Ovarian Cyst (Simple, Primary Care)

Simple cyst under 50 mm in a premenopausal woman: no follow-up needed - these usually resolve over 2-3 cycles on their own. 50 to 70 mm: yearly ultrasound. Above 70 mm: further imaging or surgical assessment, because a cyst that size is hard to characterise on ultrasound alone. No drug therapy is needed to make a simple cyst resolve - it does that on its own. The entries below are for the pain while it does, and, where functional cysts keep forming, for preventing the next one. - no routine follow-up under 50 mm; yearly from 50 to 70 mm

Adolescent simple cysts < 5 cm: observe with pelvic ultrasound over 2-3 cycles under pediatric gynecology consultation.

RCOG Green-top Guideline No. 62: Management of Suspected Ovarian Masses in Premenopausal Women, section 6.1

Simple physiological cysts (follicular or corpus luteum) < 5 cm in premenopausal women routinely resolve spontaneously without pharmacological intervention.

Ovarian Cyst - disease-level clinical article (ovarian-cyst-full.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

1 tablet (30 mcg ethinylestradiol / 150 mcg levonorgestrel) once daily for 21 days followed by 7 pill-free days for prevention of new functional cyst formation x 3-6 cycles

Adolescents post-menarche: 1 tablet daily for cycle regulation/prevention under gynecology supervision.

Microgynon 30 (ethinylestradiol 30 mcg + levonorgestrel 150 mcg) SmPC sections 4.2-4.4 (eMC product 1130)

Combined oral contraceptives do not hasten the resolution of existing functional ovarian cysts but prevent new cyst formation in women with recurrent functional cysts.

400 mg three times daily PRN with food for mild to moderate pelvic pain associated with functional ovarian cyst x 3-5 days PRN

5-10 mg/kg/dose [child max 400 mg]

(5-10 mg/kg per dose every 8 hours as needed, with food. Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, maximum 30 mg/kg daily. The suspension's own label caps pain-and-fever use lower still, at 20 mg/kg/day. Never exceed 400 mg in a single dose.)

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) for the adult dose: "The recommended dose is 200 mg-400 mg (10-20 ml), up to three times a day as required... do not take more than 1200 mg (60 ml) in any 24 hour period". That label's paediatric section gives weight bands and a 20 mg/kg/day pain-and-fever ceiling but states no mg/kg per dose, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)".

Ibuprofen is an NSAID added on top of expectant management of the functional ovarian cyst to control the pelvic pain while the cyst is left to resolve on its own; it does not treat the cyst itself.