Everything about Hemorrhagic Ovarian Cysts and its Treatment

What Is A Hemorrhagic Ovarian Cyst?

A hemorrhagic ovarian cyst is a type of cyst in the ovary that contains blood. It is termed ‘hemorrhagic’ because it contains blood, which typically results from bleeding into a functional cyst, such as a corpus luteum or follicular cyst. These cysts tend to develop during the menstrual cycle, particularly during ovulation. Some women with a hemorrhagic ovarian cyst may experience no symptoms at all, while others may experience severe abdominal pain, cramps, nausea, and changes in menstrual patterns. 

In India, hemorrhagic ovarian cysts are a relatively common gynaecological condition, affecting many women of reproductive age. It’s crucial to understand that although these cysts can be quite discomforting, they are usually benign (non-cancerous) and often resolve naturally over time. However, women need to be aware of this condition and follow regular monitoring with appropriate medical interventions if significant symptoms or complications arise. 

Types Of Ovarian Cysts

Understanding different types of ovarian cysts can help in better diagnosing and managing this condition:

• Follicular cysts: These usually form when the follicle—which releases an egg during ovulation—fails to rupture and subsequently bleeds, becoming a hemorrhagic ovarian cyst.
• Corpus luteum cysts: These develop post-ovulation when the follicle transfigures into the corpus luteum (hormone-secreting structure). If the corpus luteum gets filled with blood or fluid and doesn’t dissolve correctly, it can result in a hemorrhagic cyst.
• Functional cysts: Both follicular and corpus luteum cysts fall under this category as they result from normal ovarian function during the menstrual cycle.
• Dermoid cysts (Teratomas): These less common cysts can contain different tissue types, such as skin or hair. If they bleed, they can also be classified as hemorrhagic cysts.
• Cystadenomas: These develop from the surface cells of the ovary and may be filled with fluid or mucous. If these cysts bleed, they can become hemorrhagic ovarian cysts.

Causes Hemorrhagic Ovarian Cysts

A hemorrhagic ovarian cyst primarily results from a range of factors, often associated with normal body functions or physiological conditions. Here are some potential causes:

• Abnormal ovulation process
• Rupture of blood vessels
• Hormonal changes
• Presence of previous ovarian cysts
• Pregnancy
• Endometriosis
• Physical trauma

Symptoms Of Hemorrhagic Ovarian Cyst

Numerous symptoms can indicate a hemorrhagic ovarian cyst. Some of them are:

• Lower abdominal pain: This is usually concentrated on the side where the affected ovary is located.
• Intense cramps: These mostly occur during menstruation and can be quite severe.
• Pain during sexual intercourse: This discomfort or pain arises due to the pressure exerted on the cyst.
• Late or irregular periods: Due to hormonal imbalance, the menstrual cycle may get altered or become irregular.
• Nausea and vomiting: Often, abdominal pain is accompanied by nausea or vomiting.
• Unexplained weight loss: In some instances, women may experience unexplained weight loss that could be a serious concern.
• Signs of anaemia: Symptoms such as fatigue, pale skin, weakness, or dizziness could indicate internal bleeding.
• Bloating and fullness: A bloated sensation or feeling of fullness in the abdomen is common.

If the cyst ruptures, immediate medical attention is needed due to the risk of sudden sharp pain, heavy vaginal bleeding, and signs of internal bleeding.

Diagnosis And Evaluation Of Hemorrhagic Ovarian Cyst

Diagnosis and evaluation of a hemorrhagic ovarian cyst is multifaceted, involving several medical assessments. 

