Ovarian Cysts in Istanbul — Gentle Treatment with Preservation of the Ovary
The diagnosis "ovarian cyst" sounds alarming at first, but in the vast majority of cases it means neither cancer nor an inevitable operation. Many cysts are harmless and disappear on their own, while others should be treated in a targeted way. At our practice in Istanbul/Şişli, Associate Professor Dr. Cengiz Andan focuses on avoiding unnecessary procedures and — when surgery is needed — on preserving the ovary and your fertility as far as possible. For international patients, that is often the reason to seek a second, honest assessment.
At a Glance
- What it is: a fluid-filled cavity on the ovary, mostly benign.
- Frequency: more than 90 percent of women have at least one cyst in the course of their life.
- First choice: many functional cysts resolve on their own within a few weeks — watchful waiting often comes before surgery.
- When surgery: for large, persistent, suspicious or symptomatic cysts, gently via laparoscopy.
- Chocolate cyst: with an endometrioma, preserving the ovarian reserve is the focus.
What is an ovarian cyst — and does it even need to be treated?
An ovarian cyst is a fluid-filled cavity on the ovary, which in most cases is benign. It is often discovered incidentally on ultrasound, without any symptoms being present at all.
A fluid-filled cavity on the ovary
Most cysts are only a few centimeters in size and cause no symptoms. They often come to attention only during a routine examination.
Why most cysts are harmless
Over 90 percent of women of reproductive age develop an ovarian cyst at least once. A large proportion of these cysts resolve within about three weeks without any treatment.
Source: ACOG — evaluation and management of adnexal findings
Functional or pathological cyst — where is the difference?
The most important difference is whether a cyst is hormone-related (functional) or pathologically altered (pathological). This classification decides whether one can wait or whether treatment makes sense.
Functional cysts (hormone-related)
Functional cysts arise as part of the normal cycle and are by far the most common form. They show a high tendency to regress and usually disappear on their own.
Pathological cysts (endometrioma, dermoid, cystadenoma)
Pathological cysts do not regress spontaneously and should be treated depending on the findings. These include the chocolate cyst (endometrioma), dermoid cysts and cystadenomas.
| Cyst type | Feature | Tendency |
|---|---|---|
| Functional cyst | hormone-related, common | often regresses |
| Endometrioma | "chocolate cyst" | persists |
| Dermoid / cystadenoma | contains tissue | usually removed |
Is an ovarian cyst dangerous — how high is the cancer risk?
The vast majority of ovarian cysts are benign, and a malignant finding is rare in women of reproductive age. Nevertheless, a medical assessment is important so as not to miss the few suspicious cases.
Why the vast majority of cysts are benign
In the overwhelming majority of cases, these are harmless, benign changes. The aim of every assessment is to avoid unnecessary operations while at the same time not missing any malignant process.
Which findings are assessed more closely
Size, appearance on ultrasound and the course determine the further approach. The tumor marker CA-125 must be assessed with caution, since it can be slightly elevated for example with an endometrioma and should not on its own lead to removal of the entire ovary.
Cysts after menopause
Cysts newly arising after menopause are generally observed more attentively. Here an assessment or operation is advised more often, since the risk of a malignant change is higher.
Source: RCOG / NICE — management of ovarian cysts
What symptoms does a cyst cause — and when does it become an emergency?
Small cysts usually go unnoticed, while larger ones can cause pressure and pain. In rare cases, however, a cyst can become a real emergency.
Common symptoms
Typical are a feeling of pressure in the lower abdomen, pain or cycle changes. If a cyst reaches a certain size, it can press on neighboring organs such as the bladder or bowel.
Torsion and rupture as an emergency
If a cyst twists (torsion) or bursts with bleeding into the abdomen, sudden severe pain arises. A torsion can interrupt the blood supply to the ovary, so that only a timely operation can save the organ.
Emergency: with sudden, severe lower abdominal pain, possibly with nausea or circulatory problems, you should seek emergency care immediately — regardless of any planned trip.
How is an ovarian cyst detected?
The most important examination is the vaginal ultrasound, which reliably shows most cysts. From the image, the size, structure and type of the cyst can usually be classified well.
Ultrasound as the most important method
On ultrasound, it is often already apparent whether a cyst is functional or pathological. An endometrioma, for example, often has a typical, ground-glass appearance.
When additional examinations make sense
With unclear findings, a follow-up check, a blood test or an MRI can be added. An overall view from examination, ultrasound and history leads in most cases to the correct diagnosis.
