A hemorrhagic functional ovarian cyst may not cause any symptoms and go away on its own. Sometimes, it may lead to serious complications. Treatment may be conservative or surgical.

Hemorrhagic functional cysts are one type of ovarian cyst, and in some cases, they may lead to complications.

Ovarian cysts are fluid-filled sacs that form on the ovaries. They’re common, especially in people who are still menstruating.

An ovarian cyst often doesn’t cause symptoms and goes away without treatment, so you may not even know you’ve had one. But it’s estimated that about 7% of women have an ovarian cyst that causes symptoms at some point in their life.

Functional cysts are the most common type of ovarian cyst and are associated with the menstrual cycle.

The two types of functional cysts are:

  • Follicle cysts: The follicle is the sac where the egg grows. It bursts when the egg is released during ovulation. If the follicle doesn’t break open, a follicular cyst can form.
  • Corpus luteum cysts: The corpus luteum is a group of cells formed from an empty follicle sac after the egg is released. A corpus luteum cyst can form when the corpus luteum reseals itself and fills with fluid.

A hemorrhagic functional cyst occurs when blood builds up in a functional cyst, often a corpus luteum cyst. A 2019 review suggests that bleeding can be caused by the large number of fragile blood vessels in ovarian cysts.

The symptoms of a hemorrhagic functional cyst may vary, and some people may experience no symptoms.

When symptoms are present, pelvic pain on the side of the cyst is the most common early occurrence. This pain can come and go and may be a dull or sharp sensation, similar to a cramp.

Other possible symptoms of ovarian cysts include:

Serious symptoms of hemorrhagic functional cysts

Sometimes, a hemorrhagic functional cyst may lead to complications. For example, if it ruptures (bursts), it could cause internal bleeding.

Other complications associated with a ruptured hemorrhagic functional cyst may include:

  • hemoperitoneum, a type of internal bleeding where blood builds up in the peritoneal cavity
  • hypovolemic shock, which happens due to blood loss and can lead to organ failure
  • sepsis, a life threatening response of your body to an infection (if the cyst is also associated with a pelvic infection)

Cysts can also lead to ovarian torsion, which is when your ovary becomes twisted. This cuts off blood flow to the ovary, which can cause the tissue to die.

Signs that a hemorrhagic functional cyst has burst may include:

A ruptured hemorrhagic functional cyst and an ovarian torsion are medical emergencies and require immediate attention.

If a healthcare professional suspects an ovarian cyst, they may recommend a pelvic or intravaginal ultrasound. Ultrasound uses high frequency sound waves to create images of the inside of your body.

Ultrasound is considered to be the gold standard for diagnosing hemorrhagic functional cysts. It can help healthcare professionals get an idea of the different characteristics of a mass on your ovary, such as:

  • size
  • shape
  • location
  • internal composition, such as solid, fluid-filled, or mixed

Sometimes, a color Doppler ultrasound may be used. This looks at blood flow in and around an ovarian mass. The test can help to differentiate between a benign ovarian cyst and ovarian cancer.

A malignant (cancerous) mass will typically show blood flow in and around it because a growing tumor needs a good blood supply. A hemorrhagic functional cyst may have blood flow around it but no blood flow inside.

It’s also possible that a healthcare professional recommends additional imaging, like CT scans. They may order a variety of laboratory tests as part of the diagnostic process, including:

The treatment for a hemorrhagic functional cyst may depend on the size of the cyst and whether it’s causing symptoms.

Smaller cysts that don’t cause symptoms may not require treatment or can be managed conservatively. This means that treatment won’t involve surgery unless the cyst gets larger, starts causing significant symptoms, or both.

If pelvic pain is present, conservative management may involve over-the-counter (OTC) pain relievers or prescription pain medication. A healthcare professional may also want to do a follow-up ultrasound to monitor the cyst.

Large hemorrhagic functional cysts, such as those over 5 centimeters (cm) in diameter, may need surgical removal if they:

  • don’t go away on their own with conservative management
  • have ruptured
  • are associated with ovarian torsion

A cystectomy is surgery to remove a cyst from an ovary. In severe cases, such as when torsion has cut off blood flow to the ovary, doctors may opt to remove the entire ovary (oophorectomy).

A ruptured hemorrhagic functional cyst has the potential to cause serious bleeding. In this situation, surgery may be necessary to stop the bleeding and remove the blood from your abdomen. A blood transfusion may also be indicated.

Ruptured hemorrhagic functional cysts or those associated with torsion may require removal of the affected ovary.

While this may not affect fertility, some research suggests that the removal of one ovary may increase the chance of pregnancy issues through in vitro fertilization (IVF).

Outlook

Many functional cysts will go away on their own after 6 to 8 weeks.

Research has indicated that 87.5% of hemorrhagic functional cysts resolve within 6 weeks with conservative management.

Surgery to remove an ovarian cyst rarely leads to complications. Removal of the entire ovary typically does not affect fertility.

However, when it comes to in vitro fertilization (IVF), ovary removal may sometimes reduce the chance of pregnancy and live births.

Hemorrhagic functional cysts happen when blood begins to build up in an ovarian cyst associated with the menstrual cycle, most often a corpus luteum cyst.

Ovarian cysts may not cause any symptoms. If they do, pelvic pain on the side of the cyst is often reported. Some hemorrhagic functional cysts may go away on their own, while others can lead to complications.

The treatment for a hemorrhagic functional cyst depends on its size and whether it’s causing symptoms. Smaller cysts may be treated conservatively, while larger cysts or those causing complications typically require surgery.