Complex Ovarian Cyst

Definition - What does Complex Ovarian Cyst mean?

Complex ovarian cysts are fluid and solid matter or blood-filled sacs that develop on the surface of or within the ovary and do not occur in association with the normal menstrual cycle (unlike simple cysts). The complex ovarian cysts are so-named because they are thick-walled and divided into multiple sections (are multilocular). These rare cysts are more common in the childbearing age with 5% to 10% of American women undergoing surgery for removal of these cysts. In about 13% to 21% of cases, complex cysts can turn out to be cancerous. The chances of cancer increase with the advancing age (especially after menopause).

FertilitySmarts explains Complex Ovarian Cyst

There are three common types of ovarian cysts:

  1. Dermoid cysts emerge from dermal stem cells that are present before birth. Hence, these cysts contain tissues like skin, hair, fat, or even teeth.
  2. Cystadenomas come from cells that form the outer covering of the ovary. They are filled with ovarian tissue along with fluid or mucus.
  3. Endometriomas are secondary to endometriosis, a condition in which the uterine lining breaks off and starts growing outside the uterus on the surface of or within the ovaries.

It’s not uncommon to have small ovarian cysts that do not have any symptoms. Symptoms accompanying larger complex cysts (over 5cm) include:

  • A general feeling of pressure in the lower abdomen or bloating
  • Lower abdominal pain; this can be severe enough when the cyst has twisted on itself or ruptured
  • Pain or discomfort during intercourse
  • Painful and heavy menstrual periods (in endometriomas)
  • Nausea and vomiting
  • Frequent urination (as a large cyst can press on the urinary bladder)

The health care provider performs a transvaginal ultrasound in women suspected of having any pelvic masses like ovarian cysts. If the ultrasound is inconclusive, magnetic resonance imaging (MRI) can facilitate the diagnosis. The physician might also order a blood test for cancer antigen 125 (CA125), which when elevated serves as a useful marker for cancerous changes in the ovary.

Complex ovarian cysts can give rise to numerous complications:

  • The ovarian cysts have a potential to "torse" or twist on themselves, thereby obstructing the blood supply to the ovaries. Moreover, these cysts can rupture leading to massive bleeding. Both torsion and rupture are surgical emergencies, requiring prompt intervention.
  • Development of cancer is also a major concern in women with complex cysts. There is a steep rise in the risk of cancer with these forms of ovarian cysts (primarily with endometriomas).
  • Since most of the ovarian cysts affect only one ovary, fertility is generally preserved. However, in a few cases (especially with endometriomas), they can hamper the maturation and release of eggs (ovulation) as well as induce severe pelvic scarring blocking the fallopian tubes and contributing to infertility.

If the cysts are large enough and/or causing bothersome symptoms, they are removed via laparoscopy or laparotomy. In postmenopausal women, the ovarian cysts have increased chances of cancerous potential; hence, doctors prefer removing both the ovaries (bilateral oophorectomy) in this population, sometimes in combination with removal of the uterus (hysterectomy).


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