Wait or operate — when is which route right?
The honest answer is: not every cyst has to be operated on. With a typical functional cyst, watchful waiting is often the better choice, while certain findings make an operation worthwhile.
When watchful waiting is enough
If the typical picture of a functional cyst is seen, an ultrasound check can be carried out after the next menstrual period. Symptom-free cysts can often be observed over a period of about three months, since a large proportion resolves on its own.
When an operation makes sense
Arguments for an operation are persistent or growing cysts, severe symptoms, a suspicious appearance or complications such as a torsion. A hormonal treatment attempt on average brings no better regression rate and is usually not suitable for women who wish to conceive.
| Situation | Recommended approach |
|---|---|
| Typical functional cyst | observe, check |
| Persistent or growing | consider surgery |
| Suspicious ultrasound image | assessment, surgery if needed |
| Torsion or rupture | immediate surgery |
Chocolate cyst (endometrioma) — what is different here?
The chocolate cyst, medically an endometrioma, is a special form of ovarian cyst and belongs to endometriosis. It contains old, thickened blood and behaves differently from a functional cyst, because it does not resolve on its own.
Endometrioma as a special form of cyst
An endometrioma arises when tissue similar to the uterine lining settles on the ovary. With endometriosis, the treatment is especially experience-dependent, which is why we pay particular attention to a gentle technique here.
Operate or treat hormonally?
Not every endometrioma needs to be operated on immediately. Medication therapy can shrink the cyst and clearly lower the recurrence risk: in studies, the recurrence rate after five years fell from around 69 percent without prevention to about 4 percent with hormonal aftercare.
Effect on fertility
Endometriomas can affect fertility, but they do not have to — some women become pregnant spontaneously despite larger cysts. The decisive thing is to weigh location, size, ovarian reserve and time window together before an operation is planned.
Source: ESHRE — guideline on endometriosis and the wish to conceive
How does the laparoscopic removal (cystectomy) in Istanbul work?
An ovarian cyst is today almost always removed minimally invasively via laparoscopy. Through a few small incisions, the cyst and ovary can be assessed precisely and treated in a targeted way.
Minimally invasive through small incisions
In laparoscopy, the abdomen is expanded with CO₂ gas and operated on through small ports. This means less pain, a shorter recovery and barely visible scars compared with an open abdominal incision.
Remove the cyst, preserve the ovary (retrieval-bag technique)
In most cases, only the cyst is shelled out and the healthy part of the ovary is preserved. The cyst is retrieved in a retrieval bag to avoid spreading cells in the abdomen.
When the entire ovary must be removed
Only in a few cases — for example with suspected tumor or after menopause — is removal of the entire ovary necessary. This decision is always made individually and after careful consideration.
Source: AAGL — guideline on the laparoscopic treatment of ovarian findings
Will my ovary and my fertility be preserved?
In most procedures, the ovary is preserved and only the cyst is removed. Especially with a wish to conceive, gentle handling of the ovarian tissue is decisive.
Ovarian reserve and AMH value
The ovarian reserve, often estimated via the AMH value, describes the remaining egg count. An extensive operation, especially on both ovaries, can reduce this reserve and should therefore be carefully weighed.
Why a gentle technique protects the reserve
If too much healthy tissue is removed or too strongly cauterized, the AMH value can fall. A precise, tissue-sparing technique helps to preserve the reserve — an important point for women who want to become pregnant later.
What does our treatment approach look like?
Our approach puts the preservation of the ovary and fertility at the center. We recommend an operation only when it really makes sense, and we discuss benefits, alternatives and possible consequences openly with you.
Organ preservation and ovarian reserve at the center
We operate as precisely as possible to spare healthy ovarian tissue and thus the reserve. With over 2,000 laparoscopic procedures and more than 500 endometriosis operations, we bring a lot of experience particularly with chocolate cysts.
One responsible surgeon — no changing teams
With us, Associate Professor Dr. Cengiz Andan personally accompanies your journey from the first assessment to the aftercare. This way the contact person and responsibility remain the same throughout the entire course.
Does a cyst come back after surgery?
Whether a cyst comes back depends strongly on the type. Functional cysts can in principle arise again, while endometriomas in particular carry a certain recurrence risk.
Recurrence risk with functional cysts vs. endometriomas
With endometriomas, the recurrence risk without prevention is about 32 to 40 percent and particularly affects younger women. After complete removal of other cyst types, on the other hand, we see recurrences clearly more rarely.
