Recurrent Hemorrhagic Ovarian Cysts in Young Woman with Hormonal IUD

Case at a Glance

A 22-year-old female presented with recurrent hemorrhagic ovarian cysts occurring within a 3-month period while using a hormonal intrauterine device (Skyla IUD). The patient experienced menstrual irregularities, persistent bloating, and pelvic discomfort.

Patient's Story

The patient reported developing her second hemorrhagic ovarian cyst within 3 months. She had been using a Skyla hormonal IUD and noted changes in her previously regular menstrual cycle, including delayed periods. She experienced constant bloating and was concerned about the recurrent nature of the cysts. The patient had no history of similar gynecological issues and was seeking understanding about potential causes and prevention strategies. She specifically mentioned not having typical PCOS symptoms such as hirsutism, acne, or weight gain, as she maintained an underweight BMI.

Initial Assessment

The patient underwent comprehensive pelvic imaging including transabdominal and transvaginal ultrasounds. Initial presentation included pelvic bloating and spotting, which prompted the first imaging study. Physical examination findings were consistent with ovarian cystic changes, and the patient appeared otherwise healthy with no signs of hyperandrogenism.

The Diagnostic Journey

First ultrasound revealed a hemorrhagic ovarian cyst that had ruptured, explaining the patient's spotting and bloating symptoms. Follow-up imaging one week later confirmed resolution of fluid from the initial cyst but identified a new 4.1 cm hemorrhagic cyst on the contralateral ovary. The recurrent nature and bilateral involvement raised questions about underlying hormonal influences and the potential relationship to her contraceptive method.

Final Diagnosis

Recurrent hemorrhagic ovarian cysts, bilateral, in the setting of hormonal IUD use. PCOS was considered but deemed unlikely given the absence of clinical hyperandrogenic features and normal BMI.

Treatment Plan

Conservative management with serial imaging surveillance was recommended. Patient counseling regarding the relationship between hormonal contraception and ovarian cyst formation. Consideration of alternative contraceptive methods if cysts continue to recur. Referral to gynecology for specialized evaluation of recurrent functional ovarian cysts.

Outcome and Follow-up

Patient was advised to continue monitoring with serial ultrasounds. Education provided regarding the difference between functional ovarian cysts and pathological conditions like PCOS. Follow-up scheduled with gynecology for comprehensive hormonal evaluation and discussion of long-term management strategies, including potential IUD removal if pattern continues.