From the Guidelines
For simple ovarian cysts causing pain, the most effective treatment approach is to manage symptoms with over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220mg every 8-12 hours), and a heating pad applied to the lower abdomen for 15-20 minutes several times daily, as most simple ovarian cysts resolve on their own within 1-3 menstrual cycles without specific treatment 1.
Treatment Approach
The treatment for simple ovarian cysts causing pain primarily focuses on managing symptoms and monitoring the cyst for any changes.
- Over-the-counter pain relievers such as ibuprofen or naproxen are typically the first line of treatment for pain management.
- Applying a heating pad to the lower abdomen can also provide relief.
- If pain persists, hormonal contraceptives like birth control pills may be prescribed to prevent new cyst formation.
Monitoring and Follow-Up
Regular follow-up ultrasounds may be recommended to monitor the cyst, especially if it is large or if there are concerns about its nature.
- For premenopausal women, simple cysts less than or equal to 5 cm do not typically require follow-up, according to recent guidelines 1.
- For postmenopausal women, cysts up to 3 cm are considered low risk and may not require immediate follow-up, but those greater than 3 cm but less than 10 cm should be monitored for stability or decrease in size over at least a year, with consideration of annual follow-up for up to 5 years if stable 1.
Surgical Intervention
Surgical intervention, such as laparoscopic surgery to remove the cyst while preserving the ovary, may be considered for persistent or recurrent painful cysts.
- The decision for surgical intervention should be made on a case-by-case basis, taking into account the size of the cyst, the severity of symptoms, and the patient's overall health and preferences.
Important Considerations
It is crucial to seek medical attention if pain becomes severe, is accompanied by fever, vomiting, dizziness, rapid breathing, or if there is sudden, sharp abdominal pain, as these could indicate complications like cyst rupture or torsion.
- The risk of malignancy in simple ovarian cysts is low, especially in premenopausal women, with recent studies suggesting a risk of less than 1% 1.
From the Research
Treatment Options for Simple Ovarian Cysts Causing Pain
- For premenopausal women with simple ovarian cysts > or = 5 cm, annual ultrasound assessment is recommended as a minimum 2.
- Functional cysts, particularly when they are < 5 cm diameter, usually resolve spontaneously without the need for intervention 2.
- Watchful waiting for two or three cycles is appropriate for functional ovarian cysts, as most cysts resolve without treatment within a few cycles 3, 4, 5.
- Combined oral contraceptives appear to be of no benefit in treating functional ovarian cysts 3, 4, 5.
- Surgical management is often indicated for persistent cysts 3, 4, 5.
- For postmenopausal women, simple cysts found on ultrasound may be safely followed without intervention, and can be managed conservatively 6.
- Ovarian cancer screening and follow up for postmenopausal women include a CA-125 blood test and transvaginal ultrasonography (TVU) at baseline, an annual TVU for three additional years, and annual CA-125 tests for five years beyond baseline 6.