From the Guidelines
Physiologic ovarian cysts are normal fluid-filled sacs that develop on your ovaries as part of your regular menstrual cycle, typically less than 3 cm in diameter, and are considered benign with no increased risk of malignancy 1.
Definition and Characteristics
These cysts form when either an egg-containing follicle doesn't rupture and release the egg during ovulation (follicular cysts) or when the empty follicle sac doesn't dissolve properly after ovulation (corpus luteum cysts). According to the American College of Radiology's Ovarian-Adnexal Reporting and Data System (O-RADS) committee, 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.
Diagnosis and Management
The committee agreed that no additional management is required for simple cysts less than or equal to 5 cm in diameter in premenopausal patients, and those less than or equal to 3 cm should be considered physiologic (consistent with normal physiology, ie, follicles) 1. A recent study by Gupta et al 1 demonstrated that the risk of malignancy in these classic “benign”-appearing lesions is < 1% in a cohort of 970 average-risk women.
- Key points to consider:
- Physiologic ovarian cysts are very common and typically cause no symptoms.
- They usually disappear on their own within 1-3 menstrual cycles without requiring any treatment.
- If you experience mild symptoms, over-the-counter pain relievers like ibuprofen (400-600mg every 6 hours as needed) can help manage discomfort.
- Regular gynecological check-ups can help monitor these cysts, but they generally don't increase your risk of ovarian cancer and aren't a cause for significant concern.
- Warning signs that would require immediate medical attention include sudden severe pelvic pain, pain with fever or vomiting, or dizziness and rapid breathing, which could indicate a cyst has ruptured or caused ovarian torsion.
Recent Guidelines and Recommendations
A recent consensus update to the SRU in 2019 regarding management of simple cysts reflects these findings with higher threshold for follow-up of simple cysts 1. For postmenopausal patients, the SRU endorses follow-up of simple cysts >3 cm (and 5 cm for those that are exceptionally well seen) rather than the previous 1-cm threshold 1. The rationale of follow-up for simple cysts is based on a potential risk of mischaracterization of larger cysts and potential clinical value of size monitoring growth rates of indeterminate adnexal masses.
From the Research
Definition of Physiologic Ovarian Cysts
- Physiologic ovarian cysts are a normal developmental occurrence at all ages, resulting from follicular growth and atresia 2
- They are common, frequently regress without treatment, and are seldom associated with malignancy 2
- These cysts can be recognized as a consequence of normal ovarian physiology, particularly with the use of ultrasound 2
Characteristics of Physiologic Ovarian Cysts
- They are fluid formations, usually discovered incidentally by ultrasound, and are generally mild and asymptomatic 3
- Physiologic ovarian cysts may appear functional from the fetal period onward and can require management from the first days of life 3
- The natural history of functional cysts is eventual regression, and persistence is suggestive of organic tumor 3
Diagnosis and Management
- The diagnosis of physiologic ovarian cysts is based on pelvic ultrasound, with MRI and tumor marker assays used to determine the nature of an organic cyst before proceeding to surgery 3
- Expectant management is as effective as oral contraceptives for the resolution of functional ovarian cysts induced by ovarian stimulation 4
- Treatment with combined oral contraceptives does not hasten resolution of functional ovarian cysts, and watchful waiting for two or three cycles is often appropriate 5, 6
- Persistent cysts tend to be pathological and not physiological, and surgical management may be indicated if cysts persist 5, 6