Can a right ovarian hemorrhagic cyst cause abnormal bleeding?

From the Guidelines

Yes, a right ovarian hemorrhagic cyst can cause abnormal uterine bleeding in some women. This type of cyst forms when blood accumulates within a follicular or corpus luteum cyst in the ovary, and while many hemorrhagic cysts are asymptomatic, they can disrupt normal hormonal patterns 1. The abnormal bleeding typically presents as irregular menstrual cycles, spotting between periods, or heavier than normal menstrual flow.

Key Points to Consider

• The bleeding occurs because hemorrhagic cysts can produce excess estrogen or disrupt the normal balance between estrogen and progesterone, which affects the endometrial lining.
• Most hemorrhagic cysts resolve spontaneously within 4-8 weeks without specific treatment, as suggested by the guidelines for managing hemorrhagic cysts 1.
• Management usually involves pain control with NSAIDs like ibuprofen (400-600mg every 6 hours as needed) and monitoring with follow-up ultrasounds.
• If bleeding is severe or persistent, hormonal treatments such as combined oral contraceptives may be prescribed to regulate cycles.
• Surgical intervention is rarely needed unless the cyst is very large (>5-7cm), causes severe symptoms, or doesn't resolve after 2-3 menstrual cycles, as indicated by recent studies on adnexal masses 1.

Diagnosis and Follow-Up

• Ultrasound can accurately diagnose benign adnexal lesions, including hemorrhagic cysts, and is recommended for follow-up to assess resolution or changes in the cyst 1.
• The risk of malignancy in benign-appearing lesions on US, including hemorrhagic cysts, is less than 1% 1, which supports a conservative management approach for most cases.

From the Research

Abnormal Bleeding and Ovarian Hemorrhagic Cysts

• A right ovarian hemorrhagic cyst can cause abnormal bleeding, as it is a functional cyst resulting from bleeding into a follicular or corpus luteum cyst 2.
• The presentation of a hemorrhagic ovarian cyst often includes acute pelvic pain and menstrual irregularities, which can be accompanied by abnormal bleeding 2, 3.
• Diagnosis of a hemorrhagic ovarian cyst is typically made via pelvic ultrasound, which can reveal a complex cyst with characteristic features such as a reticular or 'lace-like' pattern 2, 4, 5.

Characteristics of Hemorrhagic Ovarian Cysts

• Hemorrhagic ovarian cysts can present with various ultrasonographic patterns, including hyperechoic and hypoechoic solid types, reticular or sponge-like types, mixture types of solid and cystic components, and cystic types 4.
• Transvaginal sonography can show a clear division into hyperechoic and other areas with the passing of time, which can finally change into a cystic pattern and disappear 4.
• The internal echograms of hemorrhagic ovarian cysts can also show septum-like or thread-like echoes, and ring blood flow with high velocity and low resistance can be detected in some cases 4, 5.

Clinical Implications

• Hemorrhagic ovarian cysts are a common gynaecological condition that often resolves spontaneously and requires only conservative management 2.
• However, complications such as rupture or significant hemorrhage may necessitate surgical intervention, and timely diagnosis and management are crucial to reduce morbidity and mortality 2, 6, 3.