What To Know About Ruptured Ovarian Cysts

Unless you're ovulating, menstruating, or struggling with fertility issues, you probably don't give much thought to your ovaries. Your ovaries are the pair of organs on either side of your uterus that produces eggs and hormones. 

Although your ovaries might not usually be at the top of your mind, they can be the home to cysts at any time. Ovarian cysts are common. Often, ovarian cysts are harmless and don't come with symptoms. But some people can experience what's known as a ruptured ovarian cyst.

The good news: Most of the time, ruptured ovarian cysts cause no or only mild symptoms. And on its own, a ruptured ovarian cyst is rarely a medical emergency. But a ruptured ovarian cyst could be life-threatening if it causes extreme pain or severe bleeding.

Here's what you need to know about ruptured ovarian cysts, including the most common symptoms and how healthcare providers treat them.

What Is an Ovarian Cyst?

An ovarian cyst is a fluid-filled, sac-like structure in the ovary. While ovarian cysts can grow on the outside of an ovary, most of the time, they grow inside the ovary, Sawsan As-Sanie, MD, an associate professor and the director of the University of Michigan Endometriosis Center at Michigan Medicine in Ann Arbor, Mich., told Health.

There are many types of ovarian cysts. And what's inside your ovarian cyst will depend on what type you have, Ja Hyun Shin, MD, director of minimally invasive gynecological surgery at Weill Cornell Medicine in New York, told Health.

Types and Causes of Ovarian Cysts

Ovarian cysts can be pathological or functional.  

Pathological ovarian cysts are not caused by the menstrual cycle, including:

• Dermoid ovarian cysts: These ovarian cysts can contain tissue, such as hair, skin, or teeth.
• Cystadenomas: Watery or mucous material fills these ovarian cysts. They develop on the surface of an ovary.
• Endometriomas: Endometrial tissue fills these ovarian cysts that develop due to endometriosis. Endometriosis is when the tissue that usually lines the inside of your uterus grows outside of your uterus. 

Functional ovarian cysts are the most common type and are related to your menstrual cycle. Functional ovarian cysts include:

• Follicular ovarian cysts: These ovarian cysts form when the ovarian follicle doesn't release its egg. The ovarian follicle typically releases its egg at the midpoint of your menstrual cycle. Instead, it continues to grow.
• Corpus luteum ovarian cysts: After your ovary releases an egg, these ovarian cysts develop. The ovarian follicle, now known as the corpus luteum, shrinks. It starts to release the hormones estrogen and progesterone. If fluid builds up inside the corpus luteum, a corpus luteum cyst forms.

According to Dr. Shin, ovarian cysts typically occur in premenopausal people. People with polycystic ovary syndrome (PCOS) are more likely to develop ovarian cysts. And again, for the most part, they often go unnoticed.

"[Ovarian] cysts are very common, and the majority of times, they're actually harmless, and [people] might not even know that they have them," explained Dr. Shin. However, sometimes a cyst makes itself known by causing irritation or rupturing.

What Is a Ruptured Ovarian Cyst?

An ovarian cyst ruptures when the tissue bursts. The ovarian cyst wall opens up, exposing the fluid in the cyst to your abdominal cavity. 

Small ovarian cysts are less likely to rupture. Still, according to Dr. Shin, when an ovarian cyst grows larger, and the surrounding tissue becomes thinner, it has a greater risk of rupturing.

It's common for functional ovarian cysts to rupture, according to Dr. As-Sanie. As for the pathological ovarian cysts, Dr. As-Sanie explained that those rarely spontaneously rupture. That's because they have a thicker cyst wall, added Dr. Shin.

Also, vigorous activity affecting the pelvis may cause a ruptured ovarian cyst. Some people who have had a ruptured cyst report recently having sex. But that doesn't mean you should restrict your lifestyle to avoid rupturing a cyst, according to Dr. Shin.

