What is the recommended treatment for a 5 cm ovarian cyst in an adolescent?

Treatment of 5 cm Ovarian Cyst in Adolescents

For a 5 cm ovarian cyst in an adolescent, no further management is required as this size is considered benign and likely to resolve spontaneously. 1

Risk Assessment and Classification

According to the Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification:

• Ovarian cysts ≤5 cm in premenopausal females (including adolescents) are classified as O-RADS 2 (almost certainly benign with <1% risk of malignancy)
• The type of cyst impacts management decisions:
  • Typical hemorrhagic cysts ≤5 cm require no further management
  • Simple cysts ≤5 cm require no additional management
  • Dermoid cysts and endometriomas <10 cm may be followed with optional 8-12 week follow-up based on diagnostic confidence

Management Algorithm for Adolescent Ovarian Cysts

For 5 cm cysts:

1. Determine cyst type by ultrasound characteristics:

   • Simple/hemorrhagic cyst: No further management needed 1
   • Dermoid cyst or endometrioma: Optional follow-up at 8-12 weeks 1

2. Follow-up recommendations:

   • If the cyst persists beyond expected timeframe or enlarges, consider referral to gynecologist
   • For hemorrhagic cysts >5 cm (but <10 cm), follow-up in 8-12 weeks is recommended 1

Special Considerations:

• Surgical intervention indications:
  • Cyst >10 cm (increased risk of malignancy)
  • Presence of solid components or complex features
  • Symptoms of pain, torsion, or rupture
  • Growth on follow-up imaging

Surgical Approach When Indicated

If surgery becomes necessary (not indicated for typical 5 cm cysts), laparoscopic approach is preferred for adolescents due to:

• Decreased postoperative pain
• Shorter hospital stay
• Lower risk of wound infection
• Superior cosmetic results (particularly important for young females) 2

Important Caveats

• Ultrasound assessment should be performed by experienced ultrasonographers to ensure accurate classification
• Follow-up ultrasound is best performed during the proliferative phase of the menstrual cycle (if applicable) to differentiate functional from persistent cysts
• Ovarian preservation should be prioritized in adolescents through cystectomy rather than oophorectomy when surgery is required
• The risk of malignancy in a symptomatic ovarian cyst in a premenopausal female is approximately 1:1,000 3

Remember that most ovarian cysts in adolescents are physiologic and will resolve spontaneously, making conservative management the appropriate first-line approach for a 5 cm cyst.