From the Guidelines
Ovarian cysts larger than 5-10 centimeters may be considered problematic due to increased risk of complications, but even smaller cysts can be problematic if they cause significant symptoms. The size of an ovarian cyst that is considered problematic depends on various factors, including symptoms, characteristics, and patient population. According to the most recent and highest quality study 1, simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer. However, cysts larger than 5 cm may warrant closer monitoring or intervention due to potential risks of mischaracterization, torsion, or rupture. Some key points to consider:
- Functional cysts under 5 cm typically resolve spontaneously within 1-3 menstrual cycles without treatment 1.
- 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.
- Cysts greater than 3 cm but less than 10 cm in postmenopausal women may require at least 1-year follow-up showing stability or decrease in size, with consideration of annual follow-up for up to 5 years, if stable 1.
- Any rapidly growing cyst, cyst with solid components, or one causing severe symptoms requires prompt medical evaluation regardless of size 1. Regular follow-up imaging is important for monitoring cysts, with ultrasound typically scheduled every 3-6 months for persistent cysts. The decision for surgical intervention depends on symptoms, growth pattern, appearance, and patient factors rather than size alone.
From the Research
Ovarian Cyst Size Considered Problematic
- The size of an ovarian cyst considered problematic can vary, but according to 2, symptomatic postmenopausal women, those with a cyst >= 5 cm, or raised CA125 levels, should be referred to secondary care.
- Functional cysts, particularly when they are < 5 cm diameter, usually resolve spontaneously without the need for intervention 2.
- In premenopausal women, simple cysts >= 5 cm are less likely to resolve and need an annual ultrasound assessment as a minimum 2.
- Larger cysts, such as those >= 20 cm in diameter, can be associated with more severe complications, including uterine torsion 3.
- Cysts that are large enough to cause symptoms, such as pelvic pain or pressure, can also be considered problematic, regardless of their exact size 4.
Indications for Surgical Intervention
- Surgical intervention may be necessary for ovarian cysts that are large, such as those >= 20 cm in diameter, or those that are associated with haemodynamic compromise or torsion 4.
- Women who undergo surgical intervention are more likely to have larger cysts and larger free fluid findings on imaging 4.
- The presence of a large ovarian cyst or a significant amount of free fluid in the pelvis can be an indication for surgical intervention 4.