How Do I Tell If I Have a Ruptured Ovarian Cyst?

Sudden abdominal or pelvic pain in a woman can be a symptom of a ruptured ovarian cyst.

Most ovarian cyst ruptures are a normal part of your menstrual cycle. When you ovulate, the cyst or follicle that holds the egg “ruptures” to release the egg.

Symptoms of a ruptured ovarian cyst can usually be managed with conservative treatment such as over-the-counter pain medication and rest.

In some cases, ruptured ovarian cysts (ovulatory and other cyst types) may develop complications and need surgery. See a doctor if your pain is severe or if it’s accompanied by other symptoms such as fever. This may be an indication of another health concern.

In this article, we’ll cover what to look for if you think you have a ruptured ovarian cyst as well as other possible causes for sudden abdominal pain.

Types of ovarian cysts

The type of ovarian cyst you have makes a difference in the kind of pain you feel as well as when you feel it.

Here are some types of cysts:

  • Functional cysts: Also referred to as ovulatory cysts, these are the most common kind of cyst that usually causes no symptoms. They can form as follicular cysts (developing in the follicle, a small sac in the ovary) or as corpus luteum cysts (developing after the follicle releases its egg).
  • Dermoid or teratoma: These are present at birth and contain other tissue such as hair, bone, teeth, or skin. They’re relatively rare, with about 10 out of 100,000 women estimated to have this type of cyst.
  • Cystadenoma: These form on the surface of the ovary and are filled with fluid or some tissue from the ovary.
  • Endometrioma: These are blood-filled cysts that grow on tissue outside of the uterus.

What are the symptoms of a ruptured ovarian cyst?

A ruptured ovarian cyst can cause sudden pain in your pelvic area. The pain is usually sharp and most often on the lower right side.

But some cysts, such as endometriomas, could be on either side.

You might feel pain after sexual intercourse or when you’re exercising. The pain from an ovarian cyst is likely to begin at the midpoint of your menstrual cycle.

Different kinds of cysts that rupture may cause pain at other times during your menstrual cycle.

In addition to pain, symptoms of a ruptured ovarian cyst can include:

  • bleeding from the vagina
  • nausea
  • vomiting
  • tenderness in the pelvic/abdominal area
  • weakness
  • feeling faint
  • fever
  • increased pain while sitting
  • full or heavy feeling in your pelvis
  • shoulder pain (if you have a lot of bleeding)

What are ovarian cysts?

Ovarian cysts are fluid-filled sacs in or on an ovary. The most common type of ovarian cyst is produced at the time of the month when you ovulate.

Ovulatory cysts are normal in women of childbearing age. Most are not harmful, have no symptoms, and resolve on their own within a few weeks.

Ovarian cysts are normal!

“When a woman goes through her normal menstrual cycle, every month we expect a woman to have a cyst,” said Dr. Stacy S. Brown, a board certified OB-GYN at Swedish Hospital in Chicago. “A cyst is just a sac of water.”

“Maybe three or four little cysts will grow in the ovaries,” Brown said. “One cyst will get pretty big, full of water with one egg inside.

Then, around the middle of your cycle, that cyst with the egg will pop and release the egg. That leftover cyst wall will usually dissolve. This happens every month unless you get pregnant.”

So, a ruptured ovarian cyst is a normal part of your menstrual cycle.

“Some women will feel the liquid coming out of that cyst with a little discomfort or pain. That’s called mittelschmerz [mid-cycle pain],” Brown added.

“But sometimes when that cyst wall breaks, there’s a little blood vessel there that can cause some bleeding.

Sometimes, this blood can end up in your abdominal cavity, and that can become very irritating and you might have more pain,” Brown said.

What causes a ruptured ovarian cyst?

Most functional ovarian cysts are a normal part of a woman’s cycle, and they’re mostly benign, or noncancerous. Other types of ovarian cysts, such as endometriomas, are not normal.

