Ovarian Cysts in Ajax: Ultrasound Follow-Up Explained

Few lines on a report cause as much quiet worry as this one: “Cyst seen in the left ovary. Follow-up ultrasound suggested.” It tends to arrive on a patient portal before anyone has explained it, and the words “cyst” and “follow-up” together can sound like the start of something serious.

In most cases, that sentence describes something very ordinary. Ovaries make cysts as part of their normal work, and repeating the scan after a few weeks or months is one of the most common ways providers confirm that a cyst is behaving the way they expect. This article explains why follow-up is suggested so often, what the sonographer and radiologist compare from one scan to the next, and which symptoms should send you for urgent care instead of waiting. It is written for people in Ajax, Pickering, Whitby and across Durham Region, and it is general information, not a substitute for advice from your own health-care provider.

A cyst is a pocket, not a diagnosis

The word cyst simply means a sac filled with fluid or other material. On its own, it says nothing about cause. The ovaries are a place where these sacs appear constantly, because of how ovulation works.

Each menstrual cycle, a small fluid-filled structure called a follicle grows on the ovary to hold a developing egg. Normally it releases the egg and then changes into a temporary structure, the corpus luteum, which produces hormones and fades away if pregnancy does not occur. Sometimes a follicle keeps growing instead of releasing its egg, or the corpus luteum fills with fluid or a little blood. The result is what providers call a functional cyst.

Functional cysts are by far the most common kind in people who still have periods. Many cause no symptoms at all and are found by chance when a pelvic ultrasound is done for another reason. Most shrink and disappear on their own over one or a few cycles. That expected disappearance is exactly what a follow-up scan is often looking for.

Other kinds a report may mention

Not every ovarian cyst is functional. A radiologist may describe features that suggest another type, and your provider will explain what applies to you. Some names you might come across:

• Haemorrhagic cyst. A functional cyst that contains some blood, which gives it a lace-like or web-like appearance inside. These also usually resolve with time.
• Endometrioma. A cyst related to endometriosis, sometimes described as containing thick, uniform fluid. Our article on pelvic pain and ultrasound touches on endometriosis and why much of it does not show on a scan.
• Dermoid cyst. A type of growth that can contain fat and other tissues, giving it a distinctive look.
• Cystadenoma. A growth arising from the surface of the ovary, which can be filled with watery or thicker fluid.

Reports also use descriptive words such as simple, complex, septated or solid component. We have a whole guide to ultrasound report terms that explains those words, including the difference between a simple and a complex cyst, so we will not go through them again here. What matters for this article is that the description guides the plan, and a follow-up scan is a normal part of many plans.

Why your provider asked for another scan

A single ultrasound is a snapshot. It shows how a cyst looks on one particular day, at one point in your cycle. Repeating the scan adds the one thing a snapshot cannot: time.

To see whether it goes away

If a cyst looks like a functional one, the most reassuring outcome is that it is smaller or gone on the next scan. Waiting a cycle or more before repeating gives it the chance to resolve.

To clarify an unclear appearance

Sometimes a cyst has features that could fit more than one explanation. A haemorrhagic cyst, for example, can look different from week to week as the blood inside changes. Seeing it again later can make its nature clearer.

To track something that is staying

Some cysts are expected to stay. In that case, follow-up scans check that size and appearance remain stable. “Stable” is a good word to see on a report of this kind.

Because life stage matters

Guidance for how closely to follow a cyst depends on age and whether a person is before or after menopause, among other things. That is why two people with similar-looking cysts may be given different follow-up plans. Your provider uses current guidance and your history to decide.

Timing the repeat scan

The interval is chosen by your provider and is often written on the requisition or in the original report. Commonly it is measured in weeks to months. For people who still menstruate, some providers prefer the follow-up to fall at a particular point in the cycle, such as soon after a period, when fewer normal follicles are present and a lingering cyst is easier to judge.

If your requisition mentions timing in your cycle, tell the clinic when you book so the appointment can fit. If it does not and you are unsure, ask your provider rather than guessing. And if you take hormonal contraception or other hormone treatment, mention it at check-in, because it can affect what the ovaries look like.

What gets compared from one scan to the next

At your follow-up, the sonographer will look at both ovaries and the uterus again, then pay close attention to the area where the cyst was seen before. The radiologist then compares the new images with the earlier ones. The main things they consider are:

1. Size. Measured in three directions so changes can be tracked accurately.
2. Wall and contents. Whether the wall is thin and smooth, and whether the inside is clear fluid, has internal echoes, or contains divisions or solid areas.
3. Blood flow. Doppler ultrasound shows whether there is blood flow in or around a part of the cyst, which can help with characterizing it.
4. Surroundings. Whether there is free fluid in the pelvis and how the other ovary and the uterus look.

Comparison works best when the radiologist has the earlier images, not just the earlier report. If your first scan was done at a different clinic, let staff know where, and consider requesting a copy to bring. Our article on copies of your imaging explains how that generally works.

How the scan is done

A pelvic ultrasound may be done through the lower abdomen, internally with a slim probe, or both. Each approach shows different things well, and the follow-up usually uses whatever gave the clearest view of the cyst last time. A full bladder is often needed for the abdominal part; our guide to pelvic ultrasound and a full bladder explains how to get the timing right. You can always ask questions or decline an internal scan, and staff will explain what that means for the exam.

When a cyst becomes urgent

Most cysts are quiet. Occasionally, a cyst can rupture, bleed, or cause the ovary to twist on itself, a problem called torsion that can cut off its blood supply. These situations need emergency care, not a booked ultrasound.

Call 911 or go to the nearest emergency department if you have:

• sudden, severe pain in the lower abdomen or pelvis, especially on one side
• pelvic pain with nausea or vomiting
• pain with fever
• dizziness, fainting, a racing heartbeat or feeling cold and clammy
• heavy vaginal bleeding, such as soaking through pads quickly
• pain or bleeding with a positive or possible pregnancy

It is better to be checked and reassured than to wait at home with these symptoms.

After menopause

Cysts are found after menopause too, often during a scan done for another reason. Many are simple and harmless, but because the ovaries are no longer ovulating, providers think about them differently and may follow them according to separate guidance. If you have had any vaginal bleeding after menopause, mention it to your provider even if you feel well, since it is a symptom they will want to look into in its own right.

Getting through the waiting period

The time between scans is often the hardest part. A few practical steps can help:

• Ask what the follow-up is looking for. Knowing whether your provider expects the cyst to disappear, or simply to stay the same, changes how the wait feels.
• Ask what would change the plan. Find out which symptoms should prompt you to call sooner.
• Keep a short diary. Note pain, its side, timing in your cycle and anything that eases it. It is useful information for your provider.
• Book the repeat scan early. Having the date settled makes it easier to put the question aside until then.
• Bring someone if it helps. A trusted friend or family member in the waiting room can make the visit feel less lonely. If you would like them in the room, ask staff when you check in.

Your follow-up ultrasound in Ajax

Pelvic ultrasound is offered by appointment at Rossland Diagnostic Clinic, Unit 102, 300 Rossland Road East, Ajax, Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm. Bring your health card and requisition, along with details of where your earlier scan was done. Preparation is confirmed when you book. You can learn more about our ultrasound services, request an appointment online, or call 905-426-3111 and our staff will help you find a time that suits your cycle and your schedule.