195. Should I Be Worried About Ovarian Cysts In Pregnancy?

Added: 2026-05-09

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[00:01:31]>> Welcome everyone. I'm Bridget Maloney >> and I'm obstitrician Dr. Patrick Maloney. And today we are going to be talking about a uh listener question that that is common that people ask this question but it's also it speaks to when we go and have a test done >> and [clears throat] we hear words said in that test or we read a report and we just really start to worry >> start to worry.

[00:01:53]>> So I'll I'm going to read the listener question first and then we'll go on for it.

[00:01:59]>> Hi guys, just found out I'm pregnant.

[00:02:01]I'm about 6 weeks with my very first. I was on the pill for 14 years, then fell pregnant in the first month after going off it. Exclamation mark. Loving the podcast so far. I've just found out that I have a cyst on my ovary that is 4 cm.

[00:02:16]I've never had cysts before as far as I know. From what I understand, this is very normal in early pregnancy and will likely resolve itself, but I can't find too much information about it and the doctors haven't given me much information. Could you please discuss this?

[00:02:30]>> Fine.

[00:02:31]>> Good. All right. So, you know, let's start really simply. Um, someone is 6 weeks pregnant >> and they've been told that they have a 4cm ovar and cyst. Should they be worried?

[00:02:43]>> Yeah, usually not. Um, so we don't have any details unfortunately on what the cyst looks looks like. Um, but it's probably um it's probably just a corpus lutal cyst which is a perfectly normal thing to find on a 6 week ultrasound. Um so when the egg comes out of the uh ovary, the bit on the surface of the ovary that the egg pops out of um forms forms a structure on the edge of the ovary called a corpus lutium. And its job is to pump out a bunch of progesterone in the second half of the cycle and help the pregnancy get up and underway. And that's the source of progesterone in the early part of the pregnancy until the placental structures kick in. So that's a perfectly normal and necessary thing to be there. And you can usually zoom in on one ovary or the other on a six week scan and see which one's ovulated because there'll be a corpus lut lutium there. And the the structure uh it's quite normal for corpus lutium to bleed when the egg comes out and sometimes it forms a little thing called a hemorrhagic cyst which is a um uh a little bit of blood clot sitting on the corpus lutium and that's a normal thing as well. one of the reasons why ovulation is mildly painful in some people >> and so that could be all that is there and and a good ultrasound report will say what it what it is if they think it's a corpus latium they should say so because that's perfectly normal. Other times the ovary might have something called a simple cyst on it which is like a sack full of water and what that sometimes is is just another follicle that was forming and then didn't ovulate. some a different one did and that's what that one's left there because once the ovulation's happened.

[00:04:26]Um there's some signaling within the ovaries not to bother ovulating any more eggs. Uh otherwise we'd have multiple pregnancies all the time and [clears throat] so uh that could just be a an arrested follicle at 4 cm which is another thing that happens all the time is normal and just resolves by itself.

[00:04:43]>> So in this case it is possibly just the egg that has erupted.

[00:04:48]>> Yeah. Or could it be the follicle >> another s with another econ? Yeah.

[00:04:53]>> Yeah. Um and I'm curious about multiple pregnancies. So what do you see? What does the ovary look like that you do you see two corpus lines or you >> uh Yeah. Well potentially. So if you saw one on each side that might be evidence that that the woman's ovulated twice. Uh which um would be the sort of two egg fraternal twins. Um and uh of course the other ones the ovulation's just once and then that that fertilized egg splits apart.

[00:05:18]>> So she talks about her cyst being 4 cm.

[00:05:23]What's the normal range at this stage of pregnancy?

[00:05:25]>> Oh the the the harmless cysts are typically about that size or smaller. Uh and we get interested in cysts that are more than about 5 cm 6 cm or painful or causing the ovary to twist or having an abnormal appearance on ultrasound. So some cysts look very different and and are very different diagnosis. Okay.

[00:05:46]>> So what do those cysts look like on ultrasound then?

