Complex Ovarian Cyst: Symptoms, Causes, and Treatment

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Complex Ovarian CystAll women have a risk of developing ovarian cysts during their childbearing years. These cysts commonly appear and disappear without the slightest notice as most cases do not present any symptoms. When this tiny, fluid-filled sac contains solid matter, it is referred to as a complex ovarian cyst.

You may experience an ovarian cyst at any point between the stages of puberty and menopause. Located on the surface of or inside the ovaries, these cysts are a natural part of a woman’s menstrual cycle. A cyst that becomes a complex ovarian cyst is not part of this process, however. It’s a rare occurrence.

In This Article:

What Are Ovarian Cysts?

Cysts are little sac-like pockets of fluid that can occur in or on the body. Ovarian cysts form on or inside ovaries, and can be the result of various causes. All ovarian cysts, however, fall under one of the following categories: simple cysts or complex cysts.

Simple cysts are the most common and are a result of the menstrual cycle. They form when the ovary does not release an egg, or when an ovarian follicle continues to grow following an egg’s release. Also known as functional cysts, these typically present no symptoms and disappear naturally over the course of a few cycles.

Complex cysts, on the other hand, have nothing to do with a normal menstrual cycle. They are much less common and are typically filled with solid material—like fat, skin, or other tissues—or blood.

Types of Complex Ovarian Cysts

Another important aspect of complex ovarian cysts involves the different types of cysts and their effects on the body.

1. Dermoid Ovarian Cyst

As the most common complex ovarian cyst, the dermoid cyst contains bone, teeth, hair, and skin fragments. They increase in size at a slow rate and can grow large enough to shift the ovary in its place, causing more pain.

2. Endometrioma

Also referred to as chocolate cysts, endometrioma cysts form when uterus cells grow elsewhere, such as in the ovaries, bladder, fallopian tubes, or in the bowel. These cysts are filled with excess blood and cause severe pain, headaches, and vaginal bleeding as they grow in size.

3. Cystadenoma

A complex ovarian cyst comprising of the outer ovary cells is known as a cystadenoma. This benign cyst can either be filled with a thick and sticky fluid or a thin and watery fluid. They can rupture, causing severe pain, and grow up to 100 pounds with a 12-inch diameter.

As they grow and twist, cystadenomas put pressure on the bowel and bladder and restrict the blood supply to the ovaries.

The Symptoms of Complex Ovarian Cysts

Although most ovarian cysts do not have any symptoms, there are circumstances that offer varying degrees of pain and other signs. These will depend on the size, stage, and type of cyst.

Causes of Complex Ovarian Cysts

Most research has yet to determine a cause behind the formation of an ovarian cyst, but it has been linked to a hormonal shift or change. A more direct explanation for the presence of these cysts can be found on the U.S. National Library of Medicine’s MedlinePlus web site:

“Each month during your menstrual cycle, a follicle grows on your ovary. The follicle is where an egg is developing. Most months, an egg is released from this follicle, called ovulation. If the follicle fails to break open and release an egg, the fluid stays in the follicle and forms a cyst.”

Unlike these regular follicle cysts, a complex ovarian cyst is not a result of the menstrual cycle process. The three types of complex ovarian cysts have their own sources and can result in overgrowth leading to further complications. This also includes the risk of ovarian cancer.

Endometriomas, in particular, result from endometriosis, a condition that causes uterine tissue— found inside the uterus—to grow outside of the uterus. When it grows on the ovaries, it can lead to a complex cyst filled with tissue. It can be quite painful and a doctor’s exam and treatment program are required.

The Risk Factors of a Complex Ovarian Cyst

You should be aware of the various risk factors associated with complex ovarian cysts.

  • Genetics
  • Menstruation before age of 12
  • Irregular periods
  • Hypothyroidism
  • Obesity
  • Infertility and treatments
  • Tobacco use

Complications Associated with Complex Ovarian Cysts

A complex ovarian cyst can lead to a number of complications. Some of the more common effects are related to the size. A large complex ovarian cyst has the potential to displace ovaries, twist ovaries—a condition known as ovarian torsion—and press against the bladder, causing a frequent and/or urgent need to urinate.

Endometriosis has the potential to cause fertility problems.

Although the overwhelming majority of ovarian cysts are not cancerous, there is an association in that complex ovarian cysts do seem to increase the risk of ovarian cancer.

Complications that can rise from a complex ovarian cyst rupturing include:

  • Bleeding
  • High fever
  • Extreme pain
  • Weakness
  • Dizziness
  • Vomiting

Complex Ovarian Cysts and Cancer Risk

The link between ovarian cysts and cancer is relatively loose, and having a post-menopausal ovarian cyst does not automatically mean cancer.

Physicians have identified a set of parameters to monitor. These include the frequency of new symptoms (12 times per month), as well as the makeup and appearance of the cyst (tissue partitions, solid material).

If the cyst meets the criteria, doctors will biopsy the cyst and look for cancer markers. Even at this point, however, it’s not necessarily going to render a cancer diagnosis.

About 10% of ovarian cancers are passed on through family genetics. If it’s in the family, it’s best have a blood test to identify your risk. If there is an increased risk, possible preventative measures include ovary and fallopian tube removal.

Diagnosing Complex Ovarian Cyst

For a proper diagnosis, you should seek advice from a medical professional. You will need to discuss any symptoms, medical history, and family history, and have a pelvic exam. The doctor may suggest no treatment and request a follow-up appointment. You may need to have the following tests to determine the cause of symptoms present, including a pregnancy test.

  • Ultrasound
  • Complete Blood Count (CBC)
  • Endocervical swabs
  • Urinalysis
  • Serum biomarker testing

Complex Ovarian Cyst Treatment

We now know most complex ovarian cysts may disappear on their own, but if not, you may require surgery. Treatment will depend on the size, type, accompanying symptoms, and the age of the patient.

Ultrasound – An ultrasound test will be repeated over a short time period to determine if the cyst is shrinking or has disappeared.

Oral contraceptives – The birth control pill is prescribed to help prevent ovarian cancer in those with recurring outbreaks of these cysts.

Surgery – Exploratory laparotomy or pelvic laparoscopy will be performed on those patients with presenting symptoms, large complex ovarian cysts, and those pre- or post-menopausal.

An ovarian cyst can be referred to as a normal fact of life for some women, at least in the cases where it goes unnoticed. A complex ovarian cyst may pose more of a serious health condition as it can be a type of cyst that grows to interfere with the flow of blood and put pressure on vital organs.

The various types of complex ovarian cysts can have mild to severe symptoms. If time does not diminish the cyst, you may need to consult with a medical professional and more serious cases may require surgery.

Article Sources (+)

Grabosch, S., “Ovarian Cysts,” Medscape, January 18, 2017;, last accessed March 21, 2017.
“Ovarian Cysts,” Medline Plus;, last accessed March 21, 2017.
Parker, L., “Knowledge is key when it comes to ovarian cancer,” University of Louisville Physicians, August 20, 2014;, last accessed May 31, 2018.