From the Guidelines
A hemorrhagic ovarian cyst is a fluid-filled sac on the ovary that has experienced bleeding inside it, typically forming during ovulation and often resolving on its own within 4-8 weeks without specific treatment. These cysts are generally benign and can be characterized by a reticular pattern or a retracting clot on ultrasound imaging 1. According to the O-RADS US risk stratification and management system, typical hemorrhagic cysts in the premenopausal age group that are less than or equal to 5 cm require no further management, while those greater than 5 cm but less than 10 cm should be followed up in 8-12 weeks 1.
Key Characteristics and Management
- Hemorrhagic cysts typically form during ovulation when the follicle that releases an egg doesn't dissolve properly and instead fills with blood.
- Symptoms may include pelvic pain, irregular menstrual bleeding, pain during intercourse, or no symptoms at all.
- Treatment usually involves pain management with over-the-counter medications like ibuprofen or acetaminophen.
- For severe pain, a healthcare provider might prescribe stronger pain relievers, and applying a heating pad to the lower abdomen can also help relieve discomfort.
- Medical attention should be sought if pain becomes severe, is accompanied by fever, or if there's sudden, sharp pain that might indicate a ruptured cyst.
Diagnostic Considerations
- Ultrasound imaging is crucial in diagnosing and characterizing hemorrhagic cysts, with features such as a reticular pattern or a retracting clot 1.
- The O-RADS US risk stratification and management system provides guidelines for the management of hemorrhagic cysts based on their size and the patient's menopausal status 1.
- Recent studies have demonstrated that the risk of malignancy in benign-appearing adnexal lesions, including hemorrhagic cysts, is less than 1% 1.
Clinical Implications
- Given the low risk of malignancy and the high likelihood of spontaneous resolution, conservative management with serial ultrasound follow-up is often the recommended approach for hemorrhagic cysts 1.
- However, it is essential to follow the guidelines set by the O-RADS US risk stratification and management system to ensure appropriate management and to minimize the risk of missing a potentially malignant lesion 1.
From the Research
Definition and Characteristics
- A hemorrhagic ovarian cyst is a functional cyst resulting from bleeding into a follicular or corpus luteum cyst 2.
- It is a common gynaecological condition that often presents with acute pelvic pain, typically localized to one side, and may be accompanied by menstrual irregularities 2.
- Hemorrhagic ovarian cysts (HOCs) are frequently seen in reproductive age women, developing in the luteal phase of ovulatory cycles 3.
Diagnosis and Presentation
- Diagnosis is usually made via pelvic ultrasound, which typically reveals a complex cyst with characteristic features such as a reticular or 'lace-like' pattern 2.
- Clinical symptoms are mainly due to peritoneal irritation by the blood effusion 4.
- The differential diagnosis is extensive and standard management is not defined 4.
- Ultrasound is the first-line investigation and is diagnostic in the case of haemorrhage 5.
Complications and Management
- Complications such as rupture or significant hemorrhage may necessitate surgical intervention 2.
- Rupture of a hemorrhagic ovarian cyst can lead to hemoperitoneum, which can create a risk of further adverse events including hypovolemic shock 6.
- Surgical therapy should be laparoscopic, with surgical options such as luteumectomy, ovarian wedge-shaped excision or oophorectomy 4.
- Prevention of further episodes can be achieved by suppressing ovulation, usually with the combined oral contraceptive, or by fixation of the ovary to prevent recurrent torsion 5.