Ovarian follicular cyst

Last revised by Dr Matt A. Morgan on 13 May 2022

An ovarian follicular cyst is type of simple physiological ovarian cyst.

The terms "ovarian cyst" and "ovarian follilcular cyst" are often used interchangeably. These two terms describe lesions >3 cm, and it is important to differentiate them from an "ovarian follicle" which is <3 cm.

They present in women of reproductive age.

They are asymptomatic and frequently present on routine pelvic scans.

They are a type of functional ovarian cyst and result from persistence of an unruptured Graafian follicle which then becomes larger in size.

They generally resolve spontaneously in two to three cycles.

  • thin-walled and unilocular
  • usually range around 3 to 8 cm in size
    • by definition, if <3 cm it the "cyst" is termed an ovarian follicle rather than an ovarian follicular cyst
  • there is typically posterior acoustic enhancement and an absence of internal echoes
  • there should be no color flow, nodules, or any solid component.

Small, simple presumed follicular cysts (<5 cm) in premenopausal patients can be left alone and require neither surgery nor imaging follow-up.  According to a recent consensus statement 6, yearly follow-up is suggested for cysts 5-7 cm, and large cysts (>7 cm) should ideally be assessed with MRI to exclude any subtle worrisome features, as it may be difficult to visualize these entirely with ultrasound.

Follicular cysts do not occur in postmenopausal women. A cystic ovarian lesion in a postmenopausal woman requires different follow-up (see ovarian cyst)

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