From the Guidelines
The management of a hemorrhagic ovarian cyst typically involves conservative treatment with monitoring, as most resolve spontaneously within 2-3 menstrual cycles, with follow-up ultrasound recommended in 8-12 weeks for cysts greater than 5 cm but less than 10 cm to confirm resolution or assess for cyst wall abnormalities 1.
Key Considerations
- Hemorrhagic cysts less than or equal to 5 cm in the premenopausal age group require no further management 1.
- For cysts greater than 5 cm but less than 10 cm, follow-up in 8-12 weeks is recommended to confirm resolution or assess for cyst wall abnormalities 1.
- If the cyst persists or enlarges, referral to a US specialist, gynecologist, or MRI study is suggested 1.
- Hemorrhagic cysts should not occur in the postmenopausal population, and when encountered, further evaluation by a US specialist, referral to a gynecologist, or performance of an MRI study is suggested 1.
Management Approach
- Conservative treatment with pain medication and monitoring is usually effective, as the body naturally reabsorbs the blood over time 1.
- NSAIDs like ibuprofen or naproxen may be recommended for pain control.
- Hormonal contraceptives may be prescribed to prevent new cyst formation.
- Medical attention is necessary for severe pain unresponsive to medication, signs of rupture, or symptoms of significant blood loss.
- Surgical intervention is rarely needed but may be considered for cysts larger than 5-8cm, those causing severe symptoms, or when malignancy cannot be ruled out.
Follow-up and Surveillance
- Follow-up ultrasound is typically performed after 6-8 weeks to confirm resolution.
- For cysts greater than 5 cm but less than 10 cm, follow-up in 8-12 weeks is recommended to confirm resolution or assess for cyst wall abnormalities 1.
- Annual follow-up for up to 5 years may be considered for simple cysts in postmenopausal women, if stable 1.