eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology
Ovarian Cysts: Treatment & Medication
Updated: Aug 11, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Prehospital Care
- Assess the patient's airway, breathing, and circulation and evaluate for signs of hemorrhagic shock.
- Secure intravenous access, provide oxygen, and monitor all potentially unstable patients.
Emergency Department Care
- Airway, breathing, and circulation remain of paramount importance. Monitor and aggressively resuscitate patients with signs of shock.
- Obtain appropriate laboratory workup and studies to aid diagnosis and involve an obstetrician/gynecologist in consultation, when appropriate.
Consultations
- Consult a general surgeon in the ED when the clinical presentation indicates an intraperitoneal process that is not clearly obstetric or gynecologic.
- Consult an obstetrician/gynecologist when an ovarian-, uterine-, or pregnancy-related emergency is suspected.
- It is imperative to expedite hemodynamically unstable patients to the operating room, with consulting services mobilized, while the initial resuscitation in the ED is in progress.
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Analgesic, Narcotic
These agents are used to relieve moderate-to-severe pain. Pain relief is of paramount concern, but it must be remedied with agents chosen for the given clinical situation.
Morphine sulfate (Astramorph, MS Contin, MSIR, Oramorph)
DOC for analgesia due to reliable and predictable effects, safety profile, and ease of reversibility with naloxone.
Various IV doses are used; commonly titrated until desired effect obtained.
Adult
Starting dose: 0.1 mg/kg IV/IM/SC
Maintenance dose: 5-20 mg/70 kg IV/IM/SC q4h
Relatively hypovolemic patients: Start with 2 mg IV/IM/SC; reassess hemodynamic effects of dose
Pediatric
Infants and children: 0.1-0.2 mg/kg dose IV/IM/SC q2-4h prn; not to exceed 15 mg/dose; may initiate at 0.05 mg/kg/dose
Phenothiazines may antagonize analgesic effects of opiate agonists; tricyclic antidepressants, MAO inhibitors, and other CNS depressants may potentiate adverse effects of morphine
Documented hypersensitivity; hypotension; potentially compromised airway where establishing rapid airway control would be difficult
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hypotension, respiratory depression, nausea, emesis, constipation, urinary retention, atrial flutter, and other supraventricular tachycardias; has vagolytic action and may increase ventricular response rate
Oxycodone (OxyContin, OxyIR, Roxicodone)
Indicated for the relief of moderate to severe pain.
Adult
Immediate release: 5 mg PO q6h prn
Controlled release: 10 mg PO bid
Pediatric
Immediate release:
<6 years: Not established
6-12 years: 1.25 mg q6h PO prn
>12 years: 2.5 mg q6h PO prn
Controlled release: Not established
Phenothiazines may antagonize analgesic effects; MAOIs, general anesthesia, CNS depressants, and tricyclic antidepressants may increase toxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in COPD, emphysema, and renal insufficiency
Analgesic Nonsteroidal Anti-inflammatory Drug
These agents are used for relief of mild-to-moderate pain. They inhibit inflammatory reactions and pain by decreasing activity of cyclooxygenase (COX), which results in a decrease of prostaglandin synthesis.
Ibuprofen (Advil, Motrin, Excedrin IB, Ibuprin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d
Pediatric
<6 months: Not established
6 months to 12 years: 4-10 mg/kg/dose PO tid/qid
>12 years: Administer as in adults
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; simultaneous administration with low-dose aspirin may decrease aspirin's cardioprotective and stroke preventive effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, beta-blockers, and diuretic effect of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; may increase phenytoin or lithium serum levels
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy
Ketorolac (Toradol)
Inhibits prostaglandin synthesis by decreasing the activity of COX, which results in decreased formation of prostaglandin precursors.
