What is the recommended follow-up for a 5.2 cm simple left ovarian cyst seen on ultrasound in a 25-year-old female?

From the Guidelines

For a 5.2 cm simple left ovarian cyst in a 25-year-old female, the recommended follow-up is a repeat ultrasound in 8-12 weeks to monitor for resolution or changes in the cyst. According to the O-RADS US risk stratification and management system, a simple cyst greater than 5 cm but less than 10 cm in a premenopausal patient should be followed up in 8-12 weeks to confirm its functional nature or to reassess for cyst wall abnormalities 1. This approach is supported by the American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology, which 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.

Some key points to consider in the management of this patient include:

• The patient should be advised to return sooner if she develops severe pelvic pain, fever, vomiting, or other concerning symptoms that could indicate complications such as cyst rupture or torsion.
• Over-the-counter pain medications like ibuprofen (400-600 mg every 6-8 hours) or acetaminophen (650-1000 mg every 6 hours) can be used for mild discomfort.
• If the cyst persists beyond 3 months, grows larger, or develops concerning features on follow-up imaging, referral to gynecology for further evaluation would be appropriate.
• The watchful waiting approach is justified because the vast majority of simple cysts in young women are physiologic and intervention carries more risk than benefit in asymptomatic cases 1.

It is essential to note that the O-RADS system provides a framework for the management of ovarian cysts, and the recommended follow-up interval may vary depending on the specific characteristics of the cyst and the patient's symptoms and medical history 1.

From the Research

Recommended Follow-up for Ovarian Cyst

The recommended follow-up for a 5.2 cm simple left ovarian cyst seen on ultrasound in a 25-year-old female is largely based on the characteristics of the cyst and the patient's overall health.

• The American College of Obstetricians and Gynecologists (ACOG) suggests that simple cysts found on ultrasound may be safely followed without intervention, even in postmenopausal women 2.
• For premenopausal women, the approach may differ, but there is evidence to suggest that simple ovarian cysts can be managed conservatively, especially if they are unilocular and do not exhibit suspicious features for malignancy.
• The management plan should be individualized to the patient's symptoms and reproductive goals, considering the potential impact of surgical intervention on ovarian reserve 3.

Considerations for Surgical Intervention

• Surgical intervention, such as laparoscopic cystectomy, may be considered for symptomatic cysts or those with suspicious features.
• The choice of surgical approach depends on various factors, including cyst size, patient age, and reproductive goals.
• Minimally invasive techniques, such as laparoscopic extracorporeal approach or single-site "in-bag" ovarian cystectomy, have been shown to be safe and effective for managing large adnexal masses 4, 5.

Risk Factors for Endometrial Cancer or Hyperplasia

• While the primary concern with ovarian cysts is their potential to be malignant or to cause symptoms, it's also important to consider other gynecologic health issues, such as endometrial cancer or hyperplasia.
• Risk factors for endometrial cancer or hyperplasia in young women include a body mass index (BMI) greater than 30, smoking, and a history of polycystic ovary syndrome (PCOS) 6.
• These factors should be considered in the overall management plan for the patient, although they are not directly related to the follow-up for the ovarian cyst.