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Pre Menopausal Complex Ovarian Cysts



 

Introduction

  • Ovarian cysts may be an incidental finding or when investigating gynaecological or gastrointestinal symptoms.
  • Common benign types of ovarian cysts include:
    • Functional or physiological cysts in premenopausal women (haemorrhagic, follicular, corpus luteal cysts) arising from the follicle or corpus luteum.
    • Paratubal and para-ovarian cysts – almost always asymptomatic.
    • Hydrosalpinx – blocked fallopian tube full of fluid.
    • Endometriomas – due to deposits of endometriosis on the ovary.
    • Dermoid cysts – often contain hair, skin, teeth, bone, and many other tissues.
    • Cystadenomas – mucinous or serous.

 

In scope          Pre-menopausal complex ovarian cysts

Not in scope   Pre-menopausal Simple cysts and Post menopausal simple ovarian cysts



Red Flag Features

  • Ovarian cancer
  • Ovarian torsion
  • Ectopic Pregnancy
  • Pelvic Inflammatory Disease

*This list is non exhaustive 
 

 Investigations required prior to referral

  • US pelvis
  • CA 125 if symptoms suspicious for ovarian cancer.

 

Management

 


Advice and Guidance

Please send advice and guidance requests to Gynaecology via eRS



Referral

Emergency and red flags

If suspected ovarian torsion, admit via the on-call Gynaecology team.

 

Fast track suspected cancer referral:

•            The cyst is solid or complex and of any size and CA125>/35

•            Features suspicious for malignancy on ultrasound

 

Routine referral to the general gynaecology clinic:

•            Indeterminate Adnexal Mass or Multiseptated ovarian Cyst and CA125 <35

•            Corpus luteal cyst in second half of cycle over 5cm, Haemorrhagic cyst over 5cm

•            Features suggestive of Dermoid or Endometrioma ≤5cm and static or increasing in size after 4 months.

•            Features suggestive of Dermoid or Endometrioma >5cm.

•            Symptomatic cysts of any size may need referral.




Supporting Information

For professionals    

 

For patients  

 

References    Levine D et al. Management of Asymptomatic Ovarian and other Adnexal Cysts Imaged at US: Society of Radiologist in Ultrasound Consensus Conference Statement. Radiology 2010;256:943-954

  

Page Review Information

 

Review date

11/10/2024

Next review date

11/10/2026

Clinical editor

Dr Melanie Schick (GP)

Contributors

Miss Sophia Julian, Consultant Gynaecologist, RCHT.  Dr Claire Keany, Consultant Radiologist, RCHT