What Is a Ruptured Ovarian Cyst?

A Fairly Common Occurrence in Premenopausal Women

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An ovarian cyst is a fluid-filled sac that forms within or on top an ovary. Ovarian cysts are common and usually go away on their own. Sometimes an ovarian cyst may rupture or break open, and this may be extremely painful for some women. 

Symptoms of a Ruptured Ovarian Cyst

The vast majority of ovarian cysts do not cause pain or any other symptoms. In fact, many are found incidentally during a routine imaging test performed for another purpose or during a woman's routine pelvic exam with her gynecologist.

That being said, some cysts cause an ache in the abdomen and pain with certain activities like having a bowel movement or having sex, especially if they are growing so large that they begin to press on other organs or nerves.

As an ovarian cyst grows larger, it may rupture, meaning the cyst bursts and bleeds within a woman's pelvis. A classic symptom of a ruptured ovarian cyst is a one-sided, sudden, and severe pain in the pelvis. The pain often begins during or following strenuous exercise or sex.  

If the bleeding from the ruptured cyst is heavy, a woman may also experience dizziness, lightheadedness shortness of breath, and a fast heart rate. The bleeding may put a woman at risk for infection, which may cause a fever and chills.  

Sometimes other fluid (not blood) is released when the cyst ruptures. However, this fluid does not tend to cause the pain that blood does. 

It's important to note that besides rupturing, another potential complication of a cyst is called ovarian torsion, in which the ovary twists upon itself, potentially cutting off its blood supply.

This can cause the ovarian tissue to die, if not treated right away by a surgeon. Like a ruptured ovarian cyst, acute and severe pain usually on one side is also a symptom of ovarian torsion. 

In both of the above instances, in which a woman experiences sudden, severe pain, she should seek medical attention right away.

Diagnosis of a Ruptured Ovarian Cyst

The first step is an ultrasound, which allows your doctor to see inside your belly. If you had a ruptured ovarian cyst, the ultrasound will show some fluid around the ovary, and may even show the empty sac. A complete blood count will also likely be drawn to check for signs of infection and blood loss.

While an ultrasound is the best test for evaluating a ruptured ovarian cyst, it is not perfect. Your doctor will want to confirm the diagnosis by ruling out other conditions that can mimic that of a ruptured ovarian cyst. For example, your doctor will check a pregnancy test to rule out ectopic pregnancy. She will also likely perform a pelvic exam to rule out pelvic inflammatory disease.

In addition to gynecological conditions, there are a number of non-gynecological conditions that can mimic those of a ruptured ovarian cyst like appendicitis and a kidney stone. This is why your doctor will be thorough, so do not be surprised if a number of tests are ordered. 

Treatment of a Ruptured Ovarian Cyst

Once an ovarian cyst has ruptured, no treatment is usually required, assuming a woman's blood counts and vitals are stable. Sometimes pain medication is prescribed to help manage the discomfort.

In this instance, a woman will often be advised to rest until the cyst fluid is reabsorbed in the body and symptoms resolve, which can take a few days.

Of course, be sure to follow your doctor's instruction about when to return, like if your pain increases or you feel dizzy or lightheaded while at home. 

If a ruptured cyst continues to bleed and/or the bleeding is heavy, a woman will need to be hospitalized and may even need surgery. 

Preventing an Ovarian Cyst From Rupturing

There is no way to prevent an ovarian cyst from rupturing. That being said, if your doctor finds an ovarian cyst and it is small and does not look concerning to the physician, she will likely recommend that you have the cyst monitored for a few months to make sure that it goes away on its own.

This process of monitoring a cyst for a change in size or how it looks is termed watchful waiting. How often your doctor will want to repeat an ultrasound varies, so be sure to follow up closely. 

Sometimes, during this time, a doctor will recommend taking a month or two of birth control pills to prevent new cysts from forming; this is only for women who are premenopausal.

Sometimes when a woman experiences pain, and a doctor suspects a ruptured cyst, but the ultrasound shows the cyst as intact. If a cyst has not ruptured, treatment varies according to the entire clinical picture.

If an ovarian cyst is causing a lot of pain, is quite large, or looks suspicious for cancer on the ultrasound, surgery to remove the cyst may be recommended—this is called a cystectomy. Sometimes, a surgeon will remove the ovary; this is called an oophorectomy. 

Normal Rupture of Small Follicular Cysts

It's important to note that there is a normal ovarian cyst "rupture" process that occurs every month with ovulation—the process through which a single follicle in the ovary develops, "ruptures" and eventually releases an egg. This process is perfectly normal and may cause mild pain halfway through your menstrual cycle—this ovulation pain is called mittelschmerz

A Word From Verywell

Anytime you are experiencing severe abdominal or pelvic pain, it should be immediately evaluated by your doctor or in the emergency room if you are not able to promptly see your doctor.

There are many other conditions that can mimic the symptoms of a ruptured ovarian cyst which can be very serious if not treated. 

Sources:

American Congress of Obstetricians and Gynecologists. (April 2017). Ovarian Cysts

Sharp HT. (July 2016). Evaluation and management of ruptured ovarian cyst. In: UpToDate, Levine D (Ed), UpToDate, Waltham, MA.

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