• Physical examination: The doctor will start with a comprehensive clinical history check and physical examination. This will include a pelvic examination to analyse symptoms such as abdominal pain, alterations in the menstrual cycle, and other related issues.
• Ultrasound: An ultrasound imaging is another essential diagnostic approach for a hemorrhagic ovarian cyst. Transvaginal or pelvic ultrasound is primarily used to identify the cyst’s size, location, and internal characteristics. A hemorrhagic cyst may appear as a complex cystic mass with low-level echoes or a solid-appearing area. 
• Doppler ultrasound: Color Doppler ultrasound, a specialised form of ultrasound, helps differentiate between a hemorrhagic cyst and other types of ovarian masses. It examines blood flow patterns, which are different in the case of a true neoplasm and a hemorrhagic cyst with a clot. 
• Blood tests: Blood tests are important in diagnosing hemorrhagic ovarian cysts. They evaluate hormone levels and check for signs of internal bleeding. If malignancy is suspected, particularly in postmenopausal women, specific tumour marker tests like CA-125 might be ordered.

How The Hemorrhagic Ovarian Cyst Can Be Treated?

Treatment for a hemorrhagic ovarian cyst depends on several factors, such as its size, the severity of symptoms, and whether there are any complications involved. 

• Observation is one of the first steps in treatment planning, especially for smaller (less than 5 cm) and asymptomatic cysts. Many hemorrhagic cysts resolve on their own within a few menstrual cycles without requiring any treatment. During this period, follow-up ultrasounds can monitor the cyst’s progress.
• Pain and discomfort associated with the cyst can be relieved using analgesics such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Application of heat therapy to the pelvic area could also help to alleviate pain and cramping.
• Additionally, doctors may prescribe hormonal medications like oral contraceptives to regulate menstrual cycles and inhibit ovulation, thereby preventing new cyst formation.
• In more severe cases where there is severe abdominal pain, concerns about malignancy, or complications such as rupture or torsion, surgical intervention might be necessary. The options for surgery include minimally invasive laparoscopy or more invasive laparotomy.
• If a hemorrhagic cyst ruptures, causing internal bleeding, immediate emergency care may be needed, including surgery to control bleeding and excise the cyst.

In conclusion, while most hemorrhagic ovarian cysts are benign and can be managed effectively with conservative measures, surgical options are available for more complicated cases, ensuring a high success rate for recovery.

When Is A Hemorrhagic Ovarian Cyst Considered Serious?

A hemorrhagic ovarian cyst can be a cause for concern under certain circumstances. These include:

• Size: A cyst larger than 5 centimetres (cm) is classified as large and carries a higher risk of complications, including rupture.
• Rupture: If a hemorrhagic cyst ruptures, it can lead to internal bleeding (hemoperitoneum), which is potentially life-threatening. Symptoms of rupture may include severe abdominal pain, nausea, vomiting, and signs of internal bleeding such as dizziness or lightheadedness.
• Severe symptoms: Immediate medical attention becomes necessary in case of severe pain, unusual vaginal bleeding, abdominal swelling, and weakness. These symptoms may suggest complications like hypovolemic shock or organ damage due to significant blood loss.
• Complications: If the cyst causes ovarian torsion (twisting of the ovary), it can reduce blood flow to the ovary, leading to severe pain and potential loss of ovarian function.

Prevention Of Hemorrhagic Ovarian Cyst

Prevention is better than cure. However, in the case of hemorrhagic ovarian cysts, it’s challenging to prevent them entirely since they often form due to the normal menstrual cycle. However, regular health check-ups and self-monitoring for any unusual symptoms can help detect these cysts early on. Regular exercise and maintaining a balanced diet may also help improve overall reproductive health.

If you suspect you have an ovarian cyst or experience any of the listed symptoms, it’s advisable to consult a gynaecologist or an endocrinologist. They have the expertise in diagnosing and treating conditions related to hormonal imbalances that may contribute to the formation of ovarian cysts.

When To Consult A Doctor For Hemorrhagic Ovarian Cyst?

Consultation with your doctor becomes necessary when you experience symptoms such as severe abdominal pain, nausea, unusual vaginal bleeding, dizziness, or lightheadedness. It’s recommended to seek immediate medical attention, particularly if you suspect a rupture of a hemorrhagic ovarian cyst.

Your family doctor is often the first point of contact, but a gynaecologist may provide more specialised care for this condition. Early diagnosis improves the success rate of recovery from a hemorrhagic ovarian cyst.