From the Guidelines
For a 5 cm ovarian cyst, follow-up ultrasound monitoring is typically recommended in 8-12 weeks for premenopausal women, as the risk of malignancy is low, and most cysts are functional and may resolve spontaneously 1.
Monitoring Frequency
The monitoring frequency balances the need to detect potential malignancy against unnecessary interventions, as most functional cysts resolve within 1-3 menstrual cycles.
- The American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology 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.
Clinical Symptoms to Report
Patients should report symptoms that indicate potential complications including:
- Severe or worsening pelvic pain
- Sudden sharp abdominal pain
- Pain with fever or vomiting
- Dizziness or fainting
- Rapid breathing
- Shoulder pain as these may suggest cyst rupture, torsion, or bleeding requiring immediate medical attention 1.
Pain Management
Pain management typically involves over-the-counter medications like ibuprofen (400-600 mg every 6 hours) or acetaminophen (650-1000 mg every 6 hours) unless contraindicated.
- Cysts larger than 5 cm or those with concerning features on imaging (solid components, irregular borders, internal septations) may require more frequent monitoring or surgical evaluation 1.
From the Research
Guidelines for 5 cm Ovarian Cysts
- The risk of malignancy in ovarian cysts increases with age, with a risk of approximately 1:1,000 in premenopausal females and 3:1,000 at the age of 50 2.
- Ovarian cysts may be asymptomatic, but presenting symptoms can include pelvic pain, pressure symptoms, discomfort, and menstrual disturbance 2.
- For premenopausal women with simple cysts ≥ 5 cm, annual ultrasound assessment is recommended as a minimum, as these cysts are less likely to resolve spontaneously 2.
- Symptomatic postmenopausal women, those with a cyst ≥ 5 cm, or raised CA125 levels, should be referred to secondary care 2.
Clinical Symptoms to Report
- Symptoms that may be suggestive of a malignant ovarian cyst, particularly in the over 50 age group, include:
- Weight loss
- Persistent abdominal distension or bloating
- Early satiety
- Pelvic or abdominal pain
- Increased urinary urgency and frequency 2.
- CA125 levels should be checked in women who present with frequent bloating, feeling full quickly, loss of appetite, pelvic or abdominal pain, or needing to urinate quickly or urgently 2.
- Sudden onset of severe colicky unilateral pain radiating from groin to loin, accompanied by nausea and vomiting, may indicate ovarian torsion, which is most common in the presence of an ovarian cyst 2.