From the Guidelines
A 1 cm ovarian cyst in the lateral recess typically doesn't require specific treatment as most small ovarian cysts are functional and resolve spontaneously within 1-3 menstrual cycles. For pain management, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600 mg every 6 hours) or naproxen (500 mg twice daily) are recommended 1. Aspiration is generally not recommended for small ovarian cysts due to risks of infection, bleeding, and cyst recurrence, as well as the possibility of spreading cancerous cells if the cyst is malignant. Additionally, a 1 cm cyst is quite small and technically challenging to aspirate.
Key Considerations
- The risk of malignancy in simple cysts, regardless of size and menopausal status, is very low 1.
- Follow-up ultrasound in 6-12 weeks is advisable to ensure the cyst resolves.
- If pain persists or worsens, or if the cyst grows or develops concerning features on follow-up imaging, further evaluation by a gynecologist is warranted.
- Hormonal contraceptives might be prescribed to prevent new cyst formation.
- The back pain may be related to the cyst if it's causing pressure on surrounding structures, but other causes of back pain should also be considered if symptoms persist despite appropriate management of the cyst.
Management Approach
- According to the American College of Radiology (ACR) Appropriateness Criteria, US can accurately diagnose benign adnexal lesions, including simple cysts, and these lesions can be followed up with US 1.
- The ACR also recommends that simple cysts, including paraovarian and paratubal cysts < 5 cm, do not need to be followed in premenopausal women.
- 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 with consideration of annual follow-up for up to 5 years, if stable 1.
Conclusion Not Provided as per Guidelines
Instead, the key points to consider in the management of a 1 cm ovarian cyst in the lateral recess are summarized above, with a focus on the low risk of malignancy and the recommendation for follow-up ultrasound and pain management with NSAIDs.
From the Research
Treatment Options for Ovarian Cysts
The treatment for a 1 cm ovarian cyst in the lateral recess causing back pain can vary depending on several factors, including the patient's age, symptoms, and the characteristics of the cyst.
- For simple ovarian cysts, aspiration can be a viable option, as seen in studies 2 and 3, which demonstrated that sonographically guided aspiration of simple ovarian cysts can be a suitable alternative to surgery, with close follow-up necessary to detect recurrence.
- However, it's essential to note that the studies 2 and 3 involved larger cysts (up to 16 cm in diameter) and a different patient population, so the results may not be directly applicable to a 1 cm cyst.
- Laparoscopy has become a favored approach for the treatment of ovarian cysts, especially in pediatric patients, as it allows for the preservation of functional ovary 4.
- Medical therapy, including estrogen/gestagen-combinations, GnRH-analogues, gestagens, and danazol, can also be considered for the treatment of ovarian cysts, particularly for follicle- and corpus luteum-cysts, as well as endometriomas 5.
Aspiration of Ovarian Cysts
Aspiration of ovarian cysts can be an effective treatment option, especially for simple cysts.
- A study published in the Journal of Ultrasound in Medicine found that sonographically guided aspiration of simple ovarian cysts resulted in no major complications and avoided surgery in 65% of cases 2.
- Another study published in the European Journal of Radiology also demonstrated that ultrasound-guided aspiration may be an alternative to other treatment modalities for benign ovarian cysts 3.
- However, it's crucial to carefully evaluate the characteristics of the cyst and the patient's symptoms before deciding on aspiration as a treatment option.