Management of Ruptured Ovarian Cyst

What is management of a ruptured ovarian cyst?

An ovarian cyst is a fluid-filled sac that forms on or inside an ovary. In some cases, the cyst can break open (rupture). A ruptured cyst may be managed in several ways:

• Tracking symptoms

• Taking pain medicine

• Having surgery

The ovaries are a pair of small, oval-shaped organs in the lower part of a person’s belly (abdomen). About once a month, one of the ovaries releases an egg. The ovaries also make the hormones estrogen and progesterone. These play roles in pregnancy, the menstrual cycle, and breast growth.

An ovarian cyst can develop for different reasons. Most ovarian cysts are harmless. A cyst that ruptures may cause no symptoms, or only mild symptoms. Ruptured cysts that cause mild symptoms can often be managed with pain medicines. The cyst may be looked at with an imaging test, such as an ultrasound.

In some cases, a ruptured cyst can cause more severe symptoms. These can include severe pain in the lower belly and bleeding. Symptoms like these need treatment right away.

You may need care in the hospital if you have severe symptoms from a ruptured cyst. You may be given IV (intravenous) pain medicines through a needle inserted into your vein. You may need to have fluids or blood replaced due to internal bleeding. In rare cases, a ruptured ovarian cyst may need surgery. This may be an emergency surgery.

If you need surgery because of internal bleeding, a surgeon will make a cut (incision) in your abdomen while you are under anesthesia. The surgeon controls the bleeding and removes any blood clots or fluid. The surgeon may then remove the cyst or your entire ovary.  

Why might I need management of a ruptured ovarian cyst?

Some ruptured ovarian cysts can cause a lot of bleeding. These need medical treatment right away. In severe cases, the blood loss can cause less blood flow to your organs. In rare cases, this can cause death.

Many ovarian cysts don't rupture. Experts don’t know why some cysts break open and some don't. A cyst is more likely to rupture during strenuous exercise or sexual activity. If you have a health condition that makes you bleed easily, you will likely need surgery for a ruptured cyst.

There are different types of ovarian cysts. Functional cysts are the most common type. These only occur in people who have not gone through menopause. They often happen when an egg doesn’t release from the ovary during ovulation. These cysts are the most common type to rupture.

What are the risks of management of a ruptured ovarian cyst?

For many people, a ruptured ovarian cyst causes no symptoms or only mild symptoms. Mild symptoms can often be managed with pain medicines. There are seldom any risks in this situation.

In some cases, you may have more severe symptoms. These can include extreme pain in your lower belly and bleeding. Uncontrolled bleeding can be life-threatening. See your healthcare provider right away. Depending on your symptoms, you may need to be hospitalized.

Severe cases may need surgery. This may be an emergency procedure. The surgery may be minimally invasive (a laparoscopy). This means it uses very small cuts (incisions). Or it may be a standard open procedure and use a much larger incision. All surgery has some risks. But in these severe cases, there are greater risks to you if surgery is not done. Risks and possible complications of surgery for a ruptured ovarian cyst include:  

• Bleeding

• Infection

• Incision doesn't heal well

• Blood clots

• Risks of anesthesia

• Damage to blood vessels, nerves, muscles, or nearby pelvic structures

• The need for a larger incision (if you had a laparoscopy)

• Scar tissue (adhesions) that occur after surgery

How do I get ready for management of a ruptured ovarian cyst?

A healthcare provider diagnoses a ruptured ovarian cyst. If you have sudden, sharp belly pain, see a provider right away. If you know that you have an ovarian cyst, be aware that it can rupture and need treatment.

Your general healthcare provider or an OB/GYN (obstetrics/gynecology) healthcare provider will diagnose the condition. Your provider will ask about your health history and your symptoms. Be sure to tell the provider if you know that you have an ovarian cyst. You will also have a physical exam. This will likely include a pelvic exam.

If your provider thinks you may have a ruptured cyst, you may need tests. These tests can help rule out other possible causes of your symptoms, such as an ectopic pregnancy, appendicitis, or a kidney stone. Some of these tests may include:

• Ultrasound. This test uses sound waves to view the cyst’s size, shape, and location.

• Pregnancy test. This test is done to check if pregnancy may be the cause of the cyst.

• Blood tests. These check for low iron in your blood (anemia). They also check for infection and for signs of cancer.

• Urine test. This test looks for other possible causes of your pain.

• Vaginal culture. This test is done to check for a pelvic infection.

• CT scan. This test uses a series of X-rays and a computer to create a detailed picture of the area.

You may need more tests to rule out other possible causes of your symptoms.

If you need surgery for your cyst, your healthcare provider will tell you how to prepare. For example, you shouldn’t eat or drink after midnight before your surgery.

What happens during management of a ruptured ovarian cyst?

Management of a ruptured ovarian cyst depends on whether it is complex. A regular cyst is a simple fluid-filled sac. A complex cyst may have solid areas, bumps on the surface, or areas filled with fluid.

Many people have functional ovarian cysts. Most of these are not complex. A ruptured cyst that is not complex can be treated with pain medicine. You may be told to watch your symptoms over time. In some cases, you may need to have follow-up ultrasound tests. You may not need any other treatment.

If the cyst is complex, you may need different care. This type of cyst may cause:

• Blood loss that causes low blood pressure or fast heart rate

• Fever

• Signs of possible cancer                                                          

If you have a complex ruptured ovarian cyst, you may need care in the hospital. Your treatment may include:

• IV (intravenous) fluids to replace lost fluid

• Careful watching of your heart rate and other vital signs

• Keeping track of your red blood cell level (hematocrit) to check the blood’s ability to carry oxygen

• Repeated ultrasounds to check for bleeding into your belly

• Surgery for a medical condition that gets worse or to check for cancer

If you need surgery, your provider may use a minimally invasive method. This is called a laparoscopy. The provider makes small cuts (incisions) in your belly while you are under anesthesia. A tiny lighted camera and other small tools are put through these incisions. The provider controls the bleeding and removes any blood clots or fluid. The provider may then remove the cyst or your entire ovary. The tools are then removed. The incisions are closed and bandaged.

If the provider does not use laparoscopy, the surgery will be done with larger incisions.

Talk with your provider about what type of treatment will work best for you.

What happens after management of a ruptured ovarian cyst?

You and your healthcare team will make a follow-up plan that makes the most sense for you.

If your ruptured ovarian cyst is not complex, you will likely continue your care at home. You can use pain medicines as needed. Your pain should go away in a few days. Let your provider know right away if your pain gets worse, if you feel dizzy, or have new symptoms. Follow up with your provider if you need imaging or blood tests.

If you have a complex ruptured ovarian cyst, you may need to stay in the hospital for one or more days. If your cyst is no longer bleeding, you may be able to go home. You can use pain medicines as needed. You may need follow-up imaging tests to make sure that your bleeding has stopped and to see if the cyst needs surgery to rule out cancer.

If you had surgery, you will be told how to care for your wound and bandage. You may need to limit your physical activity for a while. Your healthcare team will give you more information.

In rare cases, a ruptured ovarian cyst is caused by cancer. This will need careful follow-up treatment from a healthcare provider who specializes in cancer care. You may need surgery and other therapies.

Some women have more than one ovarian cyst. You can work with your healthcare provider to plan treatment for multiple cysts. A cyst that has not ruptured may need to be watched over time. In other cases, you may need surgical removal of the cyst. Your provider may prescribe medicines, such as birth control pills. In some cases, these can help shrink an ovarian cyst.

Next steps

Before you agree to the test or procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure