What Are Hemorrhagic Ovarian Cysts?

A hemorrhagic ovarian cyst is a blood-filled cyst on the ovary. Ovarian cysts are small fluid-filled sacs (similar to blisters) that can form in women of reproductive age.

This condition may be painful, but hemorrhagic cysts are usually not dangerous and do not result in complications when treated appropriately. Smaller hemorrhagic cysts may not cause any symptoms and often resolve on their own. Larger cysts may cause more intense pain and may require surgical removal.

This article will go over the symptoms and causes of hemorrhagic ovarian cysts and address diagnosis and treatment.

Hemorrhagic Ovarian Cyst Symptoms

You may not experience any symptoms from a hemorrhagic ovarian cyst. When they do cause symptoms, these may include:

• Abdominal pain 
• Pelvic pain
• Irregular or painful periods

Causes

Cysts often form during the luteal stage of a woman's menstrual cycle (the last phase in which the uterus thickens to prepare for possible pregnancy). Several types of ovarian cysts can become hemorrhagic.

• Corpus luteum cyst: This is the most common type of hemorrhagic cyst. It is caused by bleeding into a corpus luteum (the empty follicle that contained an egg before its release).
  Follicular cyst: Hemorrhagic ovarian cysts can also develop during the follicular stage. During ovulation, an egg is released from a follicle. Sometimes, the follicle develops into a cyst, forming a follicular cyst. The follicular cyst becomes hemorrhagic when bleeding occurs inside it. The exact cause of hemorrhagic ovarian cysts is unknown.

Risk Factors

Certain medications and medical conditions put you at greater risk of developing a hemorrhagic ovarian cyst. Some of these include:

• Pregnancy: If a hemorrhagic cyst develops around the same time as conception, it may persist throughout the pregnancy. These tend to be larger in the first trimester when progesterone levels are high.
  
• Fertility drugs: Certain fertility drugs like clomiphene or letrozole (Femara) are associated with the development of ovarian cysts. These usually resolve when the medication is discontinued.
• History of previous ovarian cysts: If you've had an ovarian cyst in the past, you're more likely to develop another one.

Diagnosis

An ovarian cyst may first be detected during a pelvic exam. Your healthcare provider may order additional tests to confirm the diagnosis.

Transvaginal Ultrasound

A transvaginal ultrasound can help identify the cyst's type, size, shape, and location. This image will also help your healthcare provider determine if a cyst is hemorrhagic.

In a transvaginal ultrasound, a handheld wand-like device is inserted into the vagina to produce an image of the organs in the pelvis, including the uterus, ovaries, cervix, and fallopian tube. This procedure is harmless and painless, though you may experience some pressure or discomfort. The entire process lasts about 15 minutes.

Treatment

If the cyst is small and not causing symptoms, treatment is not likely necessary. You may be able to manage your symptoms at home until they resolve on their own.

Self-Care

Taking care of yourself and managing stress can make dealing with pain a little easier.

• Diet and exercise: Try to follow a healthy diet, get enough rest, and exercise regularly.
• Heat therapy: This works for some to help relieve pain and cramping symptoms. Place a heating pad or a hot water bottle on your stomach, or try taking a warm bath. When pain is intense, the heat can help to relax your muscles.
• Over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs): Medications like Ibuprofen (e.g., Advil), are often recommended to relieve pain and cramping. NSAIDs appear to be fairly effective, with a 2015 systematic review finding that between 45% and 53% of women taking NSAIDs achieved moderate or excellent pain relief compared to 18% of those taking placebo.

If your pain is severe or frequent, consult a healthcare provider. They can help you determine if your pain level requires further management or treatment.  

Ovarian Cyst Surgery

Surgery may be necessary if:

• The cyst is large (greater than 5 centimeters in diameter).
• It is causing pain.
• It is not resolving on its own.
• Your healthcare provider cannot determine whether it is benign (harmless and noncancerous).
• It ruptures or becomes twisted (torsion).

The type of surgery—whether it is removing just the cyst (cystectomy) or the entire ovary (oophorectomy)—depends on many factors, including age, desire for future pregnancies, and concern for cancer. The surgery may be done in one of two ways:

• Laparoscopic surgery: Ovarian cyst surgery may be done laparoscopically, with small incisions in the abdomen. A small camera is inserted into one incision to assist the surgeon in visualizing the area, and the surgical instruments are inserted into the other incision. This is a minimally invasive surgery, requiring less recovery time than some other procedures.
• Laparotomy: For larger cysts, laparotomy may be necessary. In this surgical procedure, a larger incision is made into the abdomen to remove the cysts. This procedure requires a longer recovery time.
  

What if a Hemorrhagic Cyst Bursts?

If a hemorrhagic ovarian cyst ruptures, it can release blood and fluid into the surrounding abdomen and pelvis. This can cause several serious problems including hemoperitoneum (a condition in which blood accumulates in the space between the inner lining of the abdominal wall and the internal organs), less blood flow to vital organs, and sepsis.

Prognosis

Most hemorrhagic ovarian cysts are harmless and can resolve on their own. They do not typically cause complications such as infertility. Some ovarian cysts may be malignant (cancerous). If your healthcare provider suspects that your cyst indicates ovarian cancer, they will discuss further treatment options with you.

However, for women who have not gone through menopause, fewer than 1% of growths on the ovaries turn out to be cancerous.

Other Types of Ovarian Cysts

• Dermoid cyst: This is the most common type of ovarian cyst in adults and adolescents. Dermoid cysts may contain tissue that typically appears on other parts of the body, such as hair, skin, and teeth.
• Cystadenoma: This is a common benign cyst that develops on the surface of the ovary. Cystadenomas have the potential to become very large and may become cancerous over time.
• Endometrioma: Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity (on the ovaries or in the pelvic region). With endometriomas, retrograde menstruation (when menstrual blood flows back through the fallopian tubes and into the pelvic area) results in endometrial tissue becoming trapped in cysts, which causes inflammation. Ovarian endometriomas are found in 17% to 44% of women with endometriosis.
  

Summary

Hemorrhagic ovarian cysts are small blood-filled sacs found in the ovary. These cysts often form during the luteal or follicular stages of the menstrual cycle. Women with hemorrhagic ovarian cysts may experience no symptoms or may have severe abdominal pain and discomfort.

Hemorrhagic ovarian cysts can be diagnosed through ultrasound and will often resolve on their own. While rare, some cases may require surgical removal.