Ovarian Cysts During Reproductive Age (Before Menopause)

Ovarian cysts are common during the reproductive years. Statistics show that about 10% of women undergo some form of surgery in their lifetime due to an ovarian mass.
Understanding Ovarian Cysts in Reproductive-Age Women Diagnosis and Management

Key Facts:
1- Most ovarian cysts are benign (non-cancerous) in premenopausal women.
2- The risk of malignancy is very low—about 1 in 1,000 cases.

Common Symptoms:

Most cysts are asymptomatic and discovered incidentally.
Sudden lower abdominal pain may occur due to cyst torsion or rupture.
Urinary symptoms may appear if the cyst is large and presses on the bladder.
Abdominal bloating, digestive issues, and loss of appetite should prompt a thorough evaluation.

Ovarian Cyst Evaluation:

1- Pelvic ultrasound (first and most important tool).
2- Gynecological exam.
3- Laboratory tests:
– CA-125
– LDH
– AFP
– β-HCG
4- MRI scan may be needed in certain complex cases.
By combining ultrasound findings + CA-125 level + menopausal status, a malignancy risk score can be calculated to guide treatment decisions.

Management Based on Size and Type:

1. Functional simple cysts (<5 cm):
   • Thin wall, clear fluid content.
   • Usually resolve on their own within 2–3 menstrual cycles.
   • No treatment or follow-up needed.
2. Simple cysts (5–7 cm):
   • Require annual ultrasound follow-up.
3. Cysts >7 cm:
   • Require MRI or surgical evaluation depending on the case.

Any sudden abdominal pain, regardless of cyst size, warrants immediate medical consultation.

Cysts That Require Closer Evaluation:

1- Cysts with non-fluid contents (e.g., solid, hemorrhagic).
2- Cysts with internal septations or projections.
3- Bilateral cysts.
4- Presence of ascitic fluid in the abdomen.
5- Large-sized cysts.