From the Guidelines
Treatment for a painful hemorrhagic ovarian cyst typically begins with pain management and watchful waiting, as most cysts resolve on their own within 4-8 weeks, with surgical intervention reserved for severe cases or suspected complications 1. The initial approach to managing a hemorrhagic ovarian cyst involves pain management using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, with acetaminophen added for more severe pain 1. Hormonal contraceptives may also be prescribed to prevent new cyst formation. Key considerations in the management of hemorrhagic ovarian cysts include:
- Cyst size: Cysts less than or equal to 5 cm typically require no further management, while those greater than 5 cm but less than 10 cm should be followed up in 8-12 weeks to confirm their functional nature or reassess for cyst wall abnormalities 1.
- Patient age: Hemorrhagic cysts are less common in postmenopausal women, and their presence may warrant further evaluation to rule out malignancy 1.
- Symptom severity: Severe pain, suspected torsion, rupture, or inability to rule out malignancy may necessitate surgical intervention 1. According to the O-RADS US risk stratification and management system, typical hemorrhagic cysts with a reticular pattern or retracting clot should be managed based on their size, with follow-up or referral to a specialist as needed 1. In terms of specific management strategies, the evidence suggests that:
- Watchful waiting is often appropriate for hemorrhagic cysts, with patients avoiding strenuous activity and sexual intercourse if these activities worsen pain 1.
- Warm compresses applied to the lower abdomen can help relieve discomfort 1.
- Surgical intervention is typically reserved for cases with severe pain, suspected torsion, rupture, or when malignancy cannot be ruled out 1.