From the Guidelines
Simple ovarian cysts that are less than 10 cm in diameter, appear unilocular, have thin walls, and lack solid components or septations can be managed conservatively with observation rather than surgical intervention. For premenopausal women, follow-up ultrasound in 8-12 weeks is recommended to confirm resolution, as most functional cysts will disappear spontaneously within 1-3 menstrual cycles 1. Postmenopausal women with simple cysts smaller than 5 cm should have a follow-up ultrasound in 3-6 months, while those with normal CA-125 levels and cysts 5-10 cm may need repeat imaging in 3 months.
Key Considerations
- Hormonal contraceptives are no longer routinely recommended for cyst management as they don't accelerate resolution of existing cysts, though they may prevent new cyst formation.
- Pain associated with cysts can be managed with NSAIDs like ibuprofen (400-600 mg every 6 hours) or naproxen (500 mg twice daily) 1.
- Surgical intervention should be considered if cysts persist beyond 3 months, grow larger, develop concerning features on imaging, or cause significant symptoms.
Management Approach
- The American College of Radiology's O-RADS US risk stratification and management system provides a framework for managing simple ovarian cysts, categorizing them based on their risk of malignancy 1.
- For premenopausal women, simple cysts less than 5 cm do not require follow-up, while those greater than 5 cm but less than 10 cm should be followed up in 8-12 weeks to confirm resolution or assess for potential malignancy 1.
- Postmenopausal women with simple cysts should be managed based on their individual risk factors and the size of the cyst, with consideration of annual follow-up for up to 5 years if the cyst is stable 1.
Evidence-Based Recommendations
- A recent study by Gupta et al demonstrated that the risk of malignancy in simple cysts is less than 1% in average-risk women 1.
- The O-RADS US risk stratification and management system provides a standardized approach to managing simple ovarian cysts, reducing the risk of unnecessary surgical interventions and improving patient outcomes 1.
From the Research
Management Approach for Simple Ovarian Cysts
The management of simple ovarian cysts involves a conservative approach, with the aim of minimizing intervention for cysts likely to resolve spontaneously while optimizing the treatment of malignant and premalignant cysts 2.
Key Considerations
- Simple ovarian cysts are common and often resolve spontaneously 3, 4.
- The use of oral contraceptives for the treatment of functional ovarian cysts has been found to be of no benefit, with most cysts resolving without treatment within a few cycles 5, 6.
- Watchful waiting for two or three cycles is considered an appropriate approach for simple ovarian cysts, with surgical management often indicated for persistent cysts 5, 6.
Diagnostic and Monitoring Approaches
- Transvaginal ultrasonography (TVU) and CA-125 blood tests are used for ovarian cancer screening and follow-up 4.
- TVU screening examinations are considered positive when findings include ovarian volume greater than 10 cubic cm, cyst volume greater than ten cubic cm, any solid area or papillary projection, or any mixed (solid/cystic) component within a cystic ovarian tumor 4.
Treatment Options
- Laparoscopic approach may be considered for oophorectomy, depending on the clinical situation 3.
- Surgical management is often indicated for persistent cysts or those that develop solid components, abnormal Doppler flow, or CA-125 elevation 3, 4.