From the Guidelines
Treatment for a hemorrhagic ovarian cyst causing pain should begin with monitoring and possibly referral to a US specialist, gynecologist, or MRI, depending on the size and characteristics of the cyst, as outlined in the O-RADS US Risk Stratification and Management System 1.
Initial Assessment
The O-RADS US Risk Stratification and Management System provides a guideline for managing hemorrhagic ovarian cysts, categorizing them based on their appearance and size. For a typical hemorrhagic cyst with a reticular pattern, fine thin intersecting lines representing fibrin strands, and less than 5 cm in size, monitoring by a US specialist, gynecologist, or MRI is recommended 1.
Management Approach
- For cysts larger than 5 cm but less than 10 cm with a retracting clot, follow-up in 8-12 weeks is suggested. If the cyst persists or enlarges, referral to a US specialist, gynecologist, or MRI is advised 1.
- Pain management is crucial and can be achieved with over-the-counter pain medications such as ibuprofen or naproxen, along with the application of a heating pad to the lower abdomen for relief.
- In cases where the cyst is causing severe pain or is large, surgical intervention may be necessary, typically performed laparoscopically to minimize tissue damage and preserve ovarian function.
Important Considerations
- It's essential to differentiate hemorrhagic cysts from other types of ovarian lesions, such as dermoid cysts or endometriomas, as their management may differ significantly 1.
- The presence of complications like cyst rupture, infection, or internal bleeding necessitates immediate medical attention, as these conditions can lead to severe morbidity and mortality.
- Follow-up ultrasounds are crucial for monitoring the resolution of the cyst and for early detection of any potential complications or malignancy, although the optimal duration and interval for surveillance are not well-defined 1.
From the FDA Drug Label
Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
The treatment for pain caused by a hemorrhagic ovarian cyst may include naproxen. The recommended starting dose is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. 2