How are unruptured ovarian cysts smaller than 5 cm typically managed?

• A. Surgical management
• B. NSAIDs and expectant management with involution in 2-3 menstrual cycles
• C. Hormonal therapy
• D. Observation alone

Answer: (B)

Small, unruptured ovarian cysts under 5 cm are usually benign functional cysts that will resolve on their own as part of the normal cycle. Because they’re likely to involute, the best approach is to treat symptoms and watch closely rather than intervene surgically. Giving NSAIDs for pain plus expectant management capitalizes on the high chance the cyst will shrink within about 2–3 menstrual cycles. This approach is reinforced by follow-up imaging to confirm resolution, reserving any more aggressive steps for cases where the cyst persists, enlarges, or has suspicious features on ultrasound. Hormonal therapy isn’t typically needed to shrink a simple functional cyst, and simply observing without analgesia or a timeframe doesn’t provide guidance for patient comfort or monitoring. Surgical management is reserved for cysts that are large, recurrent, persistent beyond several cycles, or show concerning imaging features or complications.