Ovarian Cyst, Ruptured

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Basics

  • Ovarian cysts are frequent in reproductive-aged women.
  • Most ovarian cysts are benign physiologic follicles created by the ovary at the time of ovulation.
  • Ovarian cysts can cause symptoms when they become enlarged and exert a mass effect on surrounding structures, or when they rupture and the cyst contents cause irritation of the peritoneum or nearby pelvic organs.
  • Patients with a symptomatic ruptured cyst will usually complain of acute onset unilateral lower abdominal pain.
  • Rupture can be caused by sexual intercourse, luteal phase, exercise, trauma, or pregnancy.
  • Evaluation of the patient should include exclusion of other emergent causes: ectopic pregnancy, ovarian torsion, and nongynecologic sources of acute unilateral lower abdominal pain.
  • Once the diagnosis of a ruptured cyst is confirmed, most patients can be managed conservatively as outpatients with adequate pain control. Surgical intervention is rarely indicated.
  • OCPs are not an effective treatment for existing ovarian cysts.

Description

A suspected ruptured ovarian cyst should be treated as an unknown adnexal mass (mass of the ovary, fallopian tube, and surrounding tissue) until proven otherwise.

Epidemiology

  • The actual incidence of ovarian cysts is difficult to calculate because many ruptured cysts are asymptomatic or found incidentally.
  • Ovarian cysts can be seen on transvaginal ultrasounds in nearly all premenopausal women and in up to 18% of postmenopausal women. The vast majority of these cysts are benign or functional.
  • Most ruptured ovarian cysts are physiologic events and self-limited; expectant management with pain control is usually sufficient.
  • About 13% of ovarian masses in reproductive-aged women are malignant, as opposed to 45% in postmenopausal women. About 70% of ovarian malignancies are diagnosed at a late stage.
  • Ruptured ovarian cysts most commonly affect the right ovary, 63%.

Risk Factors

Medications or conditions associated with increased ovulation and/or increased risk of cyst rupture

  • Ovulation induction agents (i.e., Clomid, aromatase inhibitors, GnRH agonists)
  • Tamoxifen increases the risk of ovarian cysts in reproductive-aged women.
  • Polycystic ovarian syndrome (common)
  • Fibrous dysplasia/McCune-Albright syndrome (rare)

General Prevention

Ovulation suppression with combined oral contraceptives is the mainstay therapy for prevention of recurrent ovarian cysts.

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