How are ovarian cysts managed?

Management depends on age, symptoms, size, ultrasound features, and malignancy risk (RMI):

• Simple cysts <5 cm in premenopausal women - usually functional; observe (most regress), with symptomatic management/follow-up
• Larger, persistent, complex, or symptomatic cysts - surgery (laparoscopic cystectomy/oophorectomy)
• High RMI/suspected malignancy - refer to gynae-oncology for staging surgery

Clinical relevance. Management of ovarian cysts (observe simple small cysts; operate on complex/persistent; refer high-RMI) balances benign vs malignant likelihood.

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Management of ovarian cysts

Management balances the likelihood of a benign functional cyst against the risk of malignancy.

Premenopausal, simple, small cysts

• Simple cysts <5 cm are usually functional - the majority regress spontaneously; manage symptomatically with follow-up ultrasound.
• (Cysts 5-7 cm may be monitored; the combined pill does not make them resolve faster.)

Larger/complex/symptomatic cysts

• Persistent, large (>5-7 cm), complex, or symptomatic cysts - consider surgery (laparoscopic ovarian cystectomy, preserving the ovary where possible, or oophorectomy).

Postmenopausal women

• Assess with CA-125 and ultrasound (RMI); small simple cysts with normal CA-125 may be monitored, but a higher threshold for surgery.

Suspected malignancy

• High RMI/complex features - refer to gynae-oncology for staging laparotomy/surgery.

Acute

• Cyst accidents (torsion, rupture, haemorrhage) may need urgent surgery.