A hemorrhagic ovarian cyst is a type of ovarian cyst that bleeds.

Smaller cysts that do not cause symptoms may go away without treatment. However, a person may need surgery to remove a large or complicated cyst.

This article explains what hemorrhagic ovarian cysts are, as well as the symptoms, causes, and treatment options. It also provides answers to some frequently asked questions.

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Ovarian cysts are fluid-filled sacs that can develop inside a person’s ovaries. They are typically harmless and do not tend to cause symptoms.

A hemorrhagic ovarian cyst is a type of ovarian cyst that bleeds. Hemorrhagic ovarian cysts are typically functional cysts, which means they occur due to ovulation rather than due to disease.

In a small 2016 study with 48 participants, researchers found that hemorrhagic ovarian cysts occurred most commonly in those who had not yet gone through menopause and had given birth more than once.

Hemorrhagic ovarian cysts can vary in size. Experts consider a cyst more than 5 centimeters (cm) in diameter to be large. In the same 2016 study, the mean cyst size was 4.8 cm.

Hemorrhagic ovarian cysts can rupture spontaneously. When this occurs, blood and fluid can flow into a person’s abdomen and pelvis. If this occurs, a person may need surgery to stop the bleeding and remove the cyst.

Hemorrhagic ovarian cyst symptoms can vary significantly. Some people will experience no symptoms and will find out that they have this type of cyst only while undergoing tests for other reasons.

However, others may experience symptoms such as:

Symptoms may range from mild and manageable to significantly disruptive and unmanageable.

In some cases, people may experience severe symptoms that require immediate medical attention. These typically occur due to a cyst rupturing, twisting, or rapidly accumulating blood.

Serious symptoms may include:

One important complication a person should be aware of is hemoperitoneum, which is internal bleeding into the peritoneum (abdomen). This can occur when a hemorrhagic ovarian cyst ruptures.

Hemoperitoneum can be life threatening and can lead to:

  • hypovolemic shock, in which the heart cannot pump enough blood around the body
  • organ failure
  • organ damage

Symptoms of internal bleeding into the peritoneum may include:

Hemoperitoneum is a medical emergency. If a person shows symptoms of this complication, they need immediate medical care.

Experts consider ultrasound scans the most effective way to evaluate hemorrhagic ovarian cysts. Ultrasounds can help a doctor determine the size and volume of a cyst. They can also show the internal structure of a cyst, such as whether it is dense or sponge-like or has a mix of structures.

A cyst may also contain a blood clot, which can make it look similar to another type of growth called an ovarian neoplasm. In this case, a doctor may request a color Doppler ultrasound, a type of ultrasound that shows blood flow. An ovarian neoplasm will have blood flow, whereas a blood clot within a hemorrhagic ovarian cyst will not.

A doctor may also recommend blood testing to determine whether a person has anemia as a result of acute bleeding or hemorrhage from the cyst.

During menstruation, the body produces a temporary organ called the corpus luteum to help with fertility. Excessive bleeding into the corpus luteum can cause a hemorrhagic ovarian cyst to develop.

Another type of ovarian cyst, called a follicular cyst, occurs when an ovary follicle does not release its egg. In this case, the follicle instead becomes a cyst. As with corpus luteal cysts, bleeding into a follicular cyst can cause a hemorrhagic ovarian cyst.

If a person’s cyst is less than 5 cm in diameter and they have few or no symptoms, a doctor will likely recommend waiting to see whether the cyst resolves on its own. In a 2016 study, hemorrhagic ovarian cysts disappeared within 6 weeks in 87.5% of people, or 28 out of 32 people, who followed a conservative management plan.

The study authors recommend that doctors schedule weekly follow-up ultrasounds for people who are following conservative management plans. This is to ensure that doctors can detect any complications, such as twisting or rupturing of a cyst, as early as possible.

If a person has a cyst more than 5 cm in diameter, if they have significant acute symptoms, or if a diagnosis is not possible with ultrasound, a doctor may recommend surgical management. This may include emergency surgery to remove a cyst and treat blood loss in some cases. Where possible, a surgeon will choose to perform laparoscopic surgery.

In rare and extreme cases, a surgeon may need to perform an oophorectomy on the affected ovary. This is a procedure to remove the ovary when it is no longer safe for a person to keep it. In the 2016 study, a small number of participants required an oophorectomy after they developed gangrenous twisted ovaries with hemorrhagic cysts.

The following are some questions people frequently ask about hemorrhagic cysts.

Can a hemorrhagic cyst be cancerous?

Hemorrhagic ovarian cysts are nearly always benign (noncancerous). In addition, the Ovarian Cancer Research Alliance states that most ovarian cysts do not indicate a risk of future ovarian cancer.

However, a 2019 study suggests that complex cysts and solid masses have associations with an increased risk of cancer. The researchers noted that simple cysts did not have the same associations.

A doctor can determine whether a cyst is simple or complex. A person may wish to make an appointment with a doctor if they have concerns.

When should I be worried about an ovarian cyst?

Ovarian cysts tend to resolve on their own with menstrual cycles.

However, in some cases, ovarian cysts can lead to complications that require immediate medical assistance. For example, ovarian cysts may twist or rupture. Symptoms can include severe abdominal pain, fever, and nausea.

Additionally, if a person experiences ovarian cysts after menopause, they should contact a gynecologic oncologist because cysts after menopause are more likely to indicate cancer.

What happens if a hemorrhagic cyst pops?

If a hemorrhagic ovarian cyst pops, or ruptures, it is a surgical emergency. Rupture can lead to hemoperitoneum (abdominal internal bleeding), which can be life threatening.

If a person experiences any symptoms of internal bleeding, such as those listed in the symptoms section above, they should seek immediate medical help.

A hemorrhagic ovarian cyst develops when blood enters a corpus luteal or follicular cyst.

Most hemorrhagic ovarian cysts are harmless and resolve without treatment. However, in some cases, a person may need emergency medical treatment for a cyst that has ruptured or twisted or for internal bleeding.

If a person has bothersome or ongoing symptoms, they may want to contact a doctor to schedule an ultrasound. However, if a person experiences serious symptoms, they should seek immediate medical assistance.