Symptoms of a Ruptured Ovarian Cyst

Sudden onset pain in your pelvic area is the hallmark symptom of a ruptured ovarian cyst. Dr. Shin said the pain could happen before, during, or after the rupture. The pain following the rupture may last several days. The fluid from the ovarian cyst can irritate after it's released into your abdominal cavity and before your body absorbs it.

Usually, most ruptures cause only mild to moderate symptoms. Without serious complications, you can easily manage them. When it comes to a functional ovarian cyst rupture, the pain usually lasts a couple of hours to a day. It then goes away on its own or with the help of pain medication, according to Dr. As-Sanie.

But other times, "it can be quite painful," Dr. Shin says. "And oftentimes, [people] will come to the emergency room reporting really severe, intense, acute, sharp pain, kind of not knowing exactly what hit them."

The spot you feel the pain could be where the ovarian cyst is, but not necessarily. And then once it's ruptured, you can feel the pain pretty much anywhere in the pelvis since the fluid from the ovarian cyst can collect in different areas of the abdominal cavity, according to Dr. Shin.

Does Pelvic Pain Always Mean a Ruptured Ovarian Cyst?

But as Dr. As-Sanie pointed out, acute pelvic pain can be tied to several conditions, including a urinary tract infection and kidney stone. So, pain doesn't automatically mean you have a ruptured ovarian cyst.  

"It's not like I would say that you have unremitting pain and the first thing you should think of is you might have a ruptured [ovarian] cyst," said Dr. As-Sanie. 

Instead, if you have acute pain that interferes with your ability to do usual activities like walking and using the bathroom and is unrelieved with over-the-counter medications, Dr. As-Sanie recommended contacting a healthcare provider.

You should go to the emergency room if your pain is severe or accompanied by the following symptoms:

• Dizziness or faintness
• Vaginal bleeding
• Abdominal fullness
• Bloating
• Nausea
• Vomiting

If the only symptom you're experiencing is pain that's not too severe, then you can consult your OB-GYN. If you don't have established care with any healthcare provider, then it'd be appropriate to go to urgent care or an emergency department, Dr. As-Sanie said.

Diagnosing and Treating a Ruptured Cyst

Again, there are many potential causes of pelvic pain. So, when you go to your healthcare provider for your acute pelvic pain, they will need to figure out precisely what the cause of that pain is. 

The healthcare provider will determine your necessary laboratory tests based on your symptoms and physical exam findings. They will also decide whether any imaging test is necessary, according to Dr. As-Sanie. The imaging might help your healthcare provider make a retrospective diagnosis.

"In theory, if someone has a [ovarian] cyst that was ruptured, then the [ovarian] cyst isn't actually potentially visible on imaging anymore. So really, all you know is that [someone] had pain," noted Dr. As-Sanie.

Imaging and gradually reducing pain can allow a healthcare provider to assume an ovarian cyst has ruptured. The imaging might show some fluid in your abdominal cavity. But that evidence alone might not be enough to make a diagnosis. 

"Patients often get that label [that maybe an ovarian cyst ruptured], but there's nothing to actually confirm or exclude that a cyst was ruptured," said Dr. As-Sanie.

Usually, other than keeping track of symptoms, taking pain medication, and possibly scheduling a follow-up ultrasound, there is no treatment for something believed to be a ruptured ovarian cyst. 

An exception would be if the pain doesn't let up after the ovarian cyst ruptures. There are signs of irritation from the ovarian cyst's fluid in your abdominal cavity or internal bleeding—you might need emergency surgery at that point, Dr. As-Sanie said.

A Quick Review

Ovarian cysts are common fluid-filled sacs in the ovaries. While most ovarian cysts result in mild or no symptoms, some people experience ruptures. 

Ruptured ovarian cysts can be life-threatening in rare cases. See a healthcare provider if you experience severe pain, fever, heavy vaginal bleeding, or severe nausea and vomiting.