[00:05:49]>> Well, there's a whole bunch of different types. Um and occasionally these are seen on first trimester scanning as well. And some of them are more significant than the one than a simple little one that looks like a corpus lutium or a simple little one that looks like a a simple follicular cyst. And the other ones that we would commonly see would be something called a dermmoid uh which is um an ovarian cyst uh full of uh stem cells that have been in that woman's ovary for many many years. And um these are the the freaky ones that are capable of turning into any to type of tissue type. M >> uh so typically the ovarian cyst will have structures that really belong elsewhere in the body and they're formed inside the ovary from stem cells and those would you know typically there might be uh bone um cartilage hair fat uh lung tissue brain tissue um uh and those are um sort of a strange looking thing not cancerous but a strange looking thing and sometimes some of them will have a dermmoid in the ovary or even both ovaries and sometimes of a decent size, but because they haven't really affected ovarian function, nobody knew they were there. And it wasn't until the woman had a first trimester ultrasound that the dermmoid was discovered.

[00:07:08]>> And so that dermmoid, I don't want to go down that path cuz I think it's pretty rare, isn't it? Dermmoids.

[00:07:13]>> Uh, no, they're common. Yeah. Wow. Yeah, they're common.

[00:07:16]>> And so they are just sitting there and by chance that might be a discovery on ultrasound.

[00:07:22]>> Yeah. Because you hadn't had an ultrasound for any other reason. They weren't causing you pain. They weren't doing anything. your fertility was normal.

[00:07:28]>> Right? I'm going down that track now. So if if during a pregnancy a dermmoid cyst is seen, >> is anything done with it then?

[00:07:37]>> Typically not. What what you need in that situation is a high quality ultrasound to make sure that it that it has a typical appearance of a typical dermmoid. Um and uh and that that can be pretty easily done.

[00:07:48]um we would only get um interested in that dermmoid if it was very large and potentially obstructing the baby's way up >> uh or if it was uh or if it had potentially malignant features or if it caused an ovarian torsion. So if it if it made the ovary lopsided and caused the ovary to twist around on its stalk and cut off its own blood supply.

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[00:08:52]>> Let's talk about ovarian torsion because um can a cyst cause ovarian torsion apart from this dermmoid situation?

[00:08:59]>> Yeah, typically it's only a cyst that will cause it. So the ovary, a normal ovary is incredibly unlikely to get a torsion because the the stalk of the ovary um inserts into the middle and there's no reason why the ovary would would spin around >> unless it was lopsided >> and the lopsided uhness is because of a cyst. Oh my god. I've got in my mind a, you know, a goldfish. A goldfish that ends up having like a a blown up belly because of some reason goldfish do this and then the goldfish just goes around.

[00:09:31]Spins around.

[00:09:32]>> Yeah, that I guess that's what it's like. So those are not um uh you know that's something that presents with pain >> um and then you have an ultrasound, you can see an ovary with a cyst on it.

[00:09:41]There's no flow inside it. And occasionally a torted ovarian cyst is a sort of surgical emergency that could happen during pregnancy and one of the one of the rare reasons why we might need to operate in pregnancy.

[00:09:54]>> And so you know there's so much new pain that a woman experiences during the early um phase of pregnancy.

[00:10:03]>> Can you describe what the usual symptoms that people say to you they're feeling when they've got an ovarian torsion? Oh >> ovarian torsion pain is very severe. Um it's associated with nausea and vomiting. It's relentless. Um and uh not not easily missed.

[00:10:19]>> Um occasionally it comes and goes which is thought to be a process of torsion and detortion as it twists and then untwists and twists and then untwists but it's mostly the severity that brings it to people's attention.

[00:10:32]>> Yeah.

[00:10:33]>> So going back to a normal sort of common cyst in this early stage of pregnancy >> if so she was um had an [clears throat] ultrasound at 6 weeks. If she went on uh and had another ultrasound, what would they see normally?

[00:10:49]>> Well, you'd expect resolution of the simple ones and resolution of a corpus lutium. Uh and the dermmoids and so forth would still be there. M >> um and then uh if the dermmoid uh is nice and stable, it's not growing, it's not toing, then it can just be left there and that can be um assessed, reassessed postpartum and um excised laparoscopically at a later date >> if that's thought to be what the plan.

[00:11:16]Um very rarely an ovarian cyst happens in pregnancy is discovered in pregnancy that has features on ultrasound suggestive of an early malignancy. So like a stage one ovarian cancer and that's something that's that can happen but is exceedingly unlikely because hardly anyone gets ovarian cancer in the pregnancy age group anyway.

