As a woman releases an egg from her ovary, a small cyst is formed. These are called physiological ovarian cysts and occur from puberty right through to menopause. Assessment of ovarian cysts involves initially distinguishing between a physiological (normal) or pathological cyst that can potentially cause harm. Ovarian cancer is a very emotive subject to women, mainly because most are aware that the disease presents late and non-specific symptoms. There is, therefore, great anxiety around ultrasound diagnosis of ovarian cysts, and gynaecological assessment is invaluable in trying to avoid over intervention and surgery when not necessary. Assessment of the cyst with ultrasound and blood tests, such as tumour markers called CA-125, are essential tools for the gynaecologist to assess the management.