Complex Ovarian Cysts: Signs, Symptoms, and Complications

Ovarian cysts are sacs in the ovaries filled with fluid or tissue. They are common, with 20% of women developing at least one in their lifetime.

Cysts that form as part of the menstrual cycle during ovulation are functional or simple cysts. Simple cysts are usually asymptomatic (without symptoms) and resolve on their own. They are common in premenopausal women of reproductive age due to hormonal changes. 

Complex cysts are unrelated to the menstrual cycle and contain blood or solid substances. This article discusses the types of complex ovarian cysts, their symptoms, complications, and when to seek medical care.

Types of Complex Ovarian Cysts

There are several types of complex ovarian cysts; they may be categorized as:

• Endometriomas: Cysts filled with dark, thick blood, often referred to as “chocolate cysts.” They result from endometriosis, a condition in which the uterus lining grows outside the uterus. About 17–44% of women with endometriosis develop these cysts, contributing to chronic pelvic pain and infertility.
• Dermoid cysts: Also known as cystic teratomas, these are generally non-cancerous cysts that contain different types of tissues, like skin cells, teeth, hair, bone, or sebaceous glands. These cysts tend to be asymptomatic or have few symptoms. They may be present at birth, developing in the fetus, and growing during the reproductive years.
• Cystadenomas: These cysts are filled with watery fluid and may grow large. They are usually benign (not harmful) and form outside the surface of the ovaries.
  

Symptoms of Complex Ovarian Cysts

An individual with ovarian cysts may be asymptomatic, and diagnosis tends to happen incidentally during a physical exam or pelvic imaging.

Common symptoms may include:

• Sharp or dull pain or pressure in the lower abdomen that is constant or may come and go 
• Bloating
• Frequent urge to urinate
• Unusual vaginal bleeding 
• Irregular menstrual cycle

Complications

Most ovarian cysts are small and resolve on their own within a few months. In rare cases, they may grow large enough to cause complications.

Complications of ovarian cysts include:

• Rupture: Ovarian cysts can burst and leak fluid. A ruptured cyst is painful but usually harmless. In rare cases, they may cause bleeding, requiring medical attention.
• Torsion: A severe complication of larger cysts occurs when the ovary twists around the tissue. This condition blocks blood flow to the ovaries. It will cause severe pain, and immediate medical attention is needed to avoid tissue death.
• Hemorrhage: Bleeding from the cysts can cause mild to moderate symptoms. This manageable condition can be complicated if there is significant blood loss. 

Ovarian Cancer

Most ovarian cysts are not cancerous; however, in rare cases, they can become cancerous. Fewer than 1% of endometriomas and up to 3% of dermoid cysts are associated with malignancy (cancer). Though rare, the risk of ovarian cancer also increases with age.

Cysts are less common after menopause, and postmenopausal women with ovarian cysts have a higher risk of ovarian cancer. In postmenopausal women, complex ovarian cysts may increase the risk of ovarian cancer.

Ovarian Cysts and Pregnancy

Certain medical conditions that cause ovarian cysts can make it difficult to conceive, including endometriosis and polycystic ovary syndrome (PCOS). It is common and usually harmless for cysts to develop during pregnancy. If your healthcare provider finds a cyst during pregnancy, they will closely monitor the condition. A cyst that continues to grow can rupture, twist, or cause issues during childbirth. However, ovarian cysts typically do not affect the ability to get pregnant in the future.

When to See a Healthcare Provider

Seek medical attention if you're experiencing concerning symptoms of an ovarian cyst. A healthcare provider will conduct a physical and pelvic exam. If cysts are suspected, a physical exam and pelvic imaging may help determine if there is a cyst and whether it needs any further treatment or monitoring.

Immediate medical attention is required if you experience the following:

• Pain with fever or vomiting 
• Severe, sudden abdominal pain 
• Unusual vaginal bleeding
• Faintness, dizziness, or weakness 
• Rapid breathing 

Ovarian cyst ruptures or torsions may cause sudden, severe abdominal pain with nausea and vomiting. Other signs may include irregular vaginal bleeding. Immediate medical attention can reduce the risk of permanent tissue damage or the loss of the ovaries.

Summary

Ovarian cysts are common and usually harmless. Complex ovarian cysts have various causes unrelated to the menstrual cycle. Often, symptoms may be mild, or an individual may be asymptomatic (without symptoms). Generally, cysts can resolve on their own. In some cases, they develop into conditions that may require medical attention, including rupture, torsion, and hemorrhage.

It is rare for cysts to develop into ovarian cancer, but the risk increases in postmenopausal women. Although complex ovarian cysts are usually benign, a medical provider can screen, diagnose, and monitor ovarian cysts.

A Word From Verywell

It can be alarming to think you have a cyst, but getting evaluated will help determine the cause of your symptoms and whether any treatment is needed. In most cases, ovarian cysts are harmless and manageable and will not impact fertility or pregnancy. If you suspect an ovarian cyst, consult your healthcare provider to rule out any serious complications or related health conditions like endometriosis or PCOS.