[00:11:37]>> Um but u again one of the rare reasons why why we might want to operate in pregnancy would be if a ovarian malignancy was suspected.

[00:11:48]>> Wow.

[00:11:49]>> So that would not only be an ovarian cyst that looked very dodgy but also blood tests that would be abnormal.

[00:11:55]Again, going back to the normal cyst, if if someone has a cyst that you know, they they hear the synenographer or someone saying, "Oh, there's a bit of a cyst there." Or they get the read the report themselves or whatever. Does their GP or obstitrician then say, "You need to be rescanned at a certain stage or we just expect it to resolve."

[00:12:14]>> Now, we would typically rescan because a a large cyst, like if it's one of those small first trimester ones, just expect it to resolve, then they're entirely normal. Um but uh a large cyst would definitely want to be rescanned because there is a phenomenon where a very large cyst could theoretically obstruct the obstruct labor.

[00:12:36]>> Um the ovaries sit um lower um you know if we think of the the sort of the sort of uh uh secondary school diagram of the female reproductive system, it looks like the ovaries are sort of sitting out to the sides of the uterus. But when the um when the the uterus grows to a fullterm pregnancy, they're not sitting up near the top. They're sitting they're sitting much much uh much further down towards the the cervix. A and the um the a big cyst at that point could theoretically obstruct the baby on the way out.

[00:13:09]>> Yes. Cuz you only have to dilate 10 cm to push a baby out. Um and if you've got a cyst that's 10 cm, 15 cm, like that would be significant, wouldn't it?

[00:13:18]>> Potentially. Yeah. So that so in that situation um which which comes up from time to time a decision needs to be made about whether we would um go one of three ways. You can have surgery during pregnancy to take a cyst out that has significant pros and cons and ideally is best avoided. You could have a planned cesarian section um if you thought the cyst was going to obstruct the baby's way out, but that is um uh a shame if somebody doesn't want the cesarian section. Um and and lastly um you could do a trial of labor and just see how the baby goes getting getting past a large cyst.

[00:13:57]>> I think it's hilarious that you talk about that secondary school um picture of the female's anatomy and it does. The uterus looks like it's got little sort of branches and and but the other day when you were describing a uterus only being the size of an apricot, a normal uterus before pregnancy, like that isn't the picture that I have in my brain.

[00:14:19]>> No, it's not. It's quite different really. A number of things are different. Yeah. Yeah. [clears throat] Um, I think the most misleading thing about the diagrams is that is that they they show a sort of a diagrammatical rep representation where the tubes are stretched out and the ovaries are right out to the side.

[00:14:37]>> And that leads women often to think that if they've got pelvic pain that's very lateral, right out near their hip bones, that that's ovarian pain.

[00:14:45]>> Um, but in fact, the ovaries are very very close to the middle of your body.

[00:14:48]Um and um and you'd have to have a quite a big cyst on an ovary for it to reach out towards the pelvic side wall like that.

[00:14:56]>> It is funny though. So people do complain of pain during um uh ovulation which is very side.

[00:15:03]>> Yes. You can often tell the difference one side or the other. Yeah. But that doesn't mean that the ovary is located right out on the referring of your body.

[00:15:11]Yeah.

[00:15:11]>> Yeah. It's We had a student up the other day and even she was in surgery with you and went, "Oh my god, I can't believe how small the uterus is." So yeah, it's it's fascinating like we we get an understanding of our body when we listen to podcasts like this. I hope >> I hope so.

[00:15:29]>> Well, I certainly have over the years.

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[00:16:19]>> Now, I know that this podcast isn't about cysts outside of the pregnancy, but can you very briefly mention some reasons why people might have cysts outside of pregnancy?

[00:16:30]>> That's a whole bunch of podcasts in itself. Um so ovarian cysts are a really common thing that we see ranging from simple ones, little bumps on the ovary right up to uh right up to um cancerous ones. Um huge topic um and an important part of gynecological practice. Uh but today we've been sort of concentrating on the ones that might affect uh a pregnancy.

