# Ovarian Cyst (Simple, Primary Care) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: RCOG Green-top Guideline No. 62: Management of Suspected Ovarian Cysts in Premenopausal Women 2011 · RCOG Green-top Guideline No. 34: Management of Ovarian Cysts in Postmenopausal Women 2016 · NICE CKS: Ovarian cyst 2022 · RCOG Green-top Guideline No. 62: Management of Suspected Ovarian Masses in Premenopausal Women, section 6.1 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Microgynon 30 (ethinylestradiol 30 mcg + levonorgestrel 150 mcg) SmPC sections 4.2-4.4 (eMC product 1130) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) - Verified date: 2026-08 ## Verified against - RCOG Green-top Guideline No. 62: Management of Suspected Ovarian Masses in Premenopausal Women, section 6.1 - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Microgynon 30 (ethinylestradiol 30 mcg + levonorgestrel 150 mcg) SmPC sections 4.2-4.4 (eMC product 1130) - Ovarian Cyst - disease-level clinical article (ovarian-cyst-full.txt) - MSF Essential Drugs 2024 (ibuprofen oral monograph) ## Treatment metadata - Conservative Management & Pelvic Ultrasound Monitoring (Primary Care Strategy) - Referral & safety-netting (no drug therapy) - Ethinyl estradiol + Levonorgestrel — 0.03 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text OVARIAN CYST (SIMPLE, PRIMARY CARE) Sources: RCOG Green-top Guideline No. 62: Management of Suspected Ovarian Cysts in Premenopausal Women 2011 · RCOG Green-top Guideline No. 34: Management of Ovarian Cysts in Postmenopausal Women 2016 · NICE CKS: Ovarian cyst 2022 · RCOG Green-top Guideline No. 62: Management of Suspected Ovarian Masses in Premenopausal Women, section 6.1 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Microgynon 30 (ethinylestradiol 30 mcg + levonorgestrel 150 mcg) SmPC sections 4.2-4.4 (eMC product 1130) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) Review status: REVIEWED against RCOG Green-top Guideline No. 62: Management of Suspected Ovarian Masses in Premenopausal Women, section 6.1, Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560), Microgynon 30 (ethinylestradiol 30 mcg + levonorgestrel 150 mcg) SmPC sections 4.2-4.4 (eMC product 1130), Ovarian Cyst - disease-level clinical article (ovarian-cyst- full.txt), MSF Essential Drugs 2024 (ibuprofen oral monograph) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Cysts are often silent, found incidentally on exam or pelvic imaging [cyst] - One-sided lower abdominal pain or pressure, sharp or dull, intermittent or constant, is the typical complaint [abdominal pain · lower abdominal pain] - Cyst rupture or torsion can cause sudden severe pain with nausea and vomiting [cyst · nausea · vomiting] - Irregular cycles and abnormal vaginal bleeding can occur [vaginal bleeding] SIGNS - what you find (2) - Bimanual palpation assesses the ovary's location, shape, size, firmness, tenderness, and mobility, though findings can be hard to feel - Normal Doppler flow does not rule out torsion - it was seen in 27% of confirmed left torsion cases and 61% of right torsion cases TESTS (4) - A serum or urine hCG test is done first in premenopausal women to rule out pregnancy - CA-125 is raised in 85 percent of epithelial ovarian cancers overall but only half of stage I disease confined to the ovary - Benign cysts typically show thin smooth walls with no septations, solid parts, or internal Doppler flow - A cyst over 10 cm, complex multilocular appearance, papillary or solid components, thick septa, ascites, or increased Doppler flow should raise suspicion for malignancy IF NOT THIS - what else fits (8) - Ectopic pregnancy is on the differential for an adnexal mass - Pelvic inflammatory disease is on the differential - Tubo-ovarian abscess is a benign gynecological differential - Endometrioma is a benign gynecological differential - Appendicitis is on the nongynecological differential list - Diverticulitis is on the nongynecological differential list - Nephrolithiasis is on the nongynecological differential list - Psoas abscess is on the nongynecological differential list Source StatPearls "Ovarian Cyst" - disease-level clinical article Status traced to the source above 1. CONSERVATIVE MANAGEMENT & PELVIC ULTRASOUND MONITORING (PRIMARY CARE STRATEGY)[1st line] Adult 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 Peds Adolescent simple cysts < 5 cm: observe with pelvic ultrasound over 2-3 cycles under pediatric gynecology consultation. Source RCOG Green-top Guideline No. 62: Management of Suspected Ovarian Masses in Premenopausal Women, section 6.1 Why Simple physiological cysts (follicular or corpus luteum) < 5 cm in premenopausal women routinely resolve spontaneously without pharmacological intervention. Caution Rescanning a simple cyst under 50 mm is not recommended. It finds nothing, and it keeps a well woman in the system for months. Urgent referral to emergency gynecology if acute severe pelvic pain, vomiting, or peritoneal signs occur (suspected cyst rupture or ovarian torsion). Check CA-125 level and calculate Risk of Malignancy Index (RMI) in postmenopausal women or premenopausal women with complex/solid features. Refer to gynecology if cyst is > 5 cm, persistent > 3 months, complex/multilocular on ultrasound, or symptomatic. 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Ovarian Cyst - disease-level clinical article (ovarian-cyst-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Sudden onset of unilateral, moderate-to-severe sharp lower abdominal pain (with or without nausea/vomiting), especially after strenuous activity or intercourse, is a red flag for rupture/hemorrhage or torsion and needs prompt evaluation regardless of cyst size. RED FLAG - Surgical referral is indicated for suspected ovarian torsion, persistent adnexal mass, acute abdominal pain, or suspected malignancy - independent of the size- based follow-up thresholds. 3. ETHINYL ESTRADIOL + LEVONORGESTREL [2nd line] Adult 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 Peds Adolescents post-menarche: 1 tablet daily for cycle regulation/prevention under gynecology supervision. Source Microgynon 30 (ethinylestradiol 30 mcg + levonorgestrel 150 mcg) SmPC sections 4.2-4.4 (eMC product 1130) Why Combined oral contraceptives do not hasten the resolution of existing functional ovarian cysts but prevent new cyst formation in women with recurrent functional cysts. Caution Does not treat existing cysts; acts by suppressing ovulation to prevent recurrent functional cysts. Contraindicated in women with history of venous thromboembolism, ischemic heart disease, migraine with aura, severe hypertension, or age > 35 and smoking. The clot risk is highest in the first year on it - and it resets, so restarting after a break of four weeks or more carries that first-year risk again, not the lower steady- state one. Egypt MICROCEPT 21 TAB. CID 0.76 EGP (0.04/unit) -> ? strength differs MICRODETTE 3* 21 TAB. EL NILE. 7.50 EGP (0.36/unit) -> ? strength differs NORDETTE 5*21 TAB. EL NILE. > PF... 15.00 EGP (0.71/unit) -> ? strength differs MICROGENEST 30/150 MCG 21 TABS. ACDIMA INTERN... 23.00 EGP (1.10/unit) -> ? strength differs TRIOCEPT 21 TAB. X 6 STRIP (TRIPHASIC) CID 120.00 EGP (5.71/unit) -> ? strength differs 4. IBUPROFEN [add-on - not a substitute] Adult 400 mg three times daily PRN with food for mild to moderate pelvic pain associated with functional ovarian cyst x 3-5 days PRN Peds 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.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Source 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)". Why 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. Caution Symptomatic relief of mild to moderate pelvic discomfort during cyst regression. Take with food or milk to minimize gastrointestinal upset. Do not mask severe acute pain; re-evaluate for torsion or rupture if pain worsens. The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)