A hemorrhagic cyst is a fluid-filled sac containing blood that develops in the body. This condition is common, particularly in women of reproductive age, and is typically benign. It describes a specific type of cyst that has experienced internal bleeding.
Defining the Hemorrhagic Cyst
A cyst is a closed sac, lined with tissue and filled with fluid or semi-solid substance. The descriptor “hemorrhagic” specifies that the fluid within the sac is blood, indicating a small vessel has ruptured inside the structure. While cysts can form in various organs, the most frequent location for this type is the ovary.
A hemorrhagic ovarian cyst is a common gynecological finding linked to the normal function of the menstrual cycle. These cysts are non-cancerous and form as a result of a typical physiological process. They are considered a variation of a functional cyst, meaning they arise from the routine hormonal activity of the ovary rather than from a disease. The presence of blood within the cyst gives it the hemorrhagic classification.
The appearance of a hemorrhagic cyst on imaging, such as an ultrasound, is distinctive and helps doctors confirm the diagnosis. The clotted blood inside often creates a fine, web-like pattern, sometimes described as a “reticular” or “lace-like” appearance. This pattern is caused by the strands of fibrin, a protein involved in blood clotting, forming within the cyst cavity. As the blood clot ages and retracts, it can also present as a triangular, somewhat solid-looking mass inside the fluid.
Causes and Mechanism of Formation
The bleeding that defines a hemorrhagic cyst occurs within functional ovarian cysts, categorized into two main types: follicular cysts and corpus luteum cysts. These functional cysts form as part of the monthly process of ovulation. The ovarian structures involved are highly vascularized, meaning they contain many small, fragile blood vessels.
A follicular cyst develops when the follicle, the sac that holds the egg, fails to rupture at the time of ovulation and continues to grow. If a small blood vessel within the wall of this enlarged follicle breaks, blood leaks into the cyst cavity, creating a hemorrhagic follicular cyst. Similarly, after an egg is released, the empty follicle transforms into a structure called the corpus luteum, which secretes hormones to prepare the uterus for pregnancy.
The corpus luteum is intensely vascularized. If bleeding occurs inside this structure, it results in a hemorrhagic corpus luteum cyst. Bleeding into the corpus luteum is the most common reason for a hemorrhagic cyst to form, as its thin-walled vessels are particularly prone to rupture.
Recognizing Symptoms and When to Seek Medical Attention
Many hemorrhagic cysts are small and resolve on their own without causing any noticeable symptoms. When symptoms do occur, they are often related to the cyst’s size or rapid growth, causing stretching of the ovarian tissue. The most common symptom is pelvic pain, which can be a dull ache or a sharp sensation, typically localized to one side of the lower abdomen where the cyst is located.
Other common, less severe signs include a feeling of fullness or heaviness in the pelvis, abdominal bloating, or pain during sexual intercourse. These milder symptoms may come and go and often do not indicate a medical emergency. However, it is important to recognize symptoms that suggest a severe complication requiring immediate medical intervention.
Sudden, sharp, and severe pain in the lower abdomen, especially if accompanied by nausea and vomiting, can signal a serious issue. This pain may be caused by a ruptured cyst, where the blood and fluid spill into the abdominal cavity, or by ovarian torsion. Ovarian torsion occurs when the weight of the cyst causes the ovary to twist on its supportive ligaments, cutting off the blood supply to the ovary, and is a time-sensitive medical emergency.
Diagnosis and Approaches to Treatment
The primary tool for confirming the presence and characteristics of a hemorrhagic cyst is a pelvic ultrasound. This non-invasive imaging technique uses sound waves to create detailed images of the pelvic organs, including the ovaries. The ultrasound allows a physician to assess the cyst’s size, location, and internal features, such as the reticular pattern of clotted blood, which helps differentiate it from other types of ovarian growths.
For small, uncomplicated hemorrhagic cysts, the standard approach to treatment is “watchful waiting” or expectant management. Since these cysts are usually related to the menstrual cycle and are benign, they frequently resolve spontaneously as the body reabsorbs the blood and fluid over a period of a few weeks to months. During this time, pain management is often handled with over-the-counter pain relievers.
If a hemorrhagic cyst is larger than 5 to 10 centimeters, or causes persistent, severe symptoms, a more active management strategy may be necessary. Surgical intervention, typically performed via laparoscopy, becomes necessary in cases of suspected ovarian torsion or when the cyst fails to resolve after several cycles. The goal of surgery is usually to remove the cyst while preserving the ovary, though in rare cases of severe damage, the entire ovary may need to be removed.