Adult
30-60 mg IM initially; followed by 15-30 mg q6h prn; not to exceed 5 d of treatment
Pediatric
Not established; recommended dose is 0.4-1 mg/kg IM once
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding; do not administer into CNS
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; low WBC counts (rare) usually return to normal during ongoing therapy; discontinue therapy if leukopenia, granulocytopenia, or thrombocytopenia persists
More on Ovarian Cysts |
| Overview: Ovarian Cysts |
| Differential Diagnoses & Workup: Ovarian Cysts |
 Treatment & Medication: Ovarian Cysts |
| Follow-up: Ovarian Cysts |
| Multimedia: Ovarian Cysts |
| References |
| Further Reading |
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References
Katz. Comprehensive Gynecology. 5th ed. 2007.
Stany MP, Hamilton CA. Benign disorders of the ovary. Obstet Gynecol Clin North Am. Jun 2008;35(2):271-84, ix. [Medline].
Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. Mar 17 2009;[Medline].
Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. May 2005;105(5 Pt 1):1098-103. [Medline].
Kwak DW, Sohn YS, Kim SK, Kim IK, Park YW, Kim YH. Clinical experiences of fetal ovarian cyst: diagnosis and consequence. J Korean Med Sci. Aug 2006;21(4):690-4. [Medline].
Glanc P, Salem S, Farine D. Adnexal masses in the pregnant patient: a diagnostic and management challenge. Ultrasound Q. Dec 2008;24(4):225-40. [Medline].
Lambert MJ, Villa M. Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am. Aug 2004;22(3):683-96. [Medline].
Castillo G, Alcazar JL, Jurado M. Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol. Mar 2004;92(3):965-9. [Medline].
Heling KS, Chaoui R, Kirchmair F, Stadie S, Bollmann R. Fetal ovarian cysts: prenatal diagnosis, management and postnatal outcome. Ultrasound Obstet Gynecol. Jul 2002;20(1):47-50. [Medline].
Wyshak G, Frisch RE, Albright TE, Albright NL, Schiff I. Smoking and cysts of the ovary. Int J Fertil. Nov-Dec 1988;33(6):398-404. [Medline].
Holt VL, Cushing-Haugen KL, Daling JR. Risk of functional ovarian cyst: effects of smoking and marijuana use according to body mass index. Am J Epidemiol. Mar 15 2005;161(6):520-5. [Medline].
Holt VL, Cushing-Haugen KL, Daling JR. Oral contraceptives, tubal sterilization, and functional ovarian cyst risk. Obstet Gynecol. Aug 2003;102(2):252-8. [Medline].
Knight JA, Lesosky M, Blackmore KM, Voigt LF, Holt VL, Bernstein L, et al. Ovarian cysts and breast cancer: results from the Women's Contraceptive and Reproductive Experiences Study. Breast Cancer Res Treat. May 2008;109(1):157-64. [Medline].
Bosetti C, Scotti L, Negri E, Talamini R, Levi F, Franceschi S. Benign ovarian cysts and breast cancer risk. Int J Cancer. Oct 1 2006;119(7):1679-82. [Medline].
McDonald JM, Modesitt SC. The incidental postmenopausal adnexal mass. Clin Obstet Gynecol. Sep 2006;49(3):506-16. [Medline].
Vandermeer FQ, Wong-You-Cheong JJ. Imaging of acute pelvic pain. Clin Obstet Gynecol. Mar 2009;52(1):2-20. [Medline].
Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv. Jul 2006;61(7):463-70. [Medline].
Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev. Apr 15 2009;CD006134. [Medline].
Giuntoli RL 2nd, Vang RS, Bristow RE. Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol. Sep 2006;49(3):492-505. [Medline].
Keywords
ovarian cyst, cyst in ovary, cystic ovary, follicular cysts, graafian cyst, corpus luteal cyst, corpus luteum cyst, corpus luteal cyst, theca lutein cyst, hyperreactio luteinalis, adnexal torsion, ovarian necrosis, ectopic pregnancy, irregular menstrual bleeding, dysmenorrhea, dyspareunia, abdominal pain, septic shock, hypovolemic shock, adnexal mass, ovarian cancer