When hormonal recurrence prevention makes sense
If there is no immediate wish to conceive after surgery, hormonal aftercare can strongly lower the recurrence risk. We discuss this option individually, as it is not suitable for every patient.
How quickly do I recover after the procedure?
Recovery after a laparoscopy is usually quick and with little pain. Since only small incisions are made, the physical strain is low.
The first days after laparoscopy
Often only a short stay of about one day is needed, and some procedures are also performed as outpatient. A slight feeling of pressure from the CO₂ gas usually subsides within one to two days.
When you are fit for everyday life again
Light activities are often possible again after just a few days, sport and heavy lifting after about two weeks. The exact course depends on the extent of the procedure.
Typical course:
- Day of the procedure: rest, slight feeling of pressure possible
- Day 1 to 2: back to light everyday activities
- First week: no heavy physical strain
- After about 2 weeks: usually full capacity
How safe is the procedure — and what if something happens after the journey home?
Gynecological laparoscopy is regarded as a very safe standard procedure. Serious complications are rare and lie overall at under about 2 percent.
How rare serious complications are
Injuries, infections or post-operative bleeding each occur in under around 1 percent of cases and are well manageable in the vast majority of situations. With 18 years of experience and a complication rate of under about 2 percent, the risk remains low.
Reachability after the journey home and coordination with your local doctor
Should a question or abnormality arise after your journey home, we are reachable for you and coordinate where needed with your doctor at home. Findings, histology and aftercare can also be accompanied remotely.
Home country or Istanbul — where is the difference?
With a planned procedure abroad, the question of quality and safety is in the foreground. The quality is equally very high in your home country and in Istanbul, because treatment follows the same international guidelines.
Same quality, same international guidelines
The minimally invasive technique and the professional standards correspond to those at home. The difference lies not in the treatment itself, but in the surrounding conditions.
The difference lies in waiting time, continuity and cost
In Istanbul, long waiting times are eliminated, and a single responsible surgeon accompanies the entire course. Through lower operating costs and the exchange rate, the prices are often up to about 50 to 60 percent lower — with the same technique and the same standard.
| Aspect | Home country | Istanbul |
|---|---|---|
| Quality | very high | very high |
| Waiting time | often longer | plannable at short notice |
| Surgeon | may change | one responsible doctor |
| Cost | higher | clearly lower |
A second opinion from abroad — when is it worthwhile?
A second opinion is especially helpful when an operation or even the removal of an ovary has been recommended to you. Particularly in young women, the worry about a malignant finding sometimes leads to procedures that could have been avoided.
When a second opinion makes sense
If the recommendations are unclear or a larger procedure has been suggested to you, an independent assessment is worthwhile. In the online consultation, we look at your findings and tell you openly whether an operation is needed or whether watchful waiting is enough.
How the paid online consultation works
The consultation with Associate Professor Dr. Cengiz Andan takes place online and for a fee; it is not a free service. You send your documents in advance, and in the conversation we discuss findings, possible steps and — if desired — the planning in Istanbul.
Frequently Asked Questions (FAQ)
There is no fixed limit, but from a size of about 5 centimeters and with no regression, surgery is considered more often. The appearance, course and symptoms are always decisive too.
After a laparoscopy, a waiting time of about 2 weeks before a scheduled flight is often recommended. The exact timing is set individually, also to take residual gas and the thrombosis risk into account.
Yes, functional cysts very often resolve on their own within a few weeks. That is why, with typical findings, watchful waiting comes first.
Some cysts change the cycle or cause spotting, but many have no effect. Persistent cycle disturbances should be assessed by a doctor.
Many women become pregnant without problems despite a cyst. Whether fertility is affected depends on the cyst type — endometriomas can affect it more than functional cysts.
With laparoscopy, only a few small incisions are made, which usually heal almost invisibly. A large abdominal incision is rarely necessary today.
Cyst removal is mostly performed as an outpatient procedure or with a short inpatient observation. This depends on the extent of the procedure and how you feel.
No. In most cases only the cyst is removed and the ovary is preserved. Complete removal is only necessary with certain findings.
Hormonal contraceptives can have a supporting effect with recurring functional cysts by suppressing ovulation. However, there is no hundred-percent prevention.
Often a new attempt or an IVF start is possible after healing and a few weeks. The exact timing depends on the findings and the ovarian reserve.
You receive an operation report with all findings and, where applicable, the result of the histological examination. You can present these documents to your doctor at home.
The consultation and the documents for international patients are provided in English.
