Can bilateral left-sided ovarian cysts cause menorrhagia (heavy menstrual bleeding)?

Ovarian Cysts and Heavy Menstrual Bleeding

Yes, left-sided ovarian cysts can cause heavier periods, particularly if they are functional cysts or endometriomas that affect hormonal balance or cause local inflammation.

Relationship Between Ovarian Cysts and Menstrual Bleeding

Ovarian cysts can influence menstrual bleeding patterns through several mechanisms:

Types of Cysts and Their Impact on Bleeding

• Functional cysts (follicular or corpus luteum cysts):

  • Can disrupt normal hormonal regulation
  • May lead to irregular vaginal bleeding or menorrhagia 1
  • Often resolve spontaneously, especially when <5 cm in diameter

• Endometriomas:

  • Associated with endometriosis, which is a known cause of heavy menstrual bleeding
  • The LNG-IUD has been shown to be beneficial in treating menorrhagia in women with endometriosis 2

• Multiple cysts:

  • Can cause more pronounced hormonal disruption
  • May exacerbate menstrual irregularities and bleeding 3

Diagnostic Considerations

According to the O-RADS US Risk Stratification system 2, ovarian cysts are categorized based on their characteristics:

• Simple cysts (<10 cm):

  • Generally benign with minimal risk of malignancy
  • May still affect menstrual patterns

• Hemorrhagic cysts:

  • Show specific ultrasound features like reticular pattern or retracting clot
  • Can contribute to menstrual irregularities
  • Typically resolve spontaneously in 8-12 weeks 2

Management Approach for Ovarian Cysts with Heavy Bleeding

1. Assessment of bleeding severity:

   • Heavy or prolonged bleeding should raise suspicion of underlying conditions 2
   • Unusually heavy bleeding warrants thorough evaluation

2. Management based on cyst characteristics:

   • Simple cysts <5 cm in premenopausal women:

     • Often require no intervention
     • Monitor for resolution

   • Cysts 5-10 cm:

     • Follow-up ultrasound in 8-12 weeks
     • If persisting or enlarging, referral to gynecologist 2

   • Complex cysts:

     • Higher risk of underlying pathology
     • May require specialist evaluation

3. Treatment options for heavy bleeding associated with ovarian cysts:

   • Hormonal contraceptives:

     • Combined hormonal contraceptives (CHC) may help regulate bleeding 2
     • LNG-IUD has been shown effective for heavy bleeding 2

   • Surgical options:

     • Reserved for persistent, symptomatic, or larger cysts
     • Consider if medical management fails

Special Considerations

• Bilateral cysts may indicate systemic hormonal imbalance
• Persistent heavy bleeding despite cyst resolution warrants further investigation
• Postmenopausal women with ovarian cysts and bleeding require prompt evaluation due to higher risk of malignancy 4

Common Pitfalls to Avoid

1. Assuming all cysts are benign - While most are benign in premenopausal women, complex cysts require careful evaluation
2. Overlooking other causes of heavy bleeding - Fibroids, adenomyosis, and endometrial pathology can coexist with ovarian cysts
3. Delaying follow-up - Cysts >5 cm that persist require follow-up and possibly specialist referral 1

Remember that functional cysts in particular can be linked with irregular vaginal bleeding or menorrhagia 1. If heavy bleeding persists despite appropriate management of the ovarian cysts, further evaluation for other gynecological conditions is warranted.