Hemorrhagic Ovarian Cyst: Causes, Symptoms and Diagnosis Explained

What is a Hemorrhagic Ovarian Cyst?

A hemorrhagic ovarian cyst is an ovarian cyst that has bled into itself. It usually develops from a functional cyst, which can form as part of a normal menstrual cycle.

Each month, the ovary forms a small sac to release an egg. If this process does not resolve as expected, the sac may remain and become a cyst. When a tiny blood vessel within the cyst wall breaks, blood can collect inside it, forming a hemorrhagic ovarian cyst.

These cysts are most common in women of reproductive age. They are typically benign and often clear on their own over time without requiring treatment.

What Causes Hemorrhagic Cyst Formation?

A hemorrhagic cyst forms when bleeding occurs inside a functional ovarian cyst. These cysts usually develop during ovulation as part of the normal menstrual cycle. If small blood vessels in the cyst wall rupture, blood can collect inside the cyst.

The ovary contains many delicate blood vessels, which can be more vulnerable around ovulation. Hormonal changes during the cycle can also affect the stability of a cyst, making bleeding more likely.

Common reasons for hemorrhagic cyst formation include:

• A functional cyst forming during ovulation
• Rupture of small blood vessels within the cyst
• Hormonal shifts affecting cyst stability
• Rapid cyst growth stretching its blood supply
• Physical strain or pressure around ovulation
• Minor trauma or sudden movement involving the ovary

Are Hormonal Imbalances Linked to Hemorrhagic Cysts?

Yes, hormonal imbalances can increase the likelihood of hemorrhagic cyst formation. Hormones such as oestrogen and progesterone regulate ovulation, and fluctuations in these hormones can affect how a cyst forms and resolves.

When hormone levels are uneven:

• Cysts may persist longer than usual
• Blood vessel stability within the cyst wall may be reduced

Hormonal factors that may contribute include:

• Irregular menstrual cycles
• Polycystic ovary syndrome (PCOS)
• Use of, or sudden discontinuation of, hormonal medications

Can Physical Activity Cause a Hemorrhagic Ovarian Cyst to Bleed?

Physical activity does not cause a hemorrhagic ovarian cyst to form, but sudden or strenuous movement can trigger bleeding within an existing cyst. Increased pressure or abrupt motion around the ovary can stress fragile blood vessels inside the cyst.

Activities that may increase this risk include:

• Intense exercise
• Heavy lifting
• Sudden twisting or abrupt movements

What Symptoms Can a Hemorrhagic Ovarian Cyst Cause?

A hemorrhagic ovarian cyst can cause a range of symptoms, depending on its size, the amount of bleeding and individual sensitivity.

• One-sided pelvic pain: A dull ache or sharp pain on the side of the affected ovary.
• Sudden lower abdominal pain: Can occur if the cyst stretches or bleeds.
• Pain during sex: Certain positions or pressure may worsen discomfort.
• Changes in periods: Periods may become heavier, lighter or irregular due to hormonal effects.
• Bloating or lower abdominal pressure: Larger cysts can create a feeling of fullness or heaviness.
• Lower back discomfort: Pain may radiate to the lower back.
• Mild nausea or digestive discomfort: Caused by pressure on nearby organs.
• Feeling full quickly: A large cyst may press against the stomach.

How is a Hemorrhagic Ovarian Cyst Diagnosed?

Doctors diagnose a hemorrhagic ovarian cyst through a combination of symptom review, physical examination and imaging.

• Medical history: Doctors ask about menstrual cycles, pelvic pain and past cysts to understand possible causes.
• Pelvic exam: The ovaries are checked for size, tenderness or abnormalities.
• Ultrasound: The most reliable tool, performed transabdominally or transvaginally, reveals the cyst and any internal bleeding.

Ultrasound features include:

• Internal echoes: Indicate blood or fluid inside the cyst, distinguishing it from simple cysts.
• Lace-like/reticular pattern: Blood strands form a net-like structure, confirming a hemorrhagic cyst.

Can Hemorrhagic Cysts Affect Fertility?

Most hemorrhagic ovarian cysts do not affect fertility. Since they are functional and linked to normal ovulation:

• They generally resolve on their own without harming ovarian tissue.
• Fertility is usually preserved.
• Only recurrent or complicated cysts may need further evaluation to assess any impact on reproductive health.

When Should You Seek Medical Attention?

Most hemorrhagic ovarian cysts resolve on their own, but certain symptoms require prompt medical attention. Contact a healthcare professional immediately if you experience:

• Sudden, severe pelvic or lower abdominal pain: May indicate a cyst rupture or active bleeding.
• Persistent or worsening pain: Even mild pain that does not improve should be evaluated.
• Fever or repeated vomiting: Could signal infection or abdominal irritation.
• Dizziness, fainting or extreme weakness: May suggest blood loss or low blood pressure.
• Rapid heartbeat or difficulty breathing: Possible signs of internal bleeding needing urgent care.

How Are Hemorrhagic Ovarian Cysts Different From Other Ovarian Cysts?

Hemorrhagic cysts differ because they contain blood rather than clear fluid: 

Treatment Options for Hemorrhagic Ovarian Cysts

The treatment of a hemorrhagic ovarian cyst depends on its size, symptoms and underlying cause. Many cysts resolve on their own, so doctors often focus on monitoring rather than immediate intervention.

• Observation and Check-Ups: Small cysts with mild symptoms are usually monitored. Follow-up ultrasounds after a few weeks or months track whether the cyst is shrinking or stable.
• Pain Management: Mild discomfort can be managed with over-the-counter or prescription medications. Pain typically eases as the blood inside the cyst is gradually absorbed.
• Hormonal Options: Hormonal therapy may be recommended for recurrent cysts. It helps regulate ovulation and reduces the risk of new cyst formation.
• Care After a Cyst Rupture: If a cyst ruptures, surgery is not always required. Doctors monitor bleeding and symptoms until the condition stabilises.
• Surgery in Selected Cases: Surgery is reserved for large cysts, persistent pain, uncontrolled bleeding or unclear scans. The goal is to remove the cyst while preserving healthy ovarian tissue.

Conclusion

Hemorrhagic ovarian cysts are common and usually harmless, but their sudden pain or changes in periods can be alarming. Understanding why they form and knowing the early signs can reduce anxiety and help you respond appropriately.

Most cysts resolve on their own, but staying aware of your body, attending routine check-ups and seeking timely medical advice when symptoms worsen empowers you to protect your reproductive health and make informed decisions without unnecessary worry. Awareness and vigilance are key; recognising what is normal and when to act ensures peace of mind and proactive care.