually 1 to 3 cm in diameter and a few up to 5 to 6 cm in diameter, without obvious symptoms, mostly detected occasionally by ultrasonography. Follicular cysts are formed due to non-ovulation of mature follicles or the persistence of atretic follicles that retain follicular fluid. The vast majority of them can disappear on their own within two months and do not require special treatment. In contrast, luteal cysts are associated with the persistence of the corpus luteum after ovulation and with bleeding and plasma exudation, and the corpus luteum can also increase in size to become a luteal cyst during pregnancy. Luteal cysts in infertile women usually disappear in about 2 months, and luteal cysts in pregnancy usually disappear spontaneously after 3 months of pregnancy. Both follicular cysts and corpus luteum cysts are formed after ovulation, so we just need to review the ultrasound 1 to 2 days after menstruation to find out that the cysts are gone. Non-redundant ovarian cysts – ovarian neoplastic lesions Follicular cysts and corpus luteum cysts are both ovarian neoplastic lesions, also known as non-redundant ovarian cysts, which occur mostly in women of childbearing age, and also include flavin cysts, polycystic ovaries, ovarian chocolate cysts, etc. Luteinizing cysts are mostly seen in trophoblastic tumors (e.g., staphyloma, choriocarcinoma) and are formed by luteinization of follicular membrane cells due to massive chorionic gonadotropin stimulation. The luteinizing cysts may subside on their own after clearance and expulsion of the gravida or after treatment of erosive gravida or choriocarcinoma. Polycystic ovaries and ovarian chocolate cysts are benign ovarian lesions and can be diagnosed by blood sampling for basic hormones and tumor markers. In addition to non-redundant ovarian cysts, there are also redundant ovarian cysts, or pathological ovarian tumors, which are divided into benign ovarian cysts and malignant ovarian tumors, both of which require open surgery. Benign ovarian cysts have a long course and gradually increase in size; they are mostly unilateral, active, with a smooth surface and no ascites, and on ultrasound they are liquid dark areas with interval light bands and clear margins. Depending on the size of the cyst, open or laparoscopic surgery is chosen. Depending on the age and size of the cyst, cyst debridement or unilateral adnexal resection should be performed. Ovarian malignant tumors have a short course, fast progression and rapid increase in size; they are mostly bilateral, fixed, solid or cystic, with an uneven, nodular surface; they are often accompanied by ascites, mostly bloody, and cancer cells can be detected; they have poor appetite and are emaciated. Ultrasound examination of the liquid dark area with disorganized light clusters and dots, and unclear boundaries of the mass. Further examination is feasible with magnetic resonance, tumor markers CA125, CA199, HE4, CEA and AFP determination. Try to surgical exploration for clear diagnosis, staging, tumor reduction, and postoperative chemotherapy to prolong life. Therefore, for ovarian cysts detected by ultrasound, do not be too nervous and anxious if it is the first time. For ovarian cysts ≤6 cm in diameter (ultrasound shows a liquid dark area), you can observe or take short-acting oral contraceptives for 2-3 months and review the ultrasound 1 to 2 days after menstrual cleansing. If the cyst is physiological, it may disappear on its own. If ovarian cysts persist or increase in size, ovarian tumors are more likely. It is recommended to go to a regular hospital for examination and treatment, and cooperate with the doctor for examination and treatment. Do not over-medicate, but also do not delay the condition.