Ovarian Cystectomy

An ovarian cystectomy is surgery to remove a cyst from the ovary while keeping the ovary itself. It’s commonly recommended for persistent ovarian cysts and for endometriomas, which are ovarian cysts associated with endometriosis. The goal is to treat the problem cyst and preserve hormonal function and fertility whenever possible.

For many patients, ovarian cysts are discovered during an evaluation for symptoms like pelvic pain, painful periods, bloating, or fertility concerns (see infertility). Some cysts come and go on their own, while others grow, recur, or cause inflammation/scarring that can worsen pain and affect the pelvic organs.

At Lotus Endometriosis Institute, cystectomy planning is typically part of a bigger picture—understanding whether a cyst is isolated or part of complex disease (like endometriosis and adhesions). Learn more about our approach through evaluation and diagnosis and our services.

Your clinician may recommend an ovarian cystectomy when a cyst is persistent, growing, painful, or affecting fertility, or when imaging features raise concern that it is not a simple, benign cyst. If you have an endometrioma, cystectomy may be considered to help reduce pain and inflammation, improve access to follicles for fertility treatment, and address the underlying disease when combined with expert excision.

Cystectomy is also considered when cysts contribute to repeated ER visits, ongoing daily symptoms, or cycle-related flares such as worsening ovulation pain, nausea, and pressure/bloating. If pain is impacting intimacy or relationships, it may be part of a broader endometriosis pattern (see pain during intercourse).

Just as important: cystectomy is not always the best next step. Some functional cysts can be safely observed, and some symptoms come more from endometriosis elsewhere in the pelvis than from the cyst itself. A specialist evaluation can help match the plan to your goals (pain relief, fertility, ovarian preservation). If you’re unsure what you’ve been told, you can schedule a consultation.

Most patients consider ovarian cystectomy for one (or more) of these reasons: pain relief, fertility preservation, or clarity about what the cyst is. Many people experience meaningful improvement in pressure-type pain and cyst-related flares after surgery—especially when cyst removal is paired with treatment of associated endometriosis and adhesions.

If the cyst is an endometrioma, it’s important to understand the trade-off: removing the cyst wall can reduce recurrence and pain, but surgery can also impact ovarian reserve depending on cyst size, prior surgeries, and how much normal ovarian tissue is affected. A patient-centered plan discusses fertility goals up front, including whether you should consider egg/embryo freezing before surgery or coordinate timing with a reproductive endocrinologist.

You should also expect a more comprehensive conversation than “remove the cyst.” Patients with endometriomas frequently have endometriosis in other locations, which may drive symptoms like bladder pain, constipation, diarrhea, or painful bowel movements. Treating the full pattern—not just the cyst—often offers the best chance at lasting improvement.

Ovarian cystectomy is typically performed using minimally invasive surgery. The surgeon separates the cyst from the healthy ovary, removes the cyst, and aims to preserve as much normal ovarian tissue as possible. The removed tissue is usually sent to pathology to confirm the diagnosis.

When the cyst is suspected or known to be an endometrioma, cystectomy is often planned alongside evaluation for other endometriosis sites. In many cases, the most meaningful symptom relief comes from addressing both the ovarian cyst and the broader causes of inflammation and scar tissue—such as adhesions or deep endometriosis—using a comprehensive approach like surgery and advanced excision.

Your plan should be individualized based on your age, symptoms, fertility goals, cyst features, and any prior pelvic surgeries. If adenomyosis symptoms (heavy bleeding, cramping) are also part of your story, your team may discuss parallel treatment options for adenomyosis.

Recovery varies depending on cyst size, whether endometriosis is treated at the same time, and your baseline pain sensitivity. Many patients go home the same day. It’s common to have fatigue, bloating, and abdominal soreness for several days, with gradual improvement over 1–2 weeks. Some people feel ready for desk work within 1–2 weeks, while more physically demanding jobs may take longer.

If your surgery included treatment beyond the ovary (for example, endometriosis excision or adhesiolysis), you may notice a more layered recovery—less “sharp surgical pain” over time, but also a period where pelvic tissues feel tender as inflammation settles. Pelvic floor muscles can remain guarded after years of pain; Pelvic Floor Therapy can be a valuable part of recovery for persistent pain, painful sex, or bladder/bowel symptoms.

Your follow-up plan may include symptom tracking, medication adjustments, and support for long-term maintenance, including hormonal therapy or an integrative approach through integrative medicine and lifestyle care. If pain continues, it doesn’t mean you “failed”—it means you deserve a deeper, endometriosis-informed plan.

Ovarian cystectomy is not “one-size-fits-all,” especially when endometriosis is involved. Endometriomas can be densely attached to the ovary and surrounded by inflammation and adhesions. Preserving ovarian function while reducing recurrence risk requires judgment, precision, and a plan that accounts for both today’s symptoms and your future fertility and hormonal health.

Specialist expertise matters because ovarian surgery can affect ovarian reserve. A surgeon who frequently treats complex endometriosis is more likely to recognize when symptoms are coming from disease beyond the cyst and to treat the full picture—potentially reducing the chance of persistent pain and repeat surgeries. That broader skill set is central to endometriosis care, where the “visible cyst” is often only part of the problem.

At Lotus Endometriosis Institute, Dr. Steven Vasilev is a leader in complex minimally invasive gynecologic surgery and endometriosis care. You can read more about Dr. Steven Vasilev and our comprehensive approach to surgery and advanced excision. If you’re deciding between observation, drainage, ablation, or true cystectomy with excision, we encourage you to schedule a consultation for a personalized plan.