From the Guidelines
A separated ovarian cyst in a 16-year-old is typically a functional cyst that has detached from the ovary, often due to torsion or rupture, and the main causes include hormonal fluctuations during the menstrual cycle, polycystic ovary syndrome (PCOS), or rarely, benign or malignant neoplasms, with management depending on symptoms and cyst characteristics, as recommended by the most recent guidelines 1.
Causes of Separated Ovarian Cyst
The causes of a separated ovarian cyst in a 16-year-old can be attributed to various factors, including:
- Hormonal fluctuations during the menstrual cycle
- Polycystic ovary syndrome (PCOS)
- Benign or malignant neoplasms, such as dermoid cysts (mature teratomas) which are the commonest of ovarian tumours but are usually benign 1
Management of Separated Ovarian Cyst
Management of a separated ovarian cyst depends on the symptoms and characteristics of the cyst.
- For mild symptoms, conservative treatment with over-the-counter pain relievers like ibuprofen (400-600mg every 6 hours) or acetaminophen (650mg every 6 hours) is appropriate.
- Combined hormonal contraceptives may be prescribed to prevent new cyst formation.
- If the patient experiences severe pain, signs of internal bleeding, or symptoms of infection (fever, increasing pain), immediate medical attention is necessary.
- Ultrasound imaging is the primary diagnostic tool to assess the cyst's size, appearance, and potential complications, with guidelines suggesting that simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer 1.
- Surgical intervention via laparoscopy may be required for cysts larger than 5-10 cm, those causing severe symptoms, or if malignancy is suspected, with the goal of removing the detached cyst and preserving the ovary when possible.
- Follow-up ultrasounds are recommended 6-12 weeks after diagnosis to ensure resolution or monitor any remaining cysts.
Prognosis and Future Fertility
The prognosis is generally excellent, with most functional cysts resolving spontaneously within 1-3 menstrual cycles.
- Adolescents should be reassured that these cysts rarely affect future fertility and typically don't recur frequently.
- The risk of malignancy in benign-appearing lesions on US managed conservatively with 2-year follow-up was 0.3% to 0.4% for malignancy and 0.2% to 0.4% for acute complications such as torsion or cyst rupture 1.
From the Research
Causes of Separated Ovarian Cyst
- A separated ovarian cyst, also known as ovarian torsion, can occur when the ovary twists around its ligaments, cutting off blood supply to the ovary 2.
- The main risk factor for ovarian torsion is the presence of an ovarian mass or cyst 2, 3.
- Ovarian torsion can affect females of all ages, including adolescents 4, 2.
- In adolescents, most twisted cysts are benign, and the incidence of ovarian torsion is reportedly lower compared to women aged 20 to 40 years 4.
Management of Separated Ovarian Cyst
- The management of a separated ovarian cyst in a 16-year-old involves prompt surgical intervention to preserve the ovary and prevent severe morbidity 4, 5, 2.
- Early diagnosis is crucial, and pelvic ultrasonography can provide information on ovarian cysts and help diagnose ovarian torsion 2, 3.
- Laparoscopy is the preferred method for surgical intervention, and ovary preservation is the goal of treatment 4, 5, 6.
- In cases where the diagnosis is in doubt or there is hemodynamic compromise, laparoscopy may be necessary to confirm the diagnosis and provide treatment 3.