[00:16:53]>> Yeah. The other thing that I've seen from time to time in pregnancy are other types of uh of pelvic cysts in women, not ovarian cysts. Um but um there's two that that we commonly see. One's something called a a bathlan cyst which is an obstructed gland near the vaginal opening. And the bathlan's gland sits just inside the vaginal opening. And one of its jobs is to make vaginal mucus and lubrication for intercourse. And it's uh it's got a narrow duct that gets uh blocked. Um and uh you can get a bathlin cyst in pregnancy and present with a big swollen swollen um very very sore cyst right at the vaginal opening.

[00:17:38]>> And uh I've I've had a few of those that needed operations uh even in pregnancy.

[00:17:43]>> And they're managed much the same way as you would if the woman wasn't pregnant.

[00:17:46]If it's big and sore, it needs to be drained >> um >> under under general anesthetic.

[00:17:51]>> Yeah, under general anesthetic. There's another thing that's commonly um diagnosed as a cyst and it isn't really and that's something called a neoththean follicle which is a cyst in the cervix.

[00:18:01]Um and these aren't really uh they're not quite accurately called a cyst. What happens is the cervix has got little glands inside it and there's a normal process where the where the um surface of the cervix uh there's a layer on the cervix that shifts back and forth.

[00:18:18]That's the layer that we're interested in capturing when we do a a smear test.

[00:18:22]And that layer occasionally obstructs those little glands and causes a a cystic type type structure within the cervix which we can see on ultrasound or you can even see when you look at the cervix with a speculum and those are typically about a centimeter across and sometimes get reported on an ultrasound but they're an entirely normal finding.

[00:18:42]>> Yeah. Right. Um and what about the uterus? Can it get cysts? Uh not really.

[00:18:49]Um there are unusual appearances to the uterus um in that we see in ultrasound.

[00:18:55]We pick up uterine fibroids all the time. Sometimes adenomiiosis um is reported as showing cystic changes, but that that's not quite accurate. It's not a true cyst.

[00:19:06]>> Okay, >> good. Now, I'm bringing back an old favorite that we let go a long time ago.

[00:19:12]>> Stop it. What?

[00:19:13]>> Myth or fact?

[00:19:14]>> Oh, fact. Okay.

[00:19:16]Myth or fact?

[00:19:18]>> You know, I don't think anyone likes that. But anyway, good. Number one question. Coming off the pill causes ovarian cysts.

[00:19:27]>> Myth.

[00:19:29]>> Really?

[00:19:30]>> Well, it you'll get a follicular cyst, but that's the ovary working normally.

[00:19:34]>> So, I'm saying myth.

[00:19:36]>> Myth. And if people think that it is, it's probably because it was helping with something like PCOS or >> Well, yeah. Well, occasionally we'll use the pill in women who get a uh, you know, recurrent large cysts because it suppresses ovulation. That's how it works as a contraceptive and most of those cysts are ovulatory in origin.

[00:19:57]>> So, it's a good treatment. But, um, and if you come off the pill, you might get that problem back again, but that's not to say that one necessarily caused the other. You just had that problem all along.

[00:20:07]>> All along, >> and you're taking away an effective treatment. Uh, number two, a cyst can cause miscarriage in early pregnancy.

[00:20:16]>> Uh, I don't think that's true either.

[00:20:18]Um, ruptured cysts can happen in pregnancy and they can be painful. Um, but, uh, I certainly don't think it's an important cause of first trimester loss.

[00:20:27]>> Uh, it's a pretty unusual thing to happen in the first place. Um, and um, uh, >> sorry, what is the >> having a a ruptured cyst? Oh, yeah.

[00:20:38]Yeah. Um, and um, I don't believe it's an important cause of first trimester pregnancy loss. You get pain >> and occasionally that person might go and have an ultrasound and find out they miscarried, but whether one cause the other, I don't know.

[00:20:50]>> Mhm. Um, a three, a cyst can impact early implantation.

[00:20:57]Oh, he's stumped.

[00:20:59]>> I I don't think so.

[00:21:01]>> Yeah, I I doubt I doubt I doubt that's a a phenomenon. I mean, early implantation requires that the um ovaries ovulated, the the um egg's gone down the tube, uh the it's met up with some sperms coming up the other way and got fertilized, made its way down into the uterus. So, I'm not sure that novarian cyst could could necessarily interrupt that process.

