Ruptured ovarian cyst: symptoms, when to get help and what happens next

The ovaries are two almond-shaped organs, one on each side of the womb. The NHS explains that they release an egg roughly every 28 days as part of the menstrual cycle and produce the sex hormones oestrogen and progesterone. An ovarian cyst is a fluid-filled sac that develops on an ovary. It can affect one ovary or both at the same time.

A cyst is said to rupture when its wall splits. The NHS lists splitting, being very large and twisting as the three situations in which a cyst is most likely to cause symptoms. A rupture is therefore one of the ways an otherwise silent cyst can announce itself, which is why many people first learn they have had a cyst only when they develop pain.

The word rupture sounds alarming, and the pain can be sharp, but a split cyst is not the same thing as cancer and is not, in itself, the same as a twisted ovary. The different explanations for sudden pelvic pain are separated by a doctor using the history, an examination and usually a scan, which is why the NHS asks people with sudden severe pain to seek urgent advice rather than diagnose themselves.

The NHS divides ovarian cysts into two main groups. Functional cysts are linked to the menstrual cycle, are very common and are usually harmless and short-lived. Each egg develops inside a fluid-filled follicle that normally bursts when the egg is released. Sometimes a follicle does not release its egg, or does not discharge its fluid and shrink afterwards, and the follicle can swell into a cyst. Functional cysts are non-cancerous, although the NHS notes they can sometimes cause symptoms such as pelvic pain, and most disappear within a few months without treatment.

Pathological cysts are much less common. They result from abnormal cell growth, are not related to the menstrual cycle and can develop before or after the menopause. The NHS says they can sometimes burst, twist or grow very large and block the blood supply to the ovaries. They are usually non-cancerous, though a small number are cancerous.

Some cysts are caused by an underlying condition. The NHS gives endometriosis as an example, where tissue similar to the lining of the womb grows in other places such as the ovaries and blood-filled cysts can form, and polyendocrine metabolic ovarian syndrome (PMOS), which causes many small, harmless cysts that are really egg follicles that have not grown to ovulation.

The NHS lists the following as possible symptoms when a cyst splits, is very large or twists. Not everyone has all of them, and several have other common causes, so a single symptom is not proof of a cyst.

• Pelvic pain, from a dull, heavy sensation to a sudden, severe and sharp pain.

• Pain during sex.

• Difficulty emptying your bowels or a frequent need to urinate.

• Heavy, irregular or lighter than normal periods.

• Bloating and a swollen tummy, or feeling very full after eating only a little.

• Difficulty getting pregnant, although the NHS says fertility is usually unaffected by ovarian cysts.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have sudden, severe pelvic pain, or if you have pain in your tummy and also feel sick or are being sick. These features can accompany a ruptured cyst but also other problems that need prompt assessment, including a twisted ovary, so they are not something to sit out at home.

If your symptoms feel severe or are rapidly getting worse, do not wait for a routine appointment: NHS 111 can advise on the right level of care. During recovery after an operation, the NHS advises contacting a GP if you notice heavy bleeding, severe pain or swelling in your abdomen, a high temperature, or dark or smelly vaginal discharge, because these may indicate an infection.

If a GP thinks you may have an ovarian cyst you will probably be referred for an ultrasound scan, which the NHS says is carried out using a probe placed inside the vagina. If a cyst is seen, it may be monitored with a repeat ultrasound scan in a few weeks, or you may be referred to a gynaecologist, a doctor who specialises in female reproductive health.

If there is any concern that a cyst could be cancerous, the doctor will also arrange blood tests that look for raised levels of certain chemicals. The NHS stresses that a high result does not necessarily mean cancer, because high levels can also be caused by non-cancerous conditions including endometriosis, a pelvic infection, fibroids or simply your period.

According to the NHS, treatment depends on the size and appearance of the cyst, whether you have symptoms and whether you have been through the menopause. In most cases a policy of watchful waiting is recommended: no immediate treatment, with a scan some weeks or months later to check that the cyst has gone. After the menopause, when the risk of ovarian cancer is slightly higher, the NHS says scans and blood tests may be advised every 4 months for a year.

Large or persistent cysts, cysts causing symptoms and cysts that might be or become cancerous usually need to be removed surgically. Most can be removed by laparoscopy, a keyhole operation done under general anaesthetic that the NHS says causes less pain and a quicker recovery, with many people going home the same day or the next. A laparotomy, with a single larger cut, may be recommended for a particularly large cyst or when cancer is possible, and may need a hospital stay of a few days.

Recovery varies. The NHS says you will feel pain in your tummy after the operation but it should improve in a few days, and that it may take as long as 12 weeks to resume normal activities. If the cyst is sent for testing, results should come back in a few weeks and the consultant will discuss whether any further treatment is needed.

The NHS says ovarian cysts do not usually prevent you getting pregnant, although they can sometimes make it harder to conceive. If surgery is needed before the menopause, the surgeon will try to preserve as much of the reproductive system as possible. It is often possible to remove just the cyst and leave both ovaries intact. If one ovary has to be removed, the remaining ovary will still release hormones and eggs as usual, although it may be slightly harder to get pregnant.

Occasionally both ovaries must be removed, which triggers an early menopause and means no eggs are produced. The NHS notes that having a baby with a donated egg may still be possible, discussed at a specialist assisted reproduction centre. It is sensible to talk through the effects on fertility with the surgeon before any operation.

On the NHS the usual route is a GP assessment, an ultrasound scan and, when needed, referral to a gynaecologist. Sudden severe pain goes through urgent care instead. Private gynaecology services can offer faster scans and appointments for people who prefer them, and a private consultant will usually use the same tests and the same decision points described above. Keep a copy of any scan report, because it makes follow-up simpler wherever it is carried out.