From the Guidelines
For simple ovarian cysts causing pain, the most appropriate initial treatment is typically over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg every 8-12 hours), as they are effective in managing pain and have a low risk of side effects 1.
Treatment Options
- Hormonal contraceptives such as birth control pills may be prescribed for 1-3 months to prevent new cyst formation and regulate menstrual cycles.
- Heat therapy applied to the lower abdomen for 15-20 minutes several times daily can help relieve discomfort.
- Most simple cysts resolve on their own within 1-3 menstrual cycles, so watchful waiting with follow-up ultrasounds is often recommended.
Rationale
The risk of malignancy in simple ovarian cysts is very low, especially in premenopausal women, with a risk of less than 1% 1.
Follow-up
- If pain is severe or persistent, your doctor might suggest prescription pain medications or, in rare cases, minimally invasive surgery like laparoscopy to remove the cyst.
- Simple cysts cause pain due to stretching of the ovarian tissue, pressure on surrounding structures, or complications like twisting (torsion).
- It's essential to follow up with your healthcare provider to monitor the cyst's size and ensure it resolves properly, especially if pain worsens suddenly, as this could indicate complications requiring immediate medical attention.
Key Considerations
- The American College of Radiology recommends that simple cysts up to 10 cm in diameter on transvaginal ultrasonography performed by experienced ultrasonographers are likely to be benign and may be safely monitored using repeat imaging without surgical intervention, even in postmenopausal patients 1.
- A recent study by Gupta et al demonstrated that the risk of malignancy in classic “benign”-appearing lesions is < 1% in a cohort of 970 average-risk women 1.
From the Research
Treatment Options for Simple Ovarian Cysts that Cause Pain
- The use of oral contraceptives for the treatment of functional ovarian cysts has been studied in several randomized controlled trials 2, 3.
- These studies found that treatment with combined oral contraceptives did not hasten the resolution of functional ovarian cysts in any trial 2, 3.
- Most cysts resolved without treatment within a few cycles, and persistent cysts tended to be pathological rather than physiological 2, 3.
- Watchful waiting for two or three cycles is often recommended, and surgical management may be indicated if the cysts persist 2, 3.
- The current evidence suggests that combined oral contraceptives appear to be of no benefit in treating functional ovarian cysts 2, 3.