From the Guidelines
Simple ovarian cysts are typically functional cysts that develop during normal ovarian function, forming when a follicle fails to rupture and release an egg during ovulation or when the corpus luteum doesn't dissolve properly after ovulation, and most are benign, asymptomatic, and resolve spontaneously without requiring treatment. The causes of simple ovarian cysts can be attributed to the normal hormonal fluctuations during the menstrual cycle, where slight disruptions in the usual pattern of follicle development and regression can lead to fluid accumulation within ovarian structures 1.
Key Points to Consider
- Simple ovarian cysts are common and usually benign, with a low risk of malignancy, especially in premenopausal women 1.
- The management of simple ovarian cysts generally involves watchful waiting with follow-up ultrasounds to monitor the cyst's size and appearance, rather than immediate surgical intervention 1.
- For women with painful symptoms, over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort, and hormonal contraceptives may be prescribed to prevent new cyst formation 1.
- Surgical intervention is rarely needed for simple cysts but may be considered if the cyst is larger than 5-10 cm, persists beyond 2-3 months, causes severe symptoms, or has concerning features on imaging 1.
Management Approach
- In premenopausal women, simple cysts less than or equal to 5 cm do not need to be followed, while cysts greater than 5 cm but less than 10 cm may require follow-up to confirm their functional nature or to reassess for cyst wall abnormalities 1.
- In postmenopausal women, no further management is suggested for cysts up to 3 cm, while cysts greater than 3 cm but less than 10 cm may require at least 1-year follow-up showing stability or decrease in size, with consideration of annual follow-up for up to 5 years if stable 1.
- The use of ultrasound (US) is recommended for the diagnosis and follow-up of simple ovarian cysts, as it can accurately diagnose benign adnexal lesions and characterize adnexal masses 1.
Evidence-Based Recommendations
- The American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology recommends that simple cysts up to 10 cm in diameter on transvaginal ultrasonography performed by experienced ultrasonographers are likely to be benign and may be safely monitored using repeat imaging without surgical intervention, even in postmenopausal patients 1.
- A recent consensus update to the SRU in 2019 regarding management of simple cysts reflects the findings that simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer 1.
From the Research
Causes of Simple Ovarian Cysts
- The exact cause of simple ovarian cysts is not well understood, but they are common in women of all ages 2, 3.
- Simple ovarian cysts may be related to hormonal changes during the menstrual cycle, and they can occur in women with polycystic ovary syndrome (PCOS) 4.
- PCOS is a complex endocrine disorder that affects women of childbearing age, and it is characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology 4, 5.
Management of Simple Ovarian Cysts
- Simple ovarian cysts can be managed conservatively, and they often resolve spontaneously or persist unchanged over time 3, 6.
- The American College of Obstetricians and Gynecologists (ACOG) recommends that simple cysts found on ultrasound may be safely followed without intervention, even in postmenopausal women 3.
- For postmenopausal women with simple ovarian cysts, ovarian cancer screening and follow-up include a CA-125 blood test and transvaginal ultrasonography (TVU) at baseline, an annual TVU for three additional years, and annual CA-125 tests for five years beyond baseline 3.
- Women with PCOS may be treated with lifestyle modifications, oral contraceptives, and other medications to manage their symptoms and reduce their risk of complications such as endometrial cancer and cardiovascular disease 4, 5.