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Follicular Cyst: Causes, Symptoms & Treatment

A follicular cyst is a common, benign ovarian cyst that forms when a follicle fails to rupture during the menstrual cycle. It usually resolves on its own.

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Things worth knowing about "Follicular cyst"

A follicular cyst is a common, benign ovarian cyst that forms when a follicle fails to rupture during the menstrual cycle. It usually resolves on its own.

What Is a Follicular Cyst?

A follicular cyst is one of the most common types of benign ovarian cysts. It develops when a follicle – a small, fluid-filled sac in the ovary that contains an egg – does not rupture as expected during the menstrual cycle and instead continues to grow, filling with fluid. Follicular cysts belong to the category of functional ovarian cysts, meaning they arise as a result of normal ovarian activity rather than from a disease process.

Causes

Follicular cysts form when the normal ovulation process is disrupted. Under typical circumstances, a follicle matures each month, ruptures at mid-cycle (ovulation), and releases an egg. When this does not occur, a cyst may develop. Possible causes and risk factors include:

Hormonal imbalances (e.g., altered LH-to-FSH ratio)
Psychological stress and environmental factors
Certain medications (e.g., ovulation-stimulating drugs used in fertility treatments)
Polycystic ovary syndrome (PCOS)
Thyroid disorders

Symptoms

Most follicular cysts cause no symptoms and are discovered incidentally during a routine pelvic ultrasound. When symptoms do occur, they may include:

A dull ache or feeling of pressure in the lower abdomen
Pelvic pain around ovulation or during menstruation
Irregular menstrual cycles
Discomfort during sexual intercourse

In rare cases, a follicular cyst may rupture or cause the ovary to twist on itself, a condition known as ovarian torsion. This results in sudden, severe pain and requires immediate medical attention.

Diagnosis

Follicular cysts are typically diagnosed using the following methods:

Transvaginal ultrasound: The most reliable and gentle imaging method for detecting ovarian cysts. Follicular cysts typically appear as smooth, thin-walled, fluid-filled structures.
Pelvic examination: A physical exam may reveal an enlarged or tender ovary.
Blood tests: Hormone levels may indicate cycle irregularities; tumor markers such as CA-125 may be measured to rule out malignancy in unclear cases.

Treatment

Because follicular cysts are almost always benign and frequently resolve spontaneously within one to three menstrual cycles, active treatment is often not required.

Watchful Waiting

For small, asymptomatic cysts, a watch-and-wait approach with regular ultrasound monitoring is typically recommended. The majority of cysts disappear without any intervention.

Medical Treatment

Pain relievers can be used to manage discomfort. Hormonal contraceptives (the pill) may help prevent the formation of new cysts, although they do not cause existing cysts to resolve.

Surgical Treatment

Surgery is rarely needed and is considered in the following situations:

Cysts that do not resolve or continue to grow
Severe symptoms or signs of complications such as rupture or torsion
Uncertain findings where a malignant tumor must be excluded

When surgery is required, it is usually performed laparoscopically (keyhole surgery) through small incisions, making it a minimally invasive procedure.

Prognosis

The prognosis for follicular cysts is excellent. The vast majority resolve on their own without causing any lasting harm. Regular gynecological check-ups allow cysts to be identified and monitored early.

References

Berek, J. S. (Ed.) - Berek & Novak's Gynecology, 16th edition, Wolters Kluwer, 2019.
German Society of Gynecology and Obstetrics (DGGG) - S3 Guideline: Diagnosis and Treatment of Benign Ovarian Cysts, 2020. Available at: https://www.awmf.org
Bottomley, C. & Bourne, T. - Diagnosis and management of ovarian cyst accidents. Best Practice & Research Clinical Obstetrics & Gynaecology, 23(5), 711-724, 2009.

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