Exactly why a cyst ruptures isn’t known. But here are some possible risk factors:

  • You’re more likely to have a ruptured ovarian cyst if you have a history of ovarian cysts or ruptured ovarian cysts.
  • Cysts can rupture after strenuous exercise and after sexual intercourse.
  • Larger cysts may burst more easily.

Keep up to date with your gynecological examinations so that you can be aware of any existing ovarian cysts and any risk factors you may have. Your doctor can also note any changes in your ovaries.

What about cancer?

Ultrasound imaging is used to distinguish between a simple cyst, such as an ovulatory cyst, and a more complex one. A complex cyst can potentially be a malignant, or cancerous, tumor.

In general, a malignant tumor will have internal structures that can be seen via ultrasound. But these structures don’t necessarily mean that the cyst is malignant.

When an ultrasound scan finds an ovarian mass, there are guidelines that indicate whether the mass is likely benign or malignant.

If necessary, you’ll have surgery to evaluate and possibly remove the mass.

Malignant ovarian cysts are less common in younger women. According to some research, of the 5 to 10 percent of women who have surgery for ovarian cysts, 13 to 21 percent of the cysts are found to be malignant.

How are ruptured ovarian cysts treated?

If you have severe pelvic pain, see your doctor or go to the emergency room. Your doctor will take your medical history and do a physical exam.

You may undergo several tests to determine the cause of your pain, although not all are included in a routine evaluation of an ovarian cyst. These tests may include:

  • pregnancy test
  • complete blood workup
  • urine test to look for infection
  • ultrasound scan of your pelvis
  • CT or MRI scan
  • laparoscopic surgery for diagnostic purposes

An ultrasound scan may indicate a ruptured ovarian cyst if it shows a mass and fluids in the pelvis.

The cyst itself may collapse after it opens. But a scan is not definitive, and the doctor will consider other factors in making a diagnosis.

Uncomplicated vs. complicated ruptured ovarian cysts

In most cases, a ruptured ovarian cyst without complications will be treated conservatively with observation and pain medication. Functional cysts are usually in this category.

If your ruptured cyst has complications, such as heavy or ongoing blood loss, your doctor may want to admit you to the hospital for observation.

While you’re admitted to the hospital, they may:

  • monitor your vital signs and the ratio of your red blood cells to total blood volume (hematocrit)
  • conduct repeated scans to check for internal bleeding (hemoperitoneum) into the peritoneal space between the lining of the abdominal wall and your internal organs

If you need surgery

In some cases, laparoscopic surgery may be recommended to stop the bleeding.

Other factors that may indicate the need for surgery are:

  • cysts larger than 5 centimeters (cm), depending on the type of cyst
  • persistent pain
  • possibility that imaged masses may not be benign

Some cysts larger than 5 cm (even as big as 10 cm) don’t always need to be surgically removed. Some simple cysts can be managed if you’re premenopausal.

In the past, a ruptured ovarian cyst with bleeding and low blood pressure was routinely treated with surgery.

But depending on the type of cyst, many instances of a ruptured ovarian cyst can now be managed conservatively because of advances in imaging technology.

In cases with potential problems with some types of cysts, your doctor may advise you to take oral contraceptives to prevent ovulation and cyst formation.

What are the complications of an untreated ovarian cyst?

In most cases, a ruptured functional ovarian cyst will go away on its own and you may not know that it was there.

But when you have pain and other symptoms, it’s best to have your doctor check it out. Ignoring the symptoms can lead to complications:

  • If your cyst is bleeding, you might have excessive blood loss.
  • Rupture of an endometrioma can be associated with excessive bleeding.
  • If you have an infection, there’s a danger that it will spread. A ruptured dermoid cyst, for example, may result in peritonitis, or inflammation of the perineum. This can become life threatening without prompt treatment.
  • A ruptured cyst can mimic symptoms of ovarian torsion or cause torsion. Ovarian torsion happens when the ovaries twist and cut off their blood supply. This can be an emergency and cause you to lose an ovary.

What are other causes of abdominal or pelvic pain?

Pain in the abdominal or pelvic area can have many causes, including indigestion and gas.

Here are some possible causes and symptoms that may differ from those of a ruptured ovarian cyst.

