Management of Uterine Cyst
The first priority is accurate diagnosis through transvaginal ultrasound to characterize the cyst and determine its origin, followed by management based on whether it is a simple functional cyst, cystic adenomyoma, or degenerative fibroid. 1
Regarding "admexol" - this medication is not recognized in standard pharmaceutical references or medical literature. You must clarify the actual medication name with the patient, as management decisions may be affected if she is taking hormonal therapy, anticoagulants, or other medications that could influence surgical planning or medical management options.
Initial Diagnostic Approach
Transvaginal ultrasound is the essential first-line imaging modality to characterize any uterine cyst and distinguish it from adnexal pathology. 1 This is critical because:
- Non-fibroid uterine cysts are frequently misdiagnosed as adnexal masses in 75% of cases, with their true uterine origin only becoming evident during surgery 2
- Transabdominal ultrasound should be added when the mass is large and not optimally visualized transvaginally 1
Key Sonographic Features to Document:
- Cyst size, wall thickness, presence of septations, and vascularity pattern 1
- Relationship to uterine myometrium - look for continuity with uterine tissue to confirm uterine rather than ovarian origin 2, 3
- Presence of solid components, mural nodules, or internal echoes that would suggest cystic adenomyoma rather than simple cyst 4, 2
Differential Diagnosis of Uterine Cysts
The most common uterine cystic lesions include:
- Cystic degeneration of leiomyoma (fibroid) - most common, accounts for approximately 72% of uterine cystic tumors 2
- Cystic adenomyoma - endometrial tissue within myometrium forming cystic spaces 4, 2
- Congenital/developmental cysts - Müllerian duct remnants 5, 2
Management Algorithm Based on Cyst Characteristics
For Simple Uterine Cysts <5 cm in Premenopausal Women:
- Annual ultrasound surveillance is appropriate if asymptomatic 6
- Most simple cysts in premenopausal women are functional and resolve spontaneously 1
- Repeat ultrasound in 6-8 weeks to document resolution or persistence 1, 6
For Cysts ≥5 cm or Symptomatic Cysts:
MRI with contrast (if not contraindicated) should be obtained when ultrasound findings are indeterminate or when surgical planning is needed. 1 MRI provides superior soft tissue characterization to:
- Confirm uterine versus adnexal origin 1
- Identify cystic adenomyosis by demonstrating endometrial glands in cyst walls 4
- Differentiate degenerative fibroid from other pathology 3
Surgical Indications:
Laparoscopic excision is indicated for:
- Cysts ≥10 cm due to increased risk of complications 6
- Symptomatic cysts causing pain, dysmenorrhea, or mass effect 4, 2
- Rapidly growing cysts - growth is uncommon and warrants active management 7
- Diagnostic uncertainty after imaging - laparoscopy allows simultaneous diagnosis and treatment 5, 2
Laparoscopic surgery is the preferred approach over laparotomy, offering shorter hospital stay, less postoperative pain, and faster recovery. 6
Medical Management Considerations
If the cyst is associated with adenomyosis and the patient has heavy menstrual bleeding or dysmenorrhea:
- NSAIDs (mefenamic acid, naproxen, or ibuprofen) for 5-7 days during menstruation reduce bleeding by 25-50% and control pain 8
- Combined hormonal contraceptives or levonorgestrel IUD are first-line for bleeding control 1, 9
- Avoid NSAIDs if patient has cardiovascular disease, peptic ulcer history, or is >60 years old 8
Critical Pitfalls to Avoid
Do not assume an adnexal origin without confirming both ovaries are separate from the cystic mass - this is the most common diagnostic error 2, 3
Do not delay surgical evaluation for rapidly growing cysts - growth is uncommon in benign uterine cysts and may indicate malignant transformation or other pathology 7
Do not perform endometrial biopsy for cystic lesions - this is indicated for abnormal bleeding with suspected endometrial pathology, not for characterizing cystic masses 1
Verify the actual medication name before proceeding with any hormonal or surgical management, as unidentified medications could represent contraindications or drug interactions