What Are Hemorrhagic Ovarian Cysts?

A hemorrhagic ovarian cyst (a small fluid-filled sac that can form in the ovaries of women of reproductive age) occurs when a cyst bleeds.

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 can often resolve on their own. Larger cysts may cause more intense pain and may require surgical removal.

Learn more about the symptoms, causes, diagnosis, and treatment of hemorrhagic ovarian cysts.

Hemorrhagic Ovarian Cyst Symptoms

You may not experience any symptoms from a hemorrhagic ovarian cyst. However, they often cause pain and discomfort. Symptoms of a hemorrhagic ovarian cyst include:

• Abdominal pain 
• Pelvic pain
• Irregular or painful periods

Causes

Several types of ovarian cysts can become hemorrhagic, often forming during the luteal stage of a woman's menstrual cycle (the last phase in which the uterus thickens to prepare for possible pregnancy). The most common type of hemorrhagic cyst is a luteal cyst, resulting from bleeding into a corpus luteum (the empty follicle that contained an egg before its release).

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. When bleeding occurs in the follicular cyst, it's called a hemorrhagic ovarian cyst. The exact cause of hemorrhagic ovarian cysts is unknown.

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. However, if the cyst is large (greater than 5 centimeters in diameter), is causing pain, is not resolving on its own, or if your healthcare provider cannot determine whether it is benign (harmless and noncancerous) or not, it may be surgically removed. Surgical removal may also be necessary if the cyst ruptures or becomes twisted (torsion).

Ovarian Cyst 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.

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.

The type of surgery that may be done—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.

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.

Summary

Hemorrhagic ovarian cysts are small fluid-filled sacs found in the ovary that have bled. These cysts are often formed 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.