Ovarian Cyst After Hysterectomy: Causes, Types and When to Worry
Being told you have an ovarian cyst after a hysterectomy can be confusing, and a little alarming. If your uterus is gone, how can something still be growing there? The short answer: if your ovaries were kept, they are still working, and working ovaries can form cysts. Most of these cysts are harmless. This guide explains why they happen, which types are common after surgery, how doctors decide whether to treat them, and which symptoms need prompt attention.
Why can you still get ovarian cysts after a hysterectomy?
A hysterectomy removes the uterus. It does not automatically remove the ovaries; that’s a separate decision (see our guide to the different types of hysterectomy). When the ovaries stay, they keep releasing eggs and producing hormones until menopause, even though you no longer have periods.
That monthly cycle is what creates the most common cysts in women of reproductive age: functional cysts, which form when a follicle doesn’t release its egg or doesn’t shrink afterwards. They usually go away on their own within a few cycles.
If both ovaries were removed, true ovarian cysts can’t form, with one rare exception explained below.
Types of cysts that can appear after a hysterectomy
Functional cysts
The most frequent type before menopause. They’re linked to the normal ovarian cycle, are almost always benign, and often cause no symptoms at all. Many are found by chance on an ultrasound done for another reason.
Other benign cysts and growths
Retained ovaries can also develop other types of cysts, such as endometriomas (in women with endometriosis) or cystadenomas. After menopause, ovarian masses are more often benign growths of this kind than functional cysts.
Peritoneal inclusion cysts
This one is specific to women who’ve had pelvic surgery, and it’s often mistaken for an ovarian cyst. Surgery can leave adhesions (bands of scar tissue) in the pelvis. Normally, the fluid released by the ovaries each month is reabsorbed, but adhesions can trap it in a closed pocket, which slowly fills up and forms a cyst-like collection. It needs both adhesions and an active ovary to develop. Peritoneal inclusion cysts are benign and have no potential to become cancer, but they can cause pelvic pain and sometimes come back after treatment.
Residual ovary syndrome
Doctors use this name when a deliberately kept ovary causes ongoing problems after a hysterectomy. It’s estimated to affect around 2 to 3% of women whose ovaries are preserved. Symptoms can include recurring or chronic pelvic pain, pain during sex, urinary symptoms or a pelvic mass, and they can appear anywhere from a few months to many years after surgery. Functional cysts and peritoneal inclusion cysts often account for these symptoms. If the ovaries are the source of your pain, our article on ovary pain after hysterectomy goes into more detail.
Ovarian remnant syndrome (rare)
Even when both ovaries were meant to be removed, a small piece of ovarian tissue is occasionally left behind. It can keep producing hormones and form cysts or cause pain. This is uncommon, and the resulting masses are usually benign.
Symptoms to watch for
Many cysts cause no symptoms. When they do, the most common are:
- A dull ache or pressure on one side of the lower abdomen or pelvis
- Bloating or a feeling of fullness
- Pain during sex, especially with deep penetration
- Needing to urinate more often, or changes in bowel habits, if the cyst presses on nearby organs
Since you no longer have periods, you can’t use your cycle to notice patterns. Keeping a simple note of when the pain happens can still help your doctor, because pain from a functioning ovary may come and go roughly monthly.
When to seek emergency care
Go to an emergency department if you have sudden, severe pelvic or abdominal pain, especially with nausea, vomiting, fever, dizziness or fainting. These can be signs that a cyst has ruptured or that the ovary has twisted (ovarian torsion), which needs urgent treatment.
How doctors diagnose a cyst after hysterectomy
The usual first test is a transvaginal ultrasound, which shows the size of the cyst and whether it’s simple (thin-walled and filled with fluid) or complex (with solid areas, thick walls or internal divisions). That distinction matters most for deciding what to do next. Depending on the findings and your age, your doctor may also order a blood test called CA-125, which can help tell benign from malignant masses after menopause, or an MRI if the ultrasound isn’t conclusive.
Make sure the radiologist and your doctor know you’ve had a hysterectomy and whether your ovaries were kept. A peritoneal inclusion cyst can look like an ovarian tumor on imaging, and knowing your surgical history helps avoid unnecessary surgery.
Treatment options
Watchful waiting
For most simple cysts, the recommended approach is to monitor rather than operate. According to ACOG guidance, simple cysts up to 10 cm seen on a good-quality ultrasound are very likely benign and can be followed with repeat imaging, even after menopause. In one large study of postmenopausal women with simple cysts of this size, more than two-thirds resolved on their own.
Medication
Pain relievers can help with discomfort. For residual ovary syndrome, hormonal treatments that suppress ovulation are sometimes tried, although the evidence supporting them is limited.
Surgery
Surgery is considered when a cyst is large, keeps growing, causes significant pain, has features that raise concern on imaging, or when there’s a rupture or torsion. Depending on the situation, the surgeon may remove only the cyst (cystectomy), the whole ovary (oophorectomy), or adhesions that are trapping fluid. It’s usually done laparoscopically. Previous surgery can make the operation more complex because of scar tissue, so it’s worth asking your surgeon about their experience with these cases.
What about ovarian cancer?
It’s a natural worry, and it’s reasonable to ask. The reassuring part: most ovarian masses are benign, and simple cysts in particular carry a very low risk. The important part: if your ovaries were kept, you can still develop ovarian cancer, so new or persistent symptoms such as bloating, pelvic pain or feeling full quickly should always be checked.
For women who haven’t had surgery yet, there’s a relevant option to discuss: removing the fallopian tubes while keeping the ovaries (opportunistic salpingectomy). ACOG recommends discussing it with women having a hysterectomy for non-cancerous reasons, because many ovarian cancers are thought to start in the tubes. It lowers the risk without causing menopause, though it doesn’t eliminate the risk completely.
Frequently asked questions
Can I get an ovarian cyst years after my hysterectomy?
Yes. As long as your ovaries are working, cysts can form at any time. Problems related to retained ovaries have been reported from a few months to more than 20 years after surgery.
Can ovarian cysts form after menopause?
Yes, though functional cysts become much less common once ovulation stops. Simple cysts found after menopause are usually benign and are often monitored with ultrasound rather than removed.
Do ovarian cysts go away on their own?
Many do. Functional cysts typically resolve within a few cycles, and a large proportion of simple cysts disappear during follow-up. Your doctor will usually repeat the ultrasound to confirm.
Can I get a cyst if both my ovaries were removed?
True ovarian cysts need ovarian tissue, so it’s rare. It can happen if a small piece of ovary was left behind (ovarian remnant syndrome). Other fluid collections in the pelvis are possible too, so any new mass should be evaluated.
Sources
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstetrics & Gynecology, 2016.
- American Family Physician. ACOG Releases Guidelines on Management of Adnexal Masses, 2008.
- Pastore M, et al. Late aortic lymphocele and residual ovary syndrome after gynecological surgery. World Journal of Surgical Oncology, 2007.
- Residual ovarian syndrome: A case report with classic symptoms, imaging and pathology findings, and treatment. Taiwanese Journal of Obstetrics & Gynecology, 2018.
- Two cases of giant peritoneal inclusion cysts requiring treatment after total laparoscopic hysterectomy. Journal of Surgical Case Reports, 2020.
- Radiopaedia. Peritoneal inclusion cyst.
- BMC Women’s Health. Case report and review on ovarian remnant syndrome, 2023.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention. Obstetrics & Gynecology, 2019.
This article is for general information and is not a substitute for medical advice. If you have pelvic pain or have been told you have a cyst, please talk to your own doctor about your situation.
