From the Guidelines
The presence of a simple right ovarian cyst measuring up to 3.2 cm and endometrial thickness at the upper limits of normal with small volume fluid in the cervical canal may cause pelvic pain, but it is not necessarily the primary cause of pain. According to the American College of Radiology's O-RADS US risk stratification and management system 1, simple ovarian cysts less than 3 cm are considered physiologic and have a low risk of malignancy. The study by Bindman et al 1 found that no simple cysts were diagnosed as cancer in women younger than 50 years, and only a single simple cyst was ultimately diagnosed as a malignancy in women over 50 years. A recent meta-analysis by Parazzini et al 1 suggested a limited risk of malignancy in anechoic cysts among premenopausal women of approximately 0.5%. However, pelvic pain can be caused by various factors, including endometriosis, adenomyosis, pelvic inflammatory disease, or non-gynecological conditions. The ACR Appropriateness Criteria for acute pelvic pain in the reproductive age group 1 recommends a combined transabdominal and transvaginal approach for pelvic US imaging, which has a high sensitivity and specificity for diagnosing ovarian torsion, endometriotic cyst, hemorrhagic cysts, and other conditions. Some key points to consider include:
- Simple ovarian cysts under 3 cm are generally considered benign and may not require immediate intervention 1.
- Pelvic US has a high sensitivity and specificity for diagnosing various conditions that may cause pelvic pain, including ovarian torsion and pelvic inflammatory disease 1.
- Management typically involves watchful waiting with follow-up ultrasound in 2-3 months for simple cysts under 5 cm, as most resolve spontaneously 1.
- Over-the-counter pain relievers like ibuprofen or acetaminophen may help manage any discomfort, but if pain is severe, persistent, or accompanied by fever, vomiting, or other concerning symptoms, prompt medical attention is necessary.
From the Research
Pelvic Pain and Ovarian Cysts
- The presence of a simple appearing right ovarian cyst measuring up to 3.2 cm may or may not cause pelvic pain, as the relationship between ovarian cysts and pelvic pain is not always straightforward 2.
- Endometrial thickness measures upper limits of normal with small volume fluid within the cervical canal, which could be related to various conditions, including those that may cause pelvic pain 3.
- However, there is no direct evidence in the provided studies to suggest that the specific conditions described would definitely cause pelvic pain.
Ovarian Cyst Diagnosis and Management
- Ultrasonography is considered the gold standard for ovarian cyst diagnosis, with transvaginal sonography demonstrating considerable advantage over conventional transabdominal sonography 4.
- The American College of Obstetricians and Gynecologists (ACOG) recommends that simple cysts found on ultrasound may be safely followed without intervention, even in postmenopausal women 2.
- Magnetic resonance imaging (MRI) can also be useful in diagnosing ovarian cysts, particularly endometrial cysts, with characteristic findings including homogenous high signal intensity of internal fluid and clear delineation of cyst contour 5.
Endometrial Thickness and Ovarian Cysts
- Endometrial thickness can be affected by various factors, including tamoxifen treatment, and may be related to the development of ovarian cysts 3.
- However, the relationship between endometrial thickness and pelvic pain is not well established in the provided studies.