From the Guidelines
Incidentally discovered Nabothian cysts on pelvic and transvaginal ultrasound do not require any treatment or follow-up, as they are benign and considered a normal finding in women of reproductive age. These cysts are typically small, fluid-filled, and develop when mucus-secreting glands on the cervix become blocked, usually measuring between 2-10mm in diameter 1. According to the American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology, 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.
Key Considerations
- Nabothian cysts are extremely common, with most women developing them at some point, and they pose no risk for malignant transformation or fertility issues.
- No follow-up imaging or intervention is necessary unless they are unusually large (>4cm), rapidly growing, or causing symptoms such as abnormal bleeding or pain.
- During routine gynecological exams, your healthcare provider may note these cysts as they can sometimes be visible during speculum examination as small, white or yellow bumps on the cervix.
- The O-RADS US risk stratification and management system recommends no additional management 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 1.
Management Approach
- For premenopausal patients, no additional management is required for simple cysts less than or equal to 5 cm in diameter.
- For postmenopausal patients, no further management is suggested in 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 with consideration of annual follow-up for up to 5 years, if stable 1.
- If the cyst enlarges, then management by a gynecologist is suggested.
From the Research
Management of Incidentally Discovered Nabothian Cysts
- The management of incidentally discovered Nabothian cysts on pelvic and transvaginal ultrasound depends on the size and symptoms of the cyst 2, 3, 4, 5.
- Small-sized Nabothian cysts are usually clinically asymptomatic and require no treatment or intervention 2.
- Larger Nabothian cysts can be mistaken for malignant tumors and may require further evaluation, including biopsy, to rule out malignancy 2, 3, 4.
- Ultrasonography and magnetic resonance imaging (MRI) can be used to diagnose and differentiate Nabothian cysts from other conditions, including malignancies 2, 4.
- Laparoscopic excision or hysterectomy may be considered as a treatment option for large or symptomatic Nabothian cysts 2, 3, 5.
Diagnostic Considerations
- Nabothian cysts can be multiple and attain a large size, making diagnosis and differentiation from malignant cystic lesions challenging 4.
- Ultrasonography is valuable for the diagnosis of giant Nabothian cysts and can aid in excluding malignancy 4.
- Histopathologic diagnosis is necessary to confirm the presence of a Nabothian cyst and rule out malignancy 3, 4, 5.
Treatment Options
- Conservative management may be considered for asymptomatic Nabothian cysts, especially in postmenopausal women 6.
- Surgical intervention, including laparoscopic excision or hysterectomy, may be necessary for large or symptomatic Nabothian cysts 2, 3, 5.
- Local cystectomies or hysterectomies may be recommended for treating symptomatic Nabothian cysts 5.