Ectopic pregnancy

An ectopic pregnancy happens when a fertilized egg grows outside of the uterus. This can cause sharp pain in the pelvic area as well as your shoulder or neck.

Other symptoms include:

  • tender breasts
  • nausea
  • vaginal bleeding
  • dizziness
  • lightheadedness
  • fainting
  • rectal pressure

If untreated, an ectopic pregnancy can become a medical emergency.

Appendicitis

Inflammation of the appendix, known as appendicitis, is a common cause of abdominal pain.

Pain is felt on the lower right side of your abdomen or around your belly button. It may begin as mild cramping.

Other symptoms include:

  • swelling in the area
  • indigestion
  • constipation
  • diarrhea

Appendicitis can quickly become a medical emergency.

Endometriosis

Endometriosis happens when the tissue from the lining of your uterus grows outside of the uterus. This can cause inflammation and pain in the pelvic area.

You may also experience:

  • painful periods
  • cramps before and after your period
  • heavy bleeding during your period
  • uncomfortable bowel movements
  • lower back pain

Endometriosis is a chronic condition that can usually be managed with treatment. It may require surgery.

Irritable bowel syndrome (IBS)

IBS happens when your colon is irritated. This can cause periodic abdominal pain that varies in severity.

Having a bowel movement usually relieves the pain. Symptoms may increase during menstruation or pregnancy.

Other symptoms include:

  • constipation or diarrhea
  • bloating and gas
  • cramps

IBS is a chronic condition, requiring treatment to ease symptoms.

Inflammatory bowel disease (IBD)

IBD is long-term inflammation of your gastrointestinal tract that can cause stomach pain.

Crohn’s disease and ulcerative colitis are two types of inflammatory bowel disease affecting different parts of your gastrointestinal tract.

Other symptoms can include:

  • cramps and bloating
  • diarrhea
  • bleeding ulcers
  • bloody stools
  • weight loss
  • anemia
  • loss of appetite
  • fever
  • fatigue

IBD is thought to be hereditary and can be managed with treatment.

Interstitial cystitis

Interstitial cystitis is a chronic inflammation of your bladder muscles, which can cause pain in your pelvis and abdomen.

The pain is often described as burning and may be severe. It affects women more than men.

Other symptoms include:

  • urinating frequently
  • feeling like you need to urinate constantly

There isn’t a cure for interstitial cystitis, but symptoms can be treated.

Pelvic inflammatory disease (PID)

PID is a bacterial infection of your reproductive organs that may cause pain in your lower abdomen. Pain can range from mild to sharp.

Other symptoms include:

  • pain during sex
  • painful urination
  • vaginal discharge that may be smelly
  • bleeding
  • fatigue
  • vomiting
  • feeling faint
  • fever

PID is treatable with antibiotics. If you have severe symptoms, seek emergency medical treatment to stop the infection from spreading.

It’s important to note that PID can be a complication of sexually transmitted infections (STIs), which can permanently affect fertility. So, it’s critical to seek treatment if you experience STI symptoms and to make sure your partner is treated. To prevent STIs, use barrier methods.

Kidney stones

Kidney stones are masses of crystals, usually calcium, that can develop in your urinary tract. The stones cause intense abdominal or back pain.

Other symptoms include:

  • nausea or vomiting
  • discolored or smelly urine
  • fever
  • chills
  • frequent need to urinate

Kidney stones can be treated with medication and surgery.

The takeaway

Ruptured ovarian cysts are part of your normal menstrual cycle, and most often dissolve on their own. You may not even know that you have them — functional cysts are not only common but normal.

But other types of ovarian cysts may be problematic if they rupture or cause pain or other symptoms.

If you have severe pelvic pain, see your doctor as soon as possible or go to the emergency room. Pelvic pain can have many causes, and some can be life threatening if not treated promptly.

Most ruptured cysts can be treated with pain relievers. But in some cases, you may need surgery to remove the cyst.

The bottom line? Seek medical care if you have pelvic pain that doesn’t go away.

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