What is the management recommendation for a fluid-filled ovarian cyst that is symptomatic or greater than 6 cm in size?

For a fluid-filled ovarian cyst that is symptomatic or larger than 6 cm, the recommended management is laparoscopic cystectomy. This approach is suitable because such cysts can lead to significant discomfort or other complications, and larger cysts have a greater potential for complications, including rupture or torsion.

Laparoscopic cystectomy allows for direct visualization and removal of the cyst while also minimizing recovery time and potential damage to surrounding tissues compared to traditional open surgery. By removing the cyst, not only are the symptoms alleviated, but it also allows for histopathological evaluation of the cyst to rule out any underlying pathology, including malignancy.

In contrast, watchful waiting may be appropriate for small, asymptomatic cysts, but in cases where the cyst is symptomatic or exceeds 6 cm, active intervention is generally warranted. Oral contraceptives may help in managing functional ovarian cysts by suppressing ovulation but do not address existing cysts. Expectation of spontaneous resolution can apply to small, asymptomatic cysts, but again, this is not suitable for larger or symptomatic cases.