Benign ovarian cysts in premenopausal women

Benign ovarian cysts are a common gynaecological presentation seen in both the elective and emergency setting. Up to 10% of women will have surgery for an ovarian cyst in their lifetime. When an adnexal mass is diagnosed the differential diagnosis is wide and up to 10% may be non-ovarian in origin. The goal of management is to determine the underlying pathology and to risk stratify patients to guide further management. Transvaginal ultrasound scanning remains the imaging modality of choice and the use of simple rules as well as benign and malignant features should form the basis for diagnosis, with serum markers used as an adjunct. Cross-sectional imaging with other modalities including magnetic resonance imaging are useful in the management of indeterminate masses. The vast majority of ovarian cysts are benign in nature and most functional and simple cysts are likely to resolve spontaneously without intervention. This review will demonstrate four clinical scenarios with different underlying pathologies and their management.