From the Guidelines
Treatment for a hemorrhagic ovarian cyst causing pain should begin with over-the-counter pain medications, such as ibuprofen or naproxen, and may require follow-up ultrasounds to monitor resolution, with surgical intervention considered for large or persistent cysts. According to the O-RADS US Risk Stratification and Management System, a consensus guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee 1, typical hemorrhagic cysts with a reticular pattern or retracting clot can be managed with follow-up in 8-12 weeks if they are less than 10 cm in size. For larger cysts or those that persist or enlarge, referral to a US specialist, gynecologist, or MRI may be necessary.
Key Considerations
- Hemorrhagic cysts typically resolve on their own within 4-8 weeks, but may require monitoring with follow-up ultrasounds 1.
- Over-the-counter pain medications, such as ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg every 8-12 hours), can help reduce inflammation and discomfort.
- Heat therapy applied to the lower abdomen for 15-20 minutes several times daily can help relax muscles and ease pain.
- Rest and avoiding strenuous activities until symptoms improve are recommended.
- Hormonal treatments, like combined oral contraceptives, may be prescribed to prevent new cyst formation in some cases.
Surgical Intervention
- Surgical intervention may be necessary for large cysts (>5cm), those that don't resolve with time, cause severe symptoms, or if there's concern about rupture or torsion 1.
- Laparoscopic drainage or removal of the cyst while preserving the ovary may be considered in these cases.
- The O-RADS US Risk Stratification and Management System provides a framework for managing ovarian cysts, including hemorrhagic cysts, based on their size, characteristics, and risk of malignancy 1.
From the FDA Drug Label
Onset of pain relief can begin within 1 hour in patients taking naproxen and within 30 minutes in patients taking naproxen sodium Analgesic effect was shown by such measures as reduction of pain intensity scores, increase in pain relief scores, decrease in numbers of patients requiring additional analgesic medication, and delay in time to remedication. The analgesic effect has been found to last for up to 12 hours Naproxen has been studied in patients with mild to moderate pain secondary to postoperative, orthopedic, postpartumepisiotomy and uterine contraction pain and dysmenorrhea.
The treatment for a hemorrhagic ovarian cyst causing pain may include naproxen. 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 initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.