Ovarian Follicular Cysts: Definition and Management

Definition and Classification

A follicular cyst is a physiological structure that forms when a normal ovarian follicle (containing an egg) does not rupture to release the egg during ovulation and continues to grow 1, 3
According to the O-RADS (Ovarian-Adnexal Reporting and Data System), follicles are defined as simple anechoic cysts less than 3 cm and are classified as O-RADS 1, representing normal physiological structures with 0% probability of malignancy 3
To avoid misunderstandings in patients, it is recommended that ultrasound reports describe them as "follicles" instead of "cysts" 1

In premenopausal women, follicular cysts ≤3 cm do not require follow-up or treatment, as they are considered physiological 1, 4
In postmenopausal women, follicular cysts should not normally occur, and if found, require additional evaluation by a specialist in ultrasound, referral to a gynecologist, or an MRI study 5

Transvaginal ultrasound is the preferred imaging modality for follow-up 4
For larger cysts approaching 10 cm, a transabdominal examination may be necessary to fully evaluate the cyst 4

Overtreatment of simple cysts, particularly in postmenopausal women, as evidence shows they rarely represent malignancy 4
Failure to follow up at appropriate intervals based on cyst size and patient menopausal status 4
Failure to distinguish between simple cysts and other types of cysts that have different management protocols 4