From the Guidelines
A corpus luteum cyst is a normal, functional ovarian cyst that typically resolves on its own within 1-3 menstrual cycles without requiring treatment, as supported by the most recent evidence from the American College of Radiology (1).
Key Points
- Corpus luteum cysts are harmless and measure 2-6 cm in most cases.
- Symptoms may include mild pelvic pain, delayed menstruation, or spotting, but many women experience no symptoms at all.
- Pain relievers like ibuprofen (400-600 mg every 6 hours) can help manage discomfort.
- Medical attention is warranted if severe pain, fever, dizziness, or rapid breathing occurs, as these may indicate complications like cyst rupture or torsion.
- For persistent cysts, hormonal contraceptives might be prescribed to prevent ovulation and new cyst formation.
- Regular follow-up ultrasounds may be recommended to monitor the cyst until resolution, with a follow-up interval of 8-12 weeks for cysts greater than 5 cm but less than 10 cm, as suggested by the O-RADS US risk stratification and management system (1).
- Surgery is rarely needed unless complications develop or the cyst persists beyond 2-3 months.
Management
- According to the O-RADS US risk stratification and management system (1), a corpus luteum cyst less than 3 cm in diameter is considered physiologic and does not require additional management.
- For cysts greater than 3 cm but less than 10 cm, follow-up in 8-12 weeks is recommended to confirm its functional nature or to reassess for cyst wall abnormalities.
- The American College of Radiology (1) suggests that simple cysts, including paraovarian and paratubal cysts, less than 5 cm do not need to be followed in premenopausal women.
Complications
- Complications like cyst rupture or torsion are rare but can occur, and medical attention is warranted if severe pain, fever, dizziness, or rapid breathing occurs.
- The risk of malignancy in corpus luteum cysts is extremely low, and most cysts are benign, as supported by the evidence from the International Ovarian Tumor Analysis (IOTA) group (1).
From the Research
Definition and Causes
- A corpus luteum cyst is a type of ovarian cyst that forms after ovulation and can cause bleeding into the cyst, leading to a hemorrhagic corpus luteum cyst (HCLC) 2, 3.
- HCLCs are commonly associated with dysfunctional ovulation and can develop in the early period after menarche 2.
Symptoms and Diagnosis
- Primary presentation of HCLC can include persistent abdominal pain (84.6%) and acute abdominal pain (15.4%) 2.
- Ultrasound examination can show complex ovarian masses (77.23%) and simple ovarian masses (33.7%) 2.
- Imaging modalities such as ultrasound study (USS), contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI) can play a key role in the diagnosis of acute pelvic pain from gynecological causes, including HCLC 4.
Treatment and Management
- Surgical treatment of HCLCs can include laparoscopic excision, and a laparotomic approach may be required in some cases 2.
- Conservative surgery is recommended to preserve ovarian function, and no complications or disorder recurrence were reported in pediatric subjects with HCLC that required surgical intervention 2.
- A wait-and-see attitude with supportive therapies (antifibrinolytic, analgesics, liquid infusion, transfusions, and antibiotic prophylaxis) can be used to avoid unnecessary laparoscopic surgery 3.
- Prevention of further episodes of HCLC can include the use of estro-progestinics or GnRH analogues to prevent ovulation, especially in patients with bleeding disorders or undergoing anticoagulant therapy 3.
Complications and Associations
- Hemoperitoneum from corpus luteal cyst rupture is a common disorder in women in their reproductive age and can be life-threatening if not promptly recognized and treated 4.
- Bleeding from a corpus luteum appears to be a critical event in the development of endometriomas, with a direct transition from a hemorrhagic corpus luteum to an endometriotic cyst observed in 85% of cases 5.