In certain situations, the cyst is entirely removed, while with cysts with low recurrence risk, younger patients, or which are in anatomically eloquent areas of the pelvis, they can be drained. Features that may indicate the need for surgery include:
Persistent complex ovarian cysts
Persistent cysts that are causing symptoms
Complex ovarian cysts larger than 5 cm
Simple ovarian cysts larger 10 cm or larger than 5 cm in postmenopausal patients
Women who are menopausal or perimenopausal

Frequency
Most women of reproductive age develop small cysts each month, and large cysts that cause problems occur in about 8% of women before menopause. Ovarian cysts are present in about 16% of women after menopause and if present are more likely to be cancer.Benign ovarian cysts are common in asymptomatic premenarchal girls and found in approximately 68% of ovaries of girls 2–12 years old and in 84% of ovaries of girls 0–2 years old. Most of them are smaller than 9 mm while about 10–20% are larger macrocysts. While the smaller cysts mostly disappear within 6 months the larger ones appear to be more persistent. References
Further reading
McBee, W. C; Escobar, P. F; Falcone, T. (1 February 2007). "Which ovarian masses need intervention?". Cleveland Clinic Journal of Medicine. 74 (2): 149–157. doi:10.3949/ccjm.74.2.149. PMID 17333642. S2CID 45443236. Simcock, B; Anderson, N (February 2005). "Diagnosis and management of simple ovarian cysts: An audit". Australasian Radiology. 49 (1): 27–31. doi:10.1111/j.1440-1673.2005.01389.x. PMID 15727606. Ross, Elisa K.; Kebria, Medhi (August 2013). "Incidental ovarian cysts: When to reassure, when to reassess, when to refer". Cleveland Clinic Journal of Medicine. 80 (8): 503–514.
Ultrasound
Follow-up imaging in women of reproductive age for incidentally discovered simple cysts on ultrasound is not needed until 5 cm, as these are usually normal ovarian follicles. Simple cysts 5 to 7 cm in premenopausal females should be followed yearly. Simple cysts larger than 7 cm require further imaging with MRI or surgical assessment. Because they are large, they cannot be reliably assessed by ultrasound alone; it can be difficult to see posterior wall soft tissue nodularity or thickened septation due to limited ultrasound beam penetrance at this size and depth. For the corpus luteum, a dominant ovulating follicle that typically appears as a cyst with circumferentially thickened walls and crenulated inner margins, follow up is not needed if the cyst is less than 3 cm in diameter. In postmenopausal patients, any simple cyst greater than 1 cm but less than 7 cm needs yearly follow-up, while those greater than 7 cm need MRI or surgical evaluation, similar to reproductive age females. For incidentally discovered dermoids, diagnosed on ultrasound by their pathognomonic echogenic fat, either surgical removal or yearly follow up is indicated, regardless of patient age. For peritoneal inclusion cysts, which have a crumpled tissue-paper appearance and tend to follow the contour of adjacent organs, follow up is based on clinical history. Hydrosalpinx, or fallopian tube dilation, can be mistaken for an ovarian cyst due to its anechoic appearance. Follow-up for this is also based on clinical presentation.For multiloculate cysts with thin septation less than 3 mm, surgical evaluation is recommended.