From the Guidelines
Ovarian cysts should be operated on when they are larger than 10 cm in diameter, or if they exhibit suspicious characteristics on imaging, regardless of size, as recommended by the American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology 1. The decision to operate on ovarian cysts depends on several factors, including size, patient symptoms, cyst characteristics on imaging, and patient age.
- For premenopausal women, simple cysts up to 10 cm in diameter are likely to be benign and may be safely monitored using repeat imaging without surgical intervention 1.
- Cysts less than or equal to 5 cm in diameter in premenopausal patients require no additional management, and those less than or equal to 3 cm should be considered physiologic 1.
- For postmenopausal women, no further management is suggested for cysts up to 3 cm, and for cysts greater than 3 cm but less than 10 cm, at least 1-year follow-up showing stability or decrease in size is recommended 1. Key considerations in the management of ovarian cysts include:
- Patient age and menopausal status
- Cyst size and characteristics on imaging
- Patient symptoms, such as pain or bloating
- Risk of malignancy, which is higher in postmenopausal women 1. The goal of management is to balance the risks of surgery against the potential complications of leaving the cyst, such as torsion, rupture, or malignancy, while prioritizing the patient's quality of life and minimizing morbidity and mortality 1.
From the Research
Ovarian Cyst Size and Operation
The decision to operate on an ovarian cyst depends on various factors, including the size of the cyst, symptoms, and patient's age and fertility desires.
- According to 2, large cysts with more than 4 cm in diameter should be treated surgically due to the risk of rupture or torsion.
- In postmenopausal women, cysts that are unilocular or contain isolated septa have a low risk of malignancy even when they are larger than 5 cm, and may be followed up conservatively with intermittent transvaginal ultrasonography 3.
- Laparoscopic management of benign ovarian cysts has been demonstrated to be safe, and the size of the cyst is no longer a limiting factor for laparoscopic surgery 4, 5.
- For asymptomatic postmenopausal women or women over 50 years of age, unilocular ovarian cysts less than 10 cm in diameter are associated with minimal risk for ovarian cancer, while complex ovarian cysts with wall abnormalities or solid areas are associated with a significant risk for malignancy 6.
Factors Influencing the Decision to Operate
The decision to operate on an ovarian cyst is influenced by several factors, including:
- Cyst size: Large cysts are more likely to be operated on due to the risk of rupture or torsion.
- Symptoms: Symptomatic cysts are more likely to be operated on than asymptomatic ones.
- Patient's age and fertility desires: Younger women who desire to preserve fertility may be more likely to undergo conservative management, while older women or those who have completed childbearing may be more likely to undergo surgical removal of the cyst.
- Cyst morphology: Complex cysts with wall abnormalities or solid areas are more likely to be malignant and may require surgical removal.