Children's Hospital Colorado

Ovarian Cysts in Girls and Teens

What are ovarian cysts?

Ovarian cysts are fluid-filled sacs located within the ovaries. Many girls and women develop ovarian cysts at some point, but most cysts are painless and harmless. In fact, a majority of ovarian cysts resolve themselves without treatment within a couple of months.

Some ovarian cysts can cause more serious symptoms and require treatment. For these more serious cysts, our care team at Children's Hospital Colorado will evaluate the cyst and work with a multidisciplinary team to develop the appropriate care plan.

What causes ovarian cysts in girls?

Different cell types found in ovarian tissue cause different types of ovarian cysts. Many cysts develop as a result of the menstrual cycle, but less common cysts can develop in other ways.Medical illustration of non-surgical cysts: follicular ovarian and hemorrhagic.

The most common type of ovarian cyst is called a "functional cyst" because it serves a purpose in the process of normal ovulation with each menstrual cycle. A single cyst will form around a maturing egg and grow to the size of a quarter just before it pops to release its egg into the fallopian tube. Occasionally, these cysts will grow larger and persist longer, but generally they resolve on their own within 6 to 8 weeks without treatment.

Usually, functional cysts are filled with clear fluid, but they can also contain blood. These cysts are referred to as "hemorrhagic corpus luteum" cysts and will also go away on their own. At times, girls can develop ovarian cysts even before they start having menstrual cycles or when they are on medications to stop ovulation.

Medical illustration of surgical cysts: paratubal, endometrioma, dermoid and large serous.

Other types of cysts occur when part of the ovary grows abnormally. These types of ovarian cysts will not go away on their own. They can arise from an overgrowth of cells on the surface of the ovary, the hormone-producing cells that surround an egg or the egg cell itself. In most cases, these types of cysts are benign (meaning non-cancerous) but some features may raise concerns about cancer, which requires careful care and treatment.

Who gets ovarian cysts?

All females of reproductive age will likely develop functional cysts at some point in their life. Ovarian cysts in teenagers are fairly common and typically don't cause further issues. The cyst may or may not be detected, depending on if it causes pain or if the patient receives a pelvic ultrasound or other imaging.

Nonfunctional cysts that occur because of a growth in the ovary are much less common. Ovarian cysts in general are more common in girls and young women who are pregnant or experiencing other issues, such as endometriosis, hormonal problems, severe pelvic infection or a previous ovarian cyst.

What are ovarian cyst symptoms in girls and young women?

Some ovarian cysts cause no symptoms and are incidentally found during imaging or testing done for other reasons. However, some young women experience:

  • Acute pelvic pain, particularly when a cyst ruptures
  • Pain between menstrual cycles that does not go away
  • Bloating, pelvic pressure and back pain

Some other conditions can be mistaken for ovarian cysts, such as:

It is important that you talk with your gynecologist to understand what, if any, treatment or testing is needed for ovarian cyst pain or other symptoms you're experiencing.

Learn about our adolescent gynecologists and how they help girls and young women.

Ovarian cyst tests and diagnosis

A pelvic ultrasound is the most common test to look for an ovarian cyst. Our care team uses a trans-abdominal (performed through the abdomen) or trans-vaginal (performed through the vagina) approach.

The trans-abdominal approach is much more common for girls and teens. It is important to have a full bladder before this test so we can view the ovaries completely.

For larger and more complicated cysts we may use magnetic resonance imaging (MRI) or blood tests.

Repeated ultrasound testing is often necessary to confirm the resolution or persistence of the cyst.

Ovarian cyst treatment for adolescents

Treatment is different for each young woman and may involve several approaches. Common ovarian cyst treatments for girls and young women include:

  • Monitoring through ultrasound
  • Hormonal suppression
  • Surgical evaluation
  • Surgical removal

In many cases, we simply monitor smaller cysts that appear to contain fluid with repeated imaging to confirm the cyst has resolved or is shrinking. Hormonal suppression of ovulation is used to prevent another functional cyst from forming in the future.

Persistent cysts with concerning characteristics may require surgical evaluation using a laparoscopic camera or a traditional abdominal incision.

We typically monitor a ruptured ovarian cyst with a repeat ultrasound in 2 to 3 months to ensure that it has resolved. Ruptured cysts often resolve themselves and we prescribe pain medication for comfort. Most of the time, we can manage ruptured ovarian cysts without surgery.

When surgery is required, our priority is to remove only the cyst and preserve any normal ovarian tissue to preserve a young woman's eggs and ensure her future fertility.

Why choose Children's Colorado for ovarian cyst treatment?

Accurate diagnosis and monitoring are important in properly treating ovarian cysts. Our adolescent gynecologists have extensive experience in evaluating girls and teens with ovarian cysts and are able to correctly understand ovarian cyst causes and explain test results. When needed, we work closely with our urology and pediatric surgery specialists to develop a management plan that maximizes future ovarian function and reproductive potential.

Because girls and young women are still developing, treating their ovarian cysts is different than treating cysts in adults. Our board-certified pediatric and adolescent gynecologists have specialized training in the reproductive health concerns of girls and young women. We understand the complex changes that occur prior to and during puberty and can recognize both common and rare causes of ovarian cysts in girls, teens and young women. We will put both you and your daughter at ease by carefully explaining her medical condition and the various options for treatment. We also support your family through follow-up and consultation with other specialists and your primary care doctor, as needed.

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