Ovarian cysts are common fluid-filled sacs on or within an ovary. While many are “simple” cysts, often resolving without intervention, some are classified as “complex.” A complex ovarian cyst has internal characteristics that warrant closer evaluation. These cysts are less common than simple cysts and do not typically form as part of the normal menstrual cycle.
What Makes a Cyst Complex
A complex ovarian cyst is distinguished from a simple cyst by its internal structure on imaging. Unlike simple cysts, which are entirely fluid-filled, complex cysts contain additional components. These can include internal walls (septations), solid areas, or a mixture of fluid and solid material. The borders of a complex cyst may also appear irregular.
The term “complex” describes the cyst’s appearance on imaging, such as ultrasound, rather than automatically indicating a harmful condition. While these features suggest the cyst is not a typical fluid-filled follicle, most complex ovarian cysts are not cancerous. However, these structural differences mean they require more detailed assessment.
Common Types of Complex Cysts
Dermoid cysts, also known as mature teratomas, develop from reproductive cells and can contain various tissues like skin, hair, fat, or even teeth. These cysts are benign but can grow large and sometimes require surgical removal.
Endometriomas, often called “chocolate cysts,” form when tissue similar to the uterine lining grows on the ovaries. These cysts are filled with a thick, dark, blood-like fluid and are associated with endometriosis.
Hemorrhagic cysts form when a blood vessel in a functional cyst ruptures, leading to bleeding into the cyst. Many hemorrhagic cysts can resolve on their own, though a follow-up ultrasound may be recommended.
Cystadenomas arise from cells on the surface of the ovary and can be filled with watery fluid or mucus. They can grow to a considerable size and may be serous (watery fluid) or mucinous (mucus-like fluid).
Recognizing Symptoms and Seeking Care
Ovarian cysts, including complex ones, may not always cause symptoms, often discovered during routine examinations or imaging for other conditions. When symptoms occur, they can include pelvic pain (dull, aching, or sharp, often on one side of the lower abdomen). Other indications are bloating, a feeling of fullness or pressure, and changes in bowel movements or frequent urination if the cyst presses on the bladder. Pain during sexual intercourse or menstrual periods can also occur.
Certain symptoms warrant immediate medical attention, signaling a more serious complication. These include sudden, severe pelvic pain, especially if accompanied by nausea, vomiting, fever, dizziness, or weakness. Such signs could indicate a cyst rupture or ovarian torsion, where the ovary twists, potentially cutting off its blood supply. Prompt medical evaluation prevents further complications.
Diagnostic Approaches and Treatment
The diagnosis of a complex ovarian cyst begins with a pelvic examination, followed by imaging studies. Ultrasound is the most common and effective method to identify ovarian cysts, determining their size, location, and internal characteristics, which helps differentiate between simple and complex types. For further detailed assessment, especially for larger or more suspicious cysts, a magnetic resonance imaging (MRI) scan may be performed.
Blood tests, such as a CA-125 level, may also be used, though CA-125 is not a definitive cancer marker. Levels can be elevated due to various benign conditions, including endometriosis, and may not always be elevated in early-stage ovarian cancers.
Management strategies for complex ovarian cysts vary based on the cyst’s characteristics, size, symptoms, and the individual’s age and menopausal status. For many complex cysts, particularly if they are small and not causing significant symptoms, a “watchful waiting” approach may be recommended. This involves closely monitoring the cyst with regular follow-up ultrasounds to observe any changes in size or appearance. Studies indicate that many benign cysts resolve or remain stable without intervention.
Surgical removal is considered for larger cysts, those causing persistent symptoms, or if there is concern about potential malignancy. This can be done using minimally invasive laparoscopy, involving small incisions, or a more traditional laparotomy with a larger incision, often reserved for very large or potentially cancerous cysts.