Haemorrhagic Cysts
An ovarian haemorrhagic cyst forms when a normal functional ovarian cyst bleeds into itself. This can cause sudden pelvic pain, discomfort on one side, or occasionally bloating. These cysts are usually benign and often resolve on their own over time. Ultrasound is typically used to confirm the diagnosis and monitor healing, and most people recover with simple pain relief and rest unless symptoms are severe.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
What is a haemorrhagic cyst?
The ovaries are small reproductive organs that sit on each side of the uterus. Their main roles are to:
- Release an egg each month (ovulation)
- Produce hormones such as oestrogen and progesterone
During a typical menstrual cycle, small fluid-filled sacs called follicles develop in the ovaries. Usually, one follicle grows large enough to release an egg. After ovulation, the follicle transforms into a temporary structure called the corpus luteum, which helps regulate the menstrual cycle.
A haemorrhagic ovarian cyst forms when a functional cyst (usually a follicle or corpus luteum) bleeds internally. This causes blood to fill the cyst, making it slightly more complex in appearance than a simple cyst. They can occur in anyone who menstruates and are most common in people in their reproductive years. They are very common, beningn (non-cancerous), and typically resolve on their own over a few weeks to months.
Understanding Haemorrhagic Cysts
Haemorrhagic cysts can cause symptoms when they bleed, stretch the ovary, or irritate surrounding tissues. Some people have no symptoms at all, while others may notice discomfort that varies in intensity.
Common symptoms include:
- Lower abdominal or pelvic pain: Often felt on one side; may be sharp, crampy, or dull.
- Sudden onset pain: If bleeding occurs quickly, pain can come on suddenly.
- Pain during exercise, sex, or certain movements: Increased pressure on the ovary can make symptoms more noticeable.
- Bloating or a feeling of fullness: Caused by the cyst itself or irritation inside the pelvis.
- Light vaginal spotting: Sometimes occurs due to hormonal changes associated with cyst formation.
While most haemorrhagic cysts settle without treatment, seek urgent medical attention if you experience:
- Severe, sudden pelvic pain
- Pain with fever or vomiting
- Feeling faint or dizzy
These may indicate complications such as a ruptured cyst or ovarian torsion, which need prompt assessment.
Causes and Risk Factors
Haemorrhagic ovarian cysts form when a functional cyst - a normal type of cyst that develops during the menstrual cycle - bleeds into itself. These cysts are not dangerous and are a common part of ovarian function, but certain factors make them more likely to occur.
| Reproductive age | Haemorrhagic cysts are most common in people who are menstruating. They are uncommon after menopause. |
| Recent ovulation | Cysts are slightly more likely to develop soon after ovulation or if ovulation is triggered with medication (e.g., fertility treatment). |
| History of ovarian cysts | Some individuals simply form cysts more often than others. |
| Hormonal treatments | Certain medications that stimulate ovulation can increase the likelihood of cyst formation. |
Diagnosing Haemorrhagic Cysts
Haemorrhagic ovarian cysts are usually diagnosed through a combination of symptoms, clinical assessment, and imaging. Because their features are quite characteristic, they can often be confidently identified without the need for invasive tests.
A clinician will begin by asking about your symptoms, such as sudden or one-sided pelvic pain, and reviewing your menstrual history. They may also perform an abdominal or pelvic examination to check for tenderness.
| Ultrasound | A pelvic ultrasound is the key investigation for haemorrhagic cysts. It can: - Confirm the presence of a cyst - Show classic internal features such as fine internal strands (“lace-like” appearance) or clots - Determine the cyst’s size and assess for free fluid in the pelvis - Distinguish a haemorrhagic cyst from other types of ovarian cysts or masses Most haemorrhagic cysts have very recognisable ultrasound characteristics, allowing a confident diagnosis without further testing. |
| Follow-up Scan | In many cases, a repeat ultrasound may be recommended after 6–12 weeks to ensure the cyst is shrinking or has resolved, as these cysts typically disappear on their own. |
| MRI Scan | If the cyst does not resolve over time, has an atypical appearance, or there is uncertainty about the diagnosis, an MRI scan can provide more detail. |
Treatment Options
Most haemorrhagic ovarian cysts resolve on their own and do not require any major intervention. Treatment focuses on symptom relief, monitoring, and ensuring the cyst is behaving as expected.
| Observation | In many cases, the safest and most effective option is simply to monitor the cyst over time. - Haemorrhagic cysts usually shrink and disappear within 6–12 weeks. - A follow-up ultrasound may be recommended to confirm resolution. |
| Pain relief | Discomfort can be managed with simple measures such as: - Paracetamol - NSAIDs (e.g., ibuprofen) to reduce inflammation and pain - Heat packs and gentle movement, if comfortable If pain is severe, your clinician may recommend stronger short-term medication. |
| Hormonal Contraception | Hormonal methods such as the combined pill may be offered to help regulate ovulation and reduce the risk of future functional cysts forming. They do not treat an existing haemorrhagic cyst but may help prevent recurrence. |
Surgery is only considered if:
- The cyst is unusually large
- It does not resolve over time
- It causes ongoing or severe symptoms
- There is uncertainty about the diagnosis
- Complications occur (e.g., suspected torsion or rupture with heavy internal bleeding)
Surgical options may include laparoscopic cyst removal, but this is rarely necessary.
How can Lanthorn help?
Ultrasound Uterus & Ovaries - From £300
A pelvic ultrasound is the key test for diagnosing haemorrhagic cysts. It can confirm the presence, size, and appearance of the cyst, identify typical features, and check for any free fluid in the pelvis. Ultrasound is also useful for ruling out other potential causes of pelvic pain or bleeding.
Follow-up Ultrasound Scan - From £300
If a clinician recommends monitoring, we can arrange repeat scans - usually after 6–12 weeks - to check that the cyst is shrinking and healing as expected. Most haemorrhagic cysts resolve naturally over this time, and follow-up imaging helps provide reassurance while ensuring no new concerns have developed.
Pelvic MRI Scan - £550
A pelvic MRI can be used if more detailed imaging is needed. It provides a clearer view of the cyst’s structure, helps confirm the diagnosis, and rules out other possible causes of pelvic pain or abnormal bleeding. This can be particularly useful for larger or more complex cysts.
