Diagnosis and Treatment of Ruptured Ovarian Cysts

While uncommon, complications can be serious

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An ovarian cyst is a fluid-filled sac that forms within or on top of an ovary. Ovarian cysts are not all that uncommon and tend to go away on their own. However, they can sometimes rupture and cause extreme pain.

Causes and Symptoms

The vast majority of ovarian cysts are painless and will not lead to complications of any sort. There are times, however, where the location of a cyst may cause irritation or discomfort during a bowel movement or when having sex. This usually happens when the cyst has grown so large that they begin to press on nerves or other organs.

If the cyst continues to grow even larger, it may suddenly rupture, causing pain and bleeding. The pain will usually be sharp and sudden and be located to one side of the pelvis. A rupture will often occur during or immediately following strenuous exercise or sex.

If the bleeding is heavy, the woman may experience dizziness, lightheadedness, shortness of breath, and a rapid heart rate. The ruptured tissues can increased risk for infection if left untreated.

Even if the cyst doesn't rupture, it can sometimes cause the ovary to twist and cut off the blood supply. This is a serious condition called ovarian torsion in which the decreased circulation can cause ovarian tissues to die. As with a rupture, the pain will be severe and situated to one side. Immediate surgical intervention would be needed to uncoil the ovary and prevent necrosis (cell death).

Diagnosis

The diagnosis of a ruptured ovarian cyst usually starts with an ultrasound. If the cyst has ruptured, the ultrasound will show fluid around the ovary and may even reveal an empty, sac-like ulcer. A complete blood count (CBC) may be used to check for signs of infection or other abnormalities.

While an ultrasound is the best method of evaluating a ruptured cyst, it has its limitations. To confirm the diagnosis, your doctor will have to rule out any other condition with similar symptoms including an ectopic pregnancy, pelvic inflammatory disease (PID), or non-gynecological causes like appendicitis or a kidney stone.

It is important to note that ovulation itself may sometimes cause mild pain when the egg is released. We refer to this as mittelschmerz pain, the symptom of which is not inherently abnormal. However, in some women, the pain may be extreme and should warrant investigation to determine if there are any other possible causes such as endometriosis (the overgrowth of uterine tissue).

Treatment

Once an ovarian cyst has ruptured, there is often no need for treatment assuming that the woman's CBC and vital signs are stable. Pain medication may be prescribed to help manage the discomfort. Rest may be recommended for a day or two to allow the symptoms to fully resolve.

However, in some cases, a cyst may be located near a significant blood vessel, and its rupture may cause severe bleeding. With instances like these, hospitalization and surgery may be needed to stop the hemorrhage and prevent additional blood loss.

If left untreated, the bleeding can lead to a serious condition known as hematoperitoneum in which blood accumulates in the space between the inner lining of the abdominal wall and the internal organs.

Prevention

There is no way to prevent an ovarian cyst from rupturing. With that being said, if your doctor finds one during a routine exam, he or she may recommend a watch-and-wait approach to see if the cyst increases in size or goes away on its own.

If the cyst is large and already causing discomfort, the doctor may recommend laparoscopic ("keyhole") surgery to remove the growth. It is an in-hospital procedure and one that should not be confused with a cystectomy (the removal of the bladder).

A Word From Verywell

If you experience severe or persistent abdominal or pelvic pain, you should have it evaluated by your doctor immediately or seek emergency care. There is no way to diagnose a condition by either the location of the pain or type of pain experienced.

While the rupture of an ovarian cyst is rarely life-threatening, an ectopic pregnancy can be. Delayed treatment can result in severe blood loss, shock, and even death.

View Article Sources
  • American Congress of Obstetricians and Gynecologists. "Ovarian Cysts." Washington, D.C.; updated April 2017.
  • Kim, J.; Lee, S.; Lee, J. et al. "Successful Conservative Management of Ruptured Ovarian Cysts with Hemoperitoneum in Healthy Women." PLoS One. 2014; 9(3): e91171. DOI: 10.1371/journal.pone.0091171.