ovarian%20mass
OVARIAN MASS
Ovarian cysts are typically noted after clinical screening, or as a result of exam for a suspected pelvic mass, or an incidental finding in investigations done for other reasons.
Most ovarian masses manifest with few or mild nonspecific symptoms.
Ovarian masses in women of reproductive age are mostly benign but the risk of malignancy increases with age.
Ovarian cysts in the prepubertal patients especially after the first week of life are abnormal and likely to be neoplastic. In adolescent patients, majority of ovarian masses are functional cysts.

Monitoring

Postmenopausal Woman 

  • Small (<5 cm), simple, unilocular, unilateral ovarian cysts in asymptomatic patients can be followed conservatively
  • Repeat transvaginal ultrasound and serum CA-125 should be performed at 3- to 4-month intervals x 1 year to check for any change in size or development of suspicious features
    • 50% of asymptomatic cysts resolve within 2 months
  • Consider surgical management for women with moderate- to high-risk Risk of Malignancy Index (RMI) or for those who do not qualify for conservative management

Conservative Management

  • Asymptomatic, simple, unilateral, unilocular ovarian cysts <3-5 cm in diameter have a low risk of malignancy and if CA-125 is normal, the woman may be managed conservatively

Expectant Management in Premenopausal Patient

  • Conservative observation can be adopted for complex or solid ovarian cysts of benign character (<8 cm in diameter, unilateral, unilocular, cystic, mobile, smooth, solid component is <7 mm, positive acoustic shadowing, absent blood flow) with ultrasound surveillance every 2-3 months
  • Follow-up is not required for simple ovarian cysts <5 cm as it usually spontaneously resolves, follow-up with ultrasound every 3-4 months for 5- to 7-cm cysts, and consider further imaging or surgical referral for larger simple cysts
    • Laparoscopic cystectomy may be done if surgery is required
  •  70% of benign ovarian masses will resolve spontaneously by either reabsorption of the cyst fluid or silent rupture within 4-8 weeks of initial diagnosis
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
6 days ago
Intravenous (IV) iron is less toxic and more effective compared to oral iron, making it a potential frontline therapy for neonatal iron deficiency anaemia, suggests a recent study.
Shilpa Kolhe, MBBS, MD, MRCOG; Shilpa Deb, MBBS, DGO, MRCOG, 01 Aug 2012

Dysmenorrhoea is a medical condition characterized by severe uterine pain during menstruation manifesting as cyclical lower abdominal or pelvic pain, which may also radiate to the back and thighs. The term dysmenorrhoea is derived from the Greek words ‘dys’ meaning difficult, painful or abnormal, ‘meno’ meaning month, and ‘rrhea’ meaning flow. It is commonly divided into primary dysmenorrhoea, where there is no coexistent pathology, and secondary dysmenorrhoea where there is an identifiable pathological condition known to contribute to painful menstruation. Symptoms of primary dysmenorrhoea begin a few hours before the start of menstruation and are often relieved during the first few days of bleeding. The initial onset of primary dysmenorrhoea is usually shortly after menarche (6–12 months), when ovulatory cycles are established. Secondary dysmenorrhoea can also occur at any time after menarche but is most commonly observed in women in their third and fourth decade of life in association with an existing condition.

02 Dec 2014
Adolescent females often experience menstrual problems, and these are usually related to mood changes. In this study, the association between dysmenorrhea and depressive symptoms, anxiety, and premenstrual syndrome was examined.
26 Feb 2017
Placement of cervical pessary in women with short cervices and singleton pregnancies does not lower the risk of having preterm births, according to the results of a meta-analysis.