What is the follow-up for a 5.2 cm simple ovarian cyst in a 24-year-old female?

From the Guidelines

For a 5.2 cm simple ovarian cyst in a 24-year-old female, follow-up with a repeat pelvic ultrasound in 8-12 weeks is recommended. This approach is based on the American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology guidelines, which suggest that simple cysts up to 10 cm in diameter are likely to be benign and may be safely monitored using repeat imaging without surgical intervention, even in postmenopausal patients 1. According to the O-RADS US risk stratification and management system, a simple cyst greater than 5 cm but less than 10 cm in a premenopausal patient should be followed up in 8-12 weeks to confirm its functional nature or to reassess for cyst wall abnormalities 1.

Some key points to consider in the management of this patient include:

• The patient's age and premenopausal status, which suggest a low risk of malignancy 1
• The size of the cyst, which is greater than 5 cm but less than 10 cm, making follow-up in 8-12 weeks reasonable 1
• The importance of using a high-quality ultrasound examination, such as transvaginal ultrasonography performed by experienced ultrasonographers, to accurately assess the cyst 1
• The potential for the cyst to be functional and resolve spontaneously within 1-3 menstrual cycles, making conservative management the standard of care 1

During the observation period, the patient can use over-the-counter pain medications like ibuprofen (400-600 mg every 6-8 hours) or acetaminophen (650 mg every 6 hours) as needed for any discomfort. If the patient is on hormonal contraception, she should continue it; if not, combined hormonal contraceptives may be considered to prevent new cyst formation. The patient should seek immediate medical attention if she develops severe abdominal pain, fever, vomiting, or signs of cyst rupture or torsion. At the follow-up ultrasound, if the cyst has decreased in size or resolved, no further imaging is typically needed. However, if the cyst persists or grows larger than 7 cm, referral to gynecology for possible surgical evaluation would be appropriate.

From the Research

Follow-up for a 5.2 cm Simple Ovarian Cyst

• The management of a 5.2 cm simple ovarian cyst in a 24-year-old female can be approached conservatively, as the cyst is relatively small and the patient is premenopausal 2.
• According to the study by 3, conservative management of simple cysts (anechoic, diameter < 5 cm with normal Doppler and CA 125 serum level) is more reasonable and safer than surgical treatment.
• However, since the cyst is slightly larger than 5 cm, laparoscopic surgery may be considered if the patient is symptomatic 2, 4.
• Expectant management with regular ultrasound follow-up may also be an option, as the cyst may resolve spontaneously 3, 5.
• The use of oral contraceptives may have a protective effect against functional ovarian cysts, but its effectiveness in reducing the size of an existing cyst is unclear 3.

Diagnostic Evaluation

• Transvaginal ultrasonography is the gold standard for ovarian cyst diagnosis, and can help characterize the cyst and assess its likelihood of being benign or malignant 5, 4.
• Doppler flow measurement and assessment of tumor vascularity by Doppler energy can increase the confidence with which a correct diagnosis is made 5.
• A scoring system can help differentiate benign from malignant masses, but the accuracy of this method is not 100% 5.

Surgical Indications

• Laparoscopic treatment of adnexal masses is indicated when all criteria of a benign lesion are present, including a mass < 5 cm with liquid or dermoid content, and no suspicious features on ultrasound 4.
• For cysts measuring 5 to 10 cm, laparoscopy may be feasible, but precaution must be taken to avoid potential laparoscopic dissemination 4.