From the Guidelines
Ovarian cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer, and most can be safely monitored with ultrasound without surgical intervention 1.
Diagnosis and Management
Ovarian cysts are fluid-filled sacs that develop on or within the ovaries, with most being benign and resolving on their own without treatment within a few months. Common symptoms include pelvic pain, fullness or pressure in the abdomen, bloating, and sometimes pain during intercourse or bowel movements. Many women with ovarian cysts experience no symptoms at all, with cysts being discovered during routine pelvic examinations or imaging studies done for other reasons.
Recommendations
- For small, asymptomatic cysts, watchful waiting is typically recommended with follow-up ultrasounds to monitor changes 1.
- Over-the-counter pain medications like ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) can help manage discomfort.
- Hormonal birth control pills may be prescribed to prevent new cysts from forming.
- Large cysts (greater than 5-10cm), those causing severe symptoms, or suspicious cysts that might be cancerous may require surgical removal, which can often be done laparoscopically through small incisions.
- Simple cysts, including paraovarian and paratubal cysts < 5 cm, do not need to be followed in premenopausal women 1.
- For cysts greater than 3 cm but less than 10 cm in postmenopausal women, at least 1-year follow-up showing stability or decrease in size is recommended with consideration of annual follow-up for up to 5 years, if stable 1.
Key Points
- The risk of malignancy in simple cysts is very low, with a recent meta-analysis demonstrating a risk of 0.6% in premenopausal women 1.
- Unilocular cysts, as a whole, in the premenopausal population have a very low risk of malignancy, with a risk of 0.5% to 0.6% in surgically resected lesions 1.
- Seek immediate medical attention if you experience sudden, severe abdominal pain, fever, vomiting, or signs of shock, as these could indicate a ruptured cyst or ovarian torsion requiring emergency treatment.
From the Research
Ovarian Cysts Overview
- Ovarian cysts occur frequently in women of reproductive age, with most being functional cysts that resolve spontaneously 2.
- Non-functional cysts have diverse histologic origins, including serous and mucinous cystadenomas, endometriomas, and dermoid cysts 2.
- The incidence of ovarian cysts is unclear due to inconsistent reporting, but it is estimated that about 7% of women have an ovarian cyst at some point in their lives 3.
Diagnosis and Imaging
- Endovaginal ultrasound with Doppler enhancement is the best imaging technique to establish the nature of cysts and distinguish those suspicious for malignancy 2.
- Transvaginal sonography plays an important role in the detection of ovarian cysts and diagnosis of malignancy, with signs of neoplasia including large cysts, multiloculi, septa, papillae, and increased blood flow 4.
- The combination of benign findings on pelvic examination, a benign ultrasound appearance, and a cancer antigen 125 level within normal limits indicates a benign origin in practically all cases 5.
Management and Treatment
- Pelvic laparoscopy is the surgical approach of choice for the treatment of non-functional benign ovarian cysts 2.
- Conservative treatment to shell out the cyst and preserve functional ovarian tissue should be reserved for women desirous of future pregnancies 2.
- Simple cysts found on ultrasound may be safely followed without intervention, even in postmenopausal women, as they are not likely cancer precursors or markers of increased risk 3.
- Patients with cysts > 7 cm are indicated for surgical procedures, while a period of follow-up is acceptable for patients with cysts < 7 cm, and surgery is advisable if the cyst is persistent during follow-up 6.