Follicular ovarian cyst: what you need to know

A follicular ovarian cyst is one of the most common gynaecological formations, often found in women of reproductive age. Most of these cysts are benign and do not pose a threat to health, but in some cases they can cause discomfort, menstrual cycle disorders or even complications. Women often find out about the presence of a follicular cyst by accident — during a routine ultrasound scan, without experiencing any symptoms. However, sometimes a cyst manifests itself through pain, delayed menstruation, or discomfort in the lower abdomen. In this article, we will look at what an ovarian follicular cyst is, why it forms, what its signs and symptoms are, how it is treated, and what to do if an ovarian follicular cyst ruptures.

What is a follicular cyst?

An ovarian follicular cyst is a benign functional formation that forms inside the ovary as a result of a disruption in the ovulation process. Normally, every month, a follicle matures in one of the ovaries — a small sac in which an egg develops. When ovulation occurs, the follicle ruptures and the egg is released into the fallopian tube. If this does not happen, the follicle continues to grow and fill with fluid, forming a follicular cyst. Such cysts are usually small in size (2 to 6 cm), can appear in both the left and right ovaries, and in most cases do not require surgery. They often resolve on their own within a few menstrual cycles. However, if a follicular cyst continues to grow, causes pain or disrupts the cycle, it is necessary to consult a gynaecologist for observation and treatment. Follicular ovarian cysts are most common in young women, as this is when ovulation processes are most active. Although this formation is not malignant, it should not be ignored, as complications are sometimes possible — for example, a ruptured follicular cyst, which can be accompanied by acute pain and requires medical attention.

Why does a follicular cyst form?

A follicular ovarian cyst forms due to a disruption in the natural process of maturation and rupture of the follicle during ovulation. Normally, the follicle grows until it reaches a certain size, after which it bursts, releasing the egg. If this does not happen, the follicle does not rupture but continues to accumulate fluid. As a result, a follicular cyst forms. Both hormonal and external factors influence the appearance of such a formation.

1. Hormonal disorders

The main cause of follicular cysts is an imbalance of hormones, in particular oestrogen and luteinising hormone. If ovulation does not occur due to an excess or deficiency of these hormones, the follicle remains unruptured.

Such changes are often observed:

• during stress, emotional overload, chronic fatigue;
• after a sharp change in body weight or calorie-restricted diets;
• in diseases of the thyroid gland or pituitary gland;
• due to hormonal contraceptives that affect the ovulatory cycle.

2. Inflammatory processes of the pelvic organs

Chronic inflammation (adnexitis, salpingo-oophoritis, endometritis) can disrupt blood supply and ovarian function. As a result, follicle maturation is disrupted and ovarian follicular cysts form. Sexually transmitted infections also increase the risk of such formations.

3. Postpartum and adolescent hormonal fluctuations

Girls going through puberty and women after childbirth experience hormonal instability. During this period, follicular cysts appear more often, but usually disappear on their own after the cycle normalises.

4. Stress and nervous tension

Prolonged or intense stress affects the hypothalamic-pituitary system, the main regulator of hormones. As a result, ovulation may not occur and you may experience signs of a follicular cyst.

5. Medication and external factors

Taking certain medications, such as ovulation stimulants, can lead to ovarian hyperstimulation and the formation of functional cysts.

The risk also increases with:

• uncontrolled use of hormonal drugs;
• frequent abortions or diagnostic curettage;
• smoking, alcohol abuse, poor nutrition;
• a sedentary lifestyle, which causes congestion in the pelvis.

6. Individual characteristics of the body

Some women are prone to the formation of functional cysts due to genetic or anatomical factors, metabolic disorders or polycystic ovary syndrome. Thus, the causes of follicular ovarian cysts can vary from hormonal fluctuations to the effects of stress or inflammation. To prevent their recurrence, it is important to have regular check-ups with a gynaecologist, monitor your hormone levels and treat any inflammatory processes in a timely manner.

Symptoms of a follicular ovarian cyst

A follicular ovarian cyst often has a hidden course and may not manifest itself for a long time. Many women find out about it by accident — during a preventive examination or ultrasound. However, in some cases, the cyst may manifest itself with characteristic symptoms, which depend on its size, location, and the presence of complications.

1. Menstrual cycle disorders

One of the first signs of a follicular cyst is a delay in menstruation or, conversely, excessively long and heavy bleeding. This is due to the hormonal imbalance that accompanies the formation of the cyst. In some women, periods may become painful or irregular.

2. Pain in the lower abdomen

Women often experience a pulling or aching pain on one side of the abdomen — in the area of the ovary where the cyst has formed. The pain may be intermittent, worsening before menstruation or after physical exertion. If the cyst is large, it can cause a feeling of heaviness or pressure in the lower abdomen.

3. Discomfort during sexual intercourse or physical activity

As the cyst grows, pain or discomfort may occur during sexual intercourse, bending over, or sudden movements. This is due to the pressure of the cyst on the surrounding organs.

4. Bloating and changes in the digestive system

A follicular cyst can cause bloating, a feeling of fullness, or even mild nausea. In some cases, patients ask how to relieve nausea with a follicular ovarian cyst — most often, this symptom goes away on its own after the cyst shrinks or with the help of mild antispasmodics and diet.

5. Changes in urination or bowel function

If the cyst enlarges, it can press on the bladder or rectum, causing frequent urination or constipation.

6. Signs of complications

In most cases, a follicular cyst resolves without problems, but sometimes a follicular ovarian cyst may rupture. This condition is accompanied by sharp pain in the lower abdomen, dizziness, weakness, and sometimes fainting. Internal bleeding is also possible, requiring immediate medical attention.

Treatment of ovarian follicular cysts

The approach to treating ovarian follicular cysts depends on their size, symptoms, and the woman’s general condition. In most cases, these cysts are functional, meaning they are caused by temporary hormonal changes and disappear on their own within 1–3 menstrual cycles. The doctor usually recommends observation — regular ultrasound examinations to make sure that the cyst is gradually shrinking and not causing complications.

If the cyst does not resolve on its own, medication may be prescribed. Hormonal drugs (oral contraceptives) are most often used to help restore a normal ovulation cycle and prevent new cysts from forming. In cases of severe pain, the doctor may recommend painkillers or antispasmodics to reduce discomfort.

In more complex cases, when the cyst is large (more than 6 cm), there is a risk of rupture or torsion, and if it does not disappear after several months of observation, surgical intervention may be necessary. Modern medicine most often uses laparoscopic surgery, a minimally invasive method in which the cyst is removed through small incisions without significant damage to the ovarian tissue.

If a follicular ovarian cyst ruptures, urgent medical attention is required. In such cases, sharp pain, internal bleeding or dizziness may occur. Treatment may include hospitalisation, monitoring of the patient’s condition, pain relief and, if necessary, surgical removal of the consequences of the rupture.

It is also important to take care of your overall hormonal health — avoid stress, watch your weight, eat a balanced diet and get enough rest. It is also worth having regular check-ups with your gynaecologist, as timely diagnosis helps to detect and treat follicular cysts without complications.