Ovarian cysts are common in females of reproductive age. Most of these are harmless and go away naturally. However, some cysts may rupture and cause symptoms.
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth.
Ovarian cysts are not uncommon. Around 1 in 5 females develop at least one mass in their lifetime. Most of these are functional and do not require treatment.
However, complications can occur, such as cyst rupture, which may require prompt management.
This article discusses ruptured ovarian cysts, their symptoms, causes, diagnosis, and treatments. It also explores complications and other conditions related to ruptured ovarian cysts.
Symptoms
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A ruptured ovarian cyst often does not cause symptoms. If it does, they are usually mild.
The primary symptom is a sudden, severe, and sharp pain in the lower abdomen that may coincide with nausea and vomiting.
Other symptoms may include:
- irregular menstrual cycle
- vaginal bleeding
- fluid buildup in the abdomen
- pressure or heavy feeling in the pelvis
- pain during sex
A person who experiences abdominal or pelvic pain along with the following symptoms should seek immediate care:
- lightheadedness or weakness
- fainting
- heavy vaginal bleeding
- fever
- shortness of breath
- rapid heart rate
These symptoms might indicate complications such as ovarian torsion and infection, which require prompt medical attention.
What are ovarian cysts?
Ovarian cysts are fluid-filled sacs that form on one or both ovaries due to ovulation. When a person ovulates, a follicle that contains the egg ruptures to release the egg from the ovary.
Most cysts are functional and form from the follicles in the ovaries. There are two types of functional cysts:
- Follicular cysts: These form when a follicle does not break open to release the egg and turns into a cyst.
- Corpus luteum cysts: These develop after the follicle ruptures to release the egg.
A person with polycystic ovary syndrome (PCOS) has enlarged ovaries with multiple follicular cysts. This happens due to hormonal imbalances.
Doctors refer to other cysts as complex ovarian cysts. They usually form from abnormal cell growth. Some types include:
- Dermoid cysts: Also known as benign cystic teratomas, these cysts vary in appearance and come from cells present from birth. They may contain a range of tissues such as hair and teeth.
- Fibromas: These are solid masses made of connective tissue. They are slow-growing and usually appear only on one side.
- Cystadenomas: These cysts develop from the ovary’s surface and may contain some of the ovary’s tissues.
Causes
Most ovarian cysts are natural and occur as part of a person’s menstrual cycle. They are mostly benign and harmless. Some types may be ovarian malignancies that are not typical.
Experts do not know the reason why some cysts rupture. Below are potential reasons:
- size — larger cysts are more likely to burst
- sexual activity
- strenuous exercise
- abdominal trauma
- anticoagulation therapy — medicines that help prevent blood clots
A 2021 report states that only around 1% of women receiving anticoagulation therapy will have ruptured ovarian cysts.
Diagnosis
A doctor will ask about a person’s symptoms and take their medical history. They will also perform a pelvic exam along with a physical exam.
If they suspect a ruptured ovarian cyst, doctors will usually first check if a person is pre-or postmenopausal to determine whether the cyst is pregnancy-related. They will also ask them to take a urine pregnancy test.
Doctors will also use ultrasound to check the quality of the cysts and whether they have ruptured.
They may conduct further tests to rule out conditions with similar symptoms, including:
- Urine test: This is important to rule out kidney stones and urinary tract infection (UTI).
- Blood tests: A complete blood count can check for anemia. Doctors can also check for ovarian cancer.
- Endocervical swabs: This test checks for pelvic inflammatory disease (PID).
Treatment
Several treatment options are available. Management depends on the following factors:
- age and menopausal status
- size and appearance of the cyst
- presence of symptoms
- possible malignancy
Most people have noncomplex cysts. When these cysts burst but do not cause complications, doctors may recommend observation through a series of ultrasounds and prescribe pain medications.
A person showing complications such as severe bleeding requires hospitalization and urgent care. Management may include pain medications, monitoring of vital signs, repeated ultrasounds, IV fluids, and blood transfusion.