[00:21:21]>> Good. Um a cyst causes leftsided ovulation pain.

[00:21:26]>> Just ovulating on the left side causes leftsided ovulation pain. It's neither here nor there when it comes to cysts. M and I think people can refer back to your answer about you know what um pain feels like if it's a torsion or if it's something Yeah. and the referred pain to the left side. So I think you've already answered that. Okay, >> good.

[00:21:46]>> Um uh forgotten what number I'm up to, but here we go. Here's another one. Um a cyst can burst and be painful.

[00:21:54]>> Yes. So that's definitely a thing. Uh and sometimes we we make that diagnosis um retrospectively. The a woman comes in with a lot of pain. You do an ultrasound and there's a lot of free fluid within the pelvis and you assume that that fluid came out of a cyst. Now, you can no longer see the cyst because it's like a popped balloon. It's the cyst is gone.

[00:22:13]>> Um but um if you see a lot of free fluid in a woman's got a lot of pain. Um then uh a cyst rupture is sometimes the the proposed uh mechanism for that pain and the diagnosis. Typically that just goes away by itself but it can be very painful.

[00:22:29]>> And that's like the cyst problem resolving itself.

[00:22:33]>> Yes. Exactly. Yeah. Um and uh there can be pain for several days quite severe.

[00:22:39]>> All right. Uh can I just ask about that though? So the person can manage that at home with pain relief or do they need to see their doctor?

[00:22:48]>> Typically they would see their doctor because the pain would be very severe. M >> um they would have an ultrasound to rule out other things like an ovarian torsion uh like a pregnancy complication like an ectopic pregnancy and then if if all that was determined was that there was a cyst rupture then um the treatment is pain relief and rest until it resolves.

[00:23:07]>> M good last one.

[00:23:09]>> Yeah.

[00:23:09]>> And I'm sneaking it in because it's not about pregnancy.

[00:23:12]>> Sneak away.

[00:23:12]>> Uh assist means you are not ovulating properly.

[00:23:16]>> Uh that's not really true either. um those those two events may be unrelated to each other. Uh like for example, you could have a cyst on the ovary and still be ovulating just fine. Um so we if we were investigating someone who wasn't ovulating, the presence of an ovarian cyst might be of some interest. Um but it doesn't necessarily follow that someone with a cyst would not be ovulating.

[00:23:41]>> Good. All right. Well, that's the end of my myth or fact which turned into true or false.

[00:23:48]>> True or false?

[00:23:49]>> Yeah. Good. All right. Anything else to add about um >> No, look, cysts in pregnancy is worth covering. It's it's something that happens from time to time. It's not at all uh common uh but um uh definitely uh a part of, you know, of of pregnancy life and obstetric um uh theory that people um be do well to be aware of. M and I think I wanted to bring it up because you know we do there is so much that we're learning in pregnancy especially early pregnancy um and it's coming hard and fast this big learning curve and then you go into a doctor's um clinic and they sort of talk about terms like cysts >> that you think well that sounds bad it must be bad. Um so I I hope we've demystified that part of your first pregnancy visit.

[00:24:38]>> Yeah. So, the vast majority of structures referred to as a cyst on a first trimester ultrasound are normal.

[00:24:44]>> Great. Straight from the horse's mouth.

[00:24:47]Good. All right. Well, that's it for us.

[00:24:49]Uh, if you like our podcast, how you can help us spread our information to other people that I'm uh sure other people would be loving to hear the same sort of information that you are. Um, is simply just sharing it. sharing it with a friend, um saving it on your Spotify or podcast, uh by following it, and yeah, giving us a rating if you feel so inclined. Hopefully, five stars. Nice.

[00:25:13]>> That helps, too. Good. All right, everyone. Have a great week and until next week. See you later.

[00:25:18]>> Thanks for listening. [music] >> Bye for now.

[00:25:26]>> Hey, even though Dr. Pat is well a doctor and we get lots of other doctors and other experts on our podcast. I just need to remind you that this podcast is forformational purposes only. We share lots of medical insights and experience but everything we talk about is general in nature and may not apply to your specific situation. Please always consult with your own healthcare provider for your individual medical advice when you grow your baby.

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