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Your Guide to Complex Ovarian Cysts

Posted on October 26, 2021
Medically reviewed by
Howard Goodman, M.D.
Article written by
Juliana Cobb, RN

There are two main types of ovarian cysts — simple (functional) and complex. Each category is then broken down into specific types. Simple cysts are the most prevalent. Formed during a normal menstrual cycle during ovulation, these functional cysts are filled with fluid and almost always go away on their own. According to recent research, no link has been discovered between functional cysts and ovarian cancer. Simple cysts may also be found in older women. As with simple cysts in younger women, simple cysts in older women have not been associated with ovarian cancer.

Complex cysts, on the other hand, are more concerning. As the name implies, there is more going on in a complex cyst, and because of that, there are many questions regarding whether or how they might be associated with ovarian cancer.

Types of Complex Ovarian Cysts

Complex cysts can be broken down into three main types. All of these cysts can also be called tumors, whether benign or malignant, due to the solid nature of the cyst.

Endometriomas

Endometriomas are blood-filled cysts that arise as a complication of endometriosis.

Dermoid

Dermoid cysts contain cells present since birth, and hair, teeth, or skin cells can be found inside.

Cystadenomas

Although cystadenomas are fluid-filled cysts, they can grow to be quite large. The fluid inside can be mucus-like or a thinner fluid (serous). There are different kinds of cystadenomas — serous, mucinous, endometrioid, clear cell, and mixed types.

Prevalence of Complex Ovarian Cysts

The prevalence of complex ovarian cysts can be a hard number to pin down. Researchers are continuing to define exact diagnostic guidelines for the types of ovarian cysts. The percentage of women with complex ovarian cysts often depends on which research study you read.

For example, Dr. Samir Farghaly found in his research that over 15 years, 18 percent of postmenopausal women will have at least one cyst. According to her research, Dr. Elisa Ross found that only 5 percent to 10 percent of the women in the United States will have surgery for ovarian cysts.

What Causes Complex Ovarian Cysts?

Complex ovarian cysts can be caused by several conditions. A genetic disorder called polycystic ovary syndrome causes many cysts to form in the ovary. Endometriosis, pregnancy, pelvic infections, previous cysts, and hormonal issues also increase your risk for developing complex cysts.

Symptoms of Complex Ovarian Cysts

Complex cysts may cause no symptoms or can result in significant symptoms. Symptoms of complex cysts may include:

  • Urinary issues, including frequency and urgency
  • Early satiety — feeling full quickly while eating, or even difficulties with eating
  • Abdominal bloating
  • Pelvic or abdominal pain or pressure
  • Dyspareunia — painful sexual intercourse

Some symptoms of complex ovarian cysts can be similar to symptoms of ovarian cancer. If you experience acute, severe pain in your abdominal or pelvic region, seek medical care right away.

Diagnostic Testing of Ovarian Cysts

Ovarian cysts are often discovered during a routine medical screening. Some types of cysts produce pregnancy hormones that can be detected in urine or blood tests. Medical imaging, such as ultrasound and magnetic resonance imaging, can provide more details about the cyst.

Physical examination and imaging may not be enough to definitively diagnose a cyst. Sometimes a doctor will want to do an exploratory laparoscopy, a surgery where the doctor passes a small camera into your abdomen to look at the ovaries and they may take biopsies, or small pieces, of the cysts. A pathologist will study the biopsies and determine the characteristics of the tissue.

How Are Complex Ovarian Cysts Treated?

Some complex cysts will not cause symptoms. Doctors may recommend simply monitoring them with follow-up ultrasounds rather than treating them surgically.

For cysts that are larger or causing health care concerns, surgery may be recommended. Just like with an exploratory laparoscopy, a surgeon will go in with a camera and use it to guide the removal of the cyst. Depending on the size and type of the cysts, your doctor may suggest you have one or both of your ovaries removed.

Prevention of Ovarian Cysts

Certain medications, such as birth control pills, can stop ovarian cysts from forming. Birth control pills cannot treat cysts that are already present. Routine medical examinations can help detect and manage complications from ovarian cysts. Make sure you are seeing your primary care doctor and your gynecologist regularly.

As with all health conditions, taking care of your overall health goes a long way. Maintain a healthy weight for your age and body type, and ask your doctor about exercise appropriate for your abilities. If you smoke, quit smoking. Your health care provider can recommend resources to help you.

Are Complex Ovarian Cysts Related to Ovarian Cancer?

Complex ovarian cysts are filled with something other than fluid, like functional ovarian cysts, which is why they are called complex. Just because there is something more than fluid in the cysts, does not automatically make the cysts cancerous. Research is ongoing into which complex cysts are more likely to be cancerous.

Researchers at the National Cancer Institute’s epidemiology and biostatistics program have followed more than 20,000 postmenopausal women in their study on the relationship between complex ovarian cysts and ovarian cancer.

Researchers at the University of Wisconsin School of Medicine and Public Health have studied more than 1,600 menopausal and postmenopausal women who were diagnosed with ovarian cysts.

According to the study by the University of Wisconsin, there is a significant increase in risk for postmenopausal women who have ovarian cysts to develop ovarian cancer. The research conducted by the National Cancer Institute disagrees and states no link was found between complex ovarian cysts and ovarian cancer.

Both studies focus on complex ovarian cysts. The National Cancer Institute research focuses on complex ovarian cysts as a whole — taking into consideration all forms of ovarian cysts. The University of Wisconsin focused on one specific type of ovarian cysts, indeterminate adnexal cysts. This difference helps us understand the conflicting results. This means the University of Wisconsin study is more narrowly focused, specifically looking at complex ovarian cysts that can lead to ovarian cancer.

One other factor plays a part in the seeming disparity of these two research studies. According to Dr. Ross, 8 percent to 18 percent of women will have an ovarian cyst in their lifetime. Of those women, less than 21 percent will develop ovarian cancer. For this reason, data collection and concrete research on ovarian cancer can take longer than research for cancers that affect larger groups of people.

Through ongoing research, better definitions of complex ovarian cysts will develop, as well as determining which of these cysts may become cancerous.

Read more about the risk factors associated with developing ovarian cancer.

Talk With Others Who Understand

MyOvarianCancerTeam is the social network for people with ovarian cancer. On MyOvarianCancerTeam, more than 8,900 members can ask questions, share advice, and listen to the experiences of those managing day-to-day life with their diagnosis.

Did you have an ovarian cyst diagnosed before your ovarian cancer diagnosis? Are you living with ovarian cysts and ovarian cancer? Share your experience with others in the comments below, or start a conversation on the Activities page.

All updates must be accompanied by text or a picture.
Howard Goodman, M.D. is certified by the American Board of Obstetrics and Gynecology and specializes in the surgical management of women with gynecologic cancer. Review provided by VeriMed Healthcare Network.. Learn more about him here.
Juliana Cobb, RN is a registered nurse with a passion for helping others understand their health conditions. Learn more about her here.

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