In severe cases, surgery may be necessary to stop blood loss and bleeding. Other indications for surgery include:
- persistent pain
- large cyst
- ovarian torsion
- signs of possible cancer
Complications
Ovarian cyst rupture can cause some complications when not given immediate attention:
- hemorrhage
- excessive bleeding and blood loss, especially if the cyst is large
Infections
Some cysts can form in people with pelvic infections such as abscesses or PID. If the cyst bursts, the infected contents may spread and trigger sepsis, a potentially life threatening response.
Ovarian torsion
Cysts can also cause the blood vessels that supply the ovaries to twist, leading to a common gynecological emergency called ovarian torsion. This can cut blood flow to the ovary, which may need removing.
Undergoing surgery also poses risks of complications, including:
- bleeding
- infection
- blood clots
- scar tissue
- poorly healing incision
- damage to structures such as vessels and nerves
- risks associated with anesthesia
Other conditions
Symptoms for ruptured ovarian cysts may mimic those caused by other conditions.
Ectopic pregnancy
A pregnancy is said to be ectopic when a fertilized egg implants outside the uterus, usually the fallopian tube. Sometimes, it implants in the ovary.
It can cause vaginal bleeding and sharp pain in the pelvic area. This condition can be a medical emergency if untreated.
Endometriosis
Endometriosis occurs when the lining of the uterus grows outside the uterus. It can affect fertility and increase the risk of ovarian cancer.
However, a 2017 study notes that 1 in 200 women with endometriosis would have ovarian cancer.
Symptoms may include:
- excessive and painful cramping pain in the abdomen and lower back
- pain during sex
- painful urination and bowel movements
- heavy or irregular menstrual flow
PID
A person with untreated sexually transmitted infections (STIs) such as chlamydia and gonorrhea can develop PID. But it can also develop from infections due to other causes.
PID is the inflammation of the reproductive organs — 1 in 8 women who have had PID may find it difficult to conceive.
Symptoms of PID include:
- pain in the lower abdomen
- fever
- pain or bleeding during sex
- vaginal discharge with a foul odor
- burning sensation when urinating
Appendicitis
Ruptured ovarian cysts usually cause lower abdominal pain in one side, a known symptom of appendicitis.
Appendicitis is the inflammation of the appendix. A person feels pain at the lower right side of their abdomen, near the belly button.
Appendicitis is a medical emergency. A ruptured appendix may cause widespread infection and can be life threatening.
Kidney stones
Kidney stones occur when minerals build up in a person’s kidneys.
Small stones may pass out of a person’s body unnoticed in their urine. But larger stones can cause severe pain when exiting the body.
When symptoms appear, they can include:
- pain in the groin, the side of the abdomen, or both
- blood in the urine
- vomiting and nausea
- fever and chills if there is an infection
- an increased need to urinate
If kidney stones block the tube that connects the kidney to the bladder, urine may not be able to pass from a person’s body. This can cause a kidney infection.
Symptoms of kidney infections include:
- fever
- weakness and fatigue
- diarrhea
- cloudy, foul-smelling urine
If a person experiences these symptoms, they should seek medical assistance immediately.
Other causes
Alternative potential causes of severe abdominal pain include:
- other benign tumors, such as hydrosalpinx and fibroids
- malignant tumors, such as stromal tumors and metastatic cancers
- interstitial cystitis
- irritable bowel syndrome (IBS)
- irritable bowel disease (IBD)
- gastrointestinal cancer
- diverticulitis
- pelvic kidney
- UTI
When to contact a doctor
People should attend a doctor’s clinic if they experience severe pelvic or abdominal pain. While there can be many causes, some can be life threatening if not treated early.
A person should seek immediate help if the severe abdominal pain comes with:
- severe nausea and vomiting
- dizziness and feeling faint
- fever
- heavy vaginal bleeding
Summary
Ruptured ovarian cysts are not uncommon and are a natural part of the menstrual cycle. Most do not require treatment, but some may cause pain and other symptoms.
People experiencing pelvic pain should immediately consult a doctor for thorough evaluation and treatment. Doctors treat most ruptured ovarian cysts with pain relief, but some may need surgical removal.
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