Complex Ovarian Cysts
A complex ovarian cyst is an ovarian cyst that contains features beyond a simple fluid-filled sac—such as septations, solid areas, internal debris, or thickened walls. These cysts can arise from many causes, including functional cysts, hemorrhagic cysts, endometriomas, dermoid cysts, or, less commonly, ovarian tumors. While many complex cysts are benign, their appearance requires careful evaluation to determine whether follow-up or treatment is needed.
What is it?
A complex ovarian cyst is any ovarian cyst with additional internal structures or irregularities. These may include blood (as in a hemorrhagic cyst), thick fluid and tissue from endometriosis (as in an endometrioma), fat or calcifications (as in a dermoid cyst), or solid components that may raise concern for neoplasm. The exact appearance on imaging helps determine whether the cyst is likely benign or needs further evaluation.
Ultrasound is the primary tool for evaluating complex cysts, as it can show internal structures, blood flow, and wall characteristics. MRI may be used when ultrasound findings are unclear or if more detail is needed to distinguish between benign and malignant features.
Important to Know
Most complex ovarian cysts are benign, especially in younger individuals. However, certain findings—such as thick septations, nodules, or solid areas with blood flow—may require careful follow-up or specialist evaluation. Some cysts, such as dermoids or endometriomas, have characteristic features that aid diagnosis.
Red flag symptoms include sudden severe pelvic pain, fever, vomiting, or fainting, which may indicate ovarian torsion, rupture, or infection. Persistent bloating, weight loss, or early satiety may warrant further evaluation for possible malignancy. Follow-up imaging helps confirm stability or resolution.