In menstruating women with a functional ovarian cyst identified incidentally, what is the recommended initial management?

In menstruating women with a functional ovarian cyst identified incidentally, what is the recommended initial management?

• A. Follow-up ultrasonography 8-12 weeks after identification
• B. Immediate surgical removal
• C. Hormonal therapy with combined oral contraceptives
• D. CA-125 screening in postmenopausal patients

Answer: (A)

Functional ovarian cysts in menstruating women come from normal ovulatory processes and are usually benign. They often resolve on their own within a couple of menstrual cycles, so the safest first step is to observe rather than intervene. Repeating imaging after about 8–12 weeks allows you to confirm that the cyst has regressed without unnecessary procedures. If the cyst disappears, no further action is needed. If it persists, grows, becomes complex (for example, has thick walls, septations, or solid areas), or the patient develops symptoms, then further evaluation or treatment is warranted. Hormonal therapy with combined oral contraceptives does not reliably speed resolution of a simple functional cyst and isn’t routinely used for this purpose. CA-125 screening isn’t recommended for a reproductive-age patient with an incidental cyst because it has limited value and can lead to false positives.

Functional ovarian cysts in menstruating women come from normal ovulatory processes and are usually benign. They often resolve on their own within a couple of menstrual cycles, so the safest first step is to observe rather than intervene. Repeating imaging after about 8–12 weeks allows you to confirm that the cyst has regressed without unnecessary procedures. If the cyst disappears, no further action is needed. If it persists, grows, becomes complex (for example, has thick walls, septations, or solid areas), or the patient develops symptoms, then further evaluation or treatment is warranted.

Hormonal therapy with combined oral contraceptives does not reliably speed resolution of a simple functional cyst and isn’t routinely used for this purpose. CA-125 screening isn’t recommended for a reproductive-age patient with an incidental cyst because it has limited value and can lead to false positives.