although most cases of ovarian cysts involve monitoring, some cases require surgery. this may involve removing the cyst, or one or both ovaries. technique is typically laparoscopic, unless the cyst is particularly large, or if pre-operative imaging suggests malignancy or complex anatomy. 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.