From the Guidelines
Treatment guidelines for cysts prioritize a minimally invasive approach, with most cysts not requiring treatment if they are small, painless, and not causing complications, as seen in the most recent guideline from 1.
General Principles
- Most cysts don't require treatment if they're small, painless, and not causing complications.
- For symptomatic cysts, treatment options include watchful waiting with regular monitoring, aspiration (draining fluid with a needle), corticosteroid injections to reduce inflammation, or surgical removal for persistent or problematic cysts.
Specific Considerations
- Infected cysts may require antibiotics such as cephalexin 500mg four times daily for 7-10 days.
- Sebaceous cysts often need complete surgical excision including the sac wall to prevent recurrence.
- Ganglion cysts can be treated with aspiration followed by immobilization, or surgical removal if they recur.
- Ovarian cysts typically resolve spontaneously within 1-3 menstrual cycles, but hormonal contraceptives may be prescribed to prevent new cyst formation, as suggested by 1.
- Epidermal inclusion cysts should not be squeezed or drained at home due to infection risk.
Recent Guidelines
- The most recent guideline from 1 suggests that typical hemorrhagic cysts in the premenopausal age group that are less than or equal to 5 cm require no further management.
- For complicated cysts, options include aspiration or short-term follow-up with physical examination and ultrasonography with or without mammography every 6 to 12 months for 1 to 2 years to assess stability, as recommended by 1.
Conclusion Not Applicable
Instead, the key takeaway is that treatment is individualized based on the cyst's characteristics, patient symptoms, and potential for complications, with the goal of relieving discomfort while using the least invasive approach appropriate for each situation, as supported by the highest quality and most recent evidence from 1.
From the Research
Treatment Guidelines for Cysts
- The treatment guidelines for cysts vary depending on the type and size of the cyst, as well as the patient's symptoms and medical history.
- According to a study published in 2014 2, treatment with combined oral contraceptives did not hasten the resolution of functional ovarian cysts, and watchful waiting for two or three cycles is often appropriate.
- Another study published in 1994 3 suggests that medical therapy, including estrogen/gestagen-combinations, GnRH-analogues, gestagens, and danazol, can be used to treat ovarian cysts, including follicle- and corpus luteum-cysts, as well as endometriomas.
- Ultrasound-guided aspiration is also a viable alternative to surgery for benign ovarian cysts, as shown in a study published in 1996 4 and another study published in 1998 5.
- Expectant management, or waiting to see if the cyst resolves on its own, is also a valid treatment option, as shown in a study published in 1994 6, which found that oral contraceptive therapy and expectant management had similar success rates in resolving functional ovarian cysts.
Treatment Options
- Medical therapy:
- Estrogen/gestagen-combinations
- GnRH-analogues (GnRH-agonists, GnRH-antagonists)
- Gestagens
- Danazol
- Ultrasound-guided aspiration
- Expectant management (watchful waiting)
- Surgical management (for persistent or large cysts)
Considerations
- The type and size of the cyst, as well as the patient's symptoms and medical history, should be taken into account when determining the best treatment option.
- Hormonal suppression therapy may be recommended for patients with endometriomas, as shown in a study published in 1998 5.
- Recurrence rates vary depending on the type of cyst and treatment option, with endometriomas having a higher recurrence rate than benign-appearing cysts, as shown in a study published in 1998 5.