Hemorrhagic Ovarian Cysts: How to Identify and Treat Them?

Hemorrhagic ovarian cysts (HOCs) are a common type of ovarian cyst that form when blood vessels inside the cyst rupture, filling it with blood. These cysts typically occur during the natural menstrual cycle and are considered “functional” because they result from normal ovarian activity.

While most hemorrhagic cysts are harmless and resolve on their own, they can sometimes cause significant pain or lead to complications like rupture or ovarian torsion. Knowing how these cysts form, the symptoms they cause, and the available treatment options can help you make informed decisions about your reproductive health.

A] Types and Causes of Hemorrhagic Ovarian Cysts

Hemorrhagic ovarian cysts form due to hormonal changes during the menstrual cycle or because of certain underlying conditions. There are two main types:

1. Follicular Cysts

During the first half of the menstrual cycle, an ovarian follicle develops to release an egg during ovulation. If the follicle doesn’t rupture and release the egg, it can grow larger, forming a follicular cyst. Sometimes, blood vessels within the cyst rupture, leading to a hemorrhagic ovarian cyst.

2. Corpus Luteum Cysts

After ovulation, the follicle transforms into the corpus luteum, a temporary gland that produces hormones to support early pregnancy if fertilisation occurs. If the corpus luteum seals off too early or enlarges, it can fill with blood, resulting in a hemorrhagic cyst.

3. Other Contributing Factors

Some conditions and external factors increase the risk of hemorrhagic cysts:

• Endometriosis: Endometrial tissue growing on the ovaries can lead to blood-filled cysts, also known as endometriomas, which mimic hemorrhagic cysts.
• Polycystic Ovary Syndrome (PCOS): PCOS causes multiple small ovarian cysts, some of which can become hemorrhagic due to internal bleeding.
• Hormonal Imbalances: Changes in estrogen or progesterone levels can disrupt the normal ovulation process, increasing the likelihood of cyst formation.
• Physical Trauma: High-impact activities or abdominal trauma can lead to bleeding inside existing cysts.

B] Symptoms

The symptoms of hemorrhagic ovarian cysts can vary from mild discomfort to severe, life-threatening complications. You can get an ovarian cyst check-up if any of the following symptoms occur:

Common Symptoms

• Pelvic Pain: A dull ache or sharp pain on one side of the lower abdomen, often linked to the ovary with the cyst.
• Menstrual Changes: Irregular periods are an impact of ovarian cysts on menstrual health; heavy bleeding or spotting between cycles may occur. 
• Bloating or Fullness: Many women report a feeling of heaviness or pressure in the abdomen.
• Pain During Intercourse: This can range from mild discomfort to sharp pain, particularly during deep penetration.

When experiencing any of these, it’s important to be aware of general ovarian cyst symptoms to distinguish between simple and complex cysts.

Severe Symptoms to Watch For

Some symptoms signal complications that need immediate medical attention:

• Sudden, Severe Pain: A ruptured cyst or ovarian torsion can cause excruciating, localised pain.
• Nausea and Vomiting: These symptoms often occur with ovarian torsion.
• Fever and Chills: Indicate possible infection.
• Dizziness or Fainting: Could result from significant internal bleeding due to cyst rupture.

C] Diagnosis

Diagnosing hemorrhagic ovarian cysts involves imaging tests and lab work to confirm their presence and rule out other conditions.

1. Pelvic Ultrasound

A transvaginal ultrasound is the most common method for detecting ovarian cysts. It shows whether the cyst is simple (fluid-filled), complex (containing blood or other materials), or solid. Hemorrhagic cysts often appear complex structures with visible blood clots or fibrin strands.

2. MRI

In cases where the ultrasound findings are inconclusive, an MRI can provide more detailed imaging to distinguish hemorrhagic cysts from other growths like endometriomas or ovarian tumours.

3. Blood Tests

Blood tests can help assess hormone levels and detect markers of inflammation or malignancy. In postmenopausal women, doctors may test for CA-125, a protein elevated in some ovarian cancers, to rule out malignancy. This is crucial, especially in cases where cysts deviate from the normal size of ovarian cysts in mm (which is around 3-5 cm).

D] Treatment Options

The treatment for hemorrhagic ovarian cysts depends on their size, symptoms, and the presence of complications.

1. Watchful Waiting

Many hemorrhagic cysts resolve naturally within one to two menstrual cycles. Doctors often recommend regular follow-up ultrasounds to monitor the cyst’s progress.

2. Pain Management

For mild to moderate symptoms, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain. In more severe cases, prescription pain relievers may be necessary.

3. Hormonal Therapy

Birth control pills or other hormonal treatments can regulate your menstrual cycle and reduce the risk of developing new cysts, although they won’t shrink existing ones.

4. Surgery

Surgical intervention is recommended in cases of:

• Persistent cysts that don’t resolve naturally.
• Large cysts causing severe pain or complications.
• Suspected malignancy.
• Emergencies like cyst rupture or ovarian torsion.

Ovarian cyst removal surgery options like laparoscopic cystectomy are considered for severe or persistent cases. For example, in cases of right ovarian hemorrhagic cyst treatment, doctors may opt to remove the cyst while preserving ovarian tissue surgically. The same approach applies to left ovarian hemorrhagic cyst treatment, depending on which ovary is affected.

E] Potential Complications

Although most hemorrhagic ovarian cysts resolve without incident, complications can occur, especially if they’re left untreated.

1. Cyst Rupture

A ruptured cyst can cause significant pain and internal bleeding, sometimes leading to life-threatening blood loss.

2. Ovarian Torsion

A large cyst can twist the ovary, cutting off its blood supply. This is a medical emergency requiring immediate surgical intervention to save the ovary.

3. Infections

In rare cases, a ruptured cyst can infect, causing fever, chills, and worsening pain.

4. Impact on Fertility

While hemorrhagic cysts themselves don’t usually cause infertility, complications like ovarian torsion or damage from repeated surgeries can impact reproductive health.

Conclusion

Hemorrhagic ovarian cysts are a common aspect of reproductive health, and while they often resolve on their own, understanding their causes, symptoms, and treatment options is crucial. If you experience pelvic pain, menstrual changes, or severe symptoms like sudden intense pain, nausea, or dizziness, consult a private gynaecologist in London or in your area immediately.

Regular gynaecological exams and timely imaging tests can help detect cysts early, prevent complications, and protect reproductive health. Whether monitoring small cysts or seeking specialised hemorrhagic cyst treatment, taking proactive steps can significantly improve overall health.