Complex Ovarian Cyst

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Hello, I'm a 19 year old, with a complex ovarian cyst. Back in November 2015 I had An MRI for hip problems and it picked up cysts on my ovaries. I saw an OB/GYN in December and at that time since I was still having regular periods we decided to watch it. Well beginning I then began having irregular/missed periods and I went back to the Dr. In April, she ordered an Ultrasound and blood work. The blood work was normal, and the ultrasound showed a 3.0 cm mildly complex heterogenous cyst in the right ovary consistent with a hemorrhagic cyst. She gave me a order to do a repeat US in 6 weeks and put me on progesterone to start my cycle. I started my cycle and it was regular for 2 cycles and then began to get irregular again, so I went in for the follow up US on 09/06 and the report states "dominant complex cyst within the right ovary has increased in size to 4.6 cm, and appears to have a possible retractile clot along one margin. An additional follow up US in 6 weeks is recommended to exclude endometrioma or ovarian neoplasm" My Dr has now put me on Birth Control and gave me a referall for another US in 6 weeks. My concern is 1. It's a complex cyst and 2. They feel that it'll be gone by the next US, in 6 weeks despite the fact that it's persisted for 5 months and grown 1.6 cm. can anyone give any input on whether I should get a second opinion or if this is the right approach for something like this? Sorry for the lengthy post but thank you for any advice!

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  • Posted

    I would get a second opinion. I had a cyst on my right ovary and I also had a follow up ultrasound and the cyst got bigger. They scheduled surgery 4 days later and the biopsy showed that it was a serous borderline tumor. Don't wait especially when they use the word possible neoplasm.

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    • Posted

      Thank you for the reply, I was concerned and I don't like how they keep saying wait 6 more weeks when I've been waiting April-Septemebr and all it did was grow 1.6 cms. How likely is the BC to resolve this cyst?

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    • Posted

      I don't believe bc will help with it. Waiting another 6 weeks seems outrageous to me. My oncologist did a ct scan bc of my diagnosis and found a 1.5 cm tumor on my other ovary. I decided to opt for a full hysterectomy bc of it and 4 weeks later it was the size of an orange! It was very painful. My final diagnosis after the hysterectomy was stage 1 ovarian cancer. I'm very lucky it was caught early. Definitely not something to mess around with. I wish you the best of luck and pray you get answers soon

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    • Posted

      Thank you. I don't like the whole waiting game as it clearly is growing. I obviously also don't want to have surgery unless it's absolutely necessary, but it also bugs me that every time I go in I see a NP, I've never actually met the doctor. It's not that I don't trust the NPs, but it'd be nice to actually meet the doctor and establish a connection with the one who would be doing the surgery if it comes down to that.

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    • Posted

      Moment, cyst is not cyst, growth is not growth.

      Denise's cyst (liquid filled blob with some white stripes/clots in it) has only grown ca 1.6cm (a few mm more or less are measurement problems) in 5 months, that is not rapid growth.

      Yours, but a tumor (not cyst? or a tumor in cyst?), Holly, grew ca 7cm (to orange size) in 4 weeks if I see correctly.

      That's already a very big difference in growth rate between you two.

      And your's Holly seemed to have been called 1.5cm tumor, not cyst even from the start, or was it a 1.5cm cyst -liquid blob- mainly filled with a tumor. ??

      It seems yours Holly had a different appearance from the start, hence the quick move. (?) 

      Ovarian (bigger, functioning ovaries always have some cyst) cysts are luckily in 95% not cancerous,

      most are just liquid filled and if neoplasm, the neoplasms often benign.

      (Just to not panic poor 19 yr old denise completely, leave all possibilities open, but don't just look at the negative side before knowing. And surgery is the only answer....)

      Good that yours Holly was caught in time.

      How did they find the tumor at a small 1.5cm size already may I ask? Did you have symptoms? Which ones? That would be very good experience to share and know. That must have been truely scary.

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    • Posted

      PS: oops. I think I got Holly and Denise's name wrong. (?) Confused me. Sorry. Just wanted to point out the differences in found cyts/tumors/growth rates not matter whom they belong to. redface

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  • Posted

    To distinguish a hemorrhagic (purely blood filled, hence often a luteal functional hemorrhagic) cyst

    from an

    endometrioma (blood not due to functional cyst bleeding upon ovulation, but repetatively bleeding due to endometrial implant cells)

    via ultrasound or MRIs 

    is very, very difficult if not impossible.

    Both are blood, both have 'fibrin', that show up as 'white' clots and bands.

    (some hemorrhagic cysts have no fibrin showing up though and stay 'simple'wink

    When such a cyst disappears on its own, it was for sure a plain, simple functional hemorrhagic cyst.

    (My daughter tend to have them all the time, always found coincidantally on this and that side, 3cm, and need about 2 months to rupture.)

    When such a cyst does not disappear on its own, it can be anything, can still be a simple functional hemorrhagic luteal cyst, but also endometrioma (=chocolate cyst) or any other growth even.

    Even simple functional cysts larger than 6cm in diameter tend to not disappear sponaneously (via rupture) anymore and play havoc via its weight or squeeze on ovarian tissue.

    Second opinion is good, but until it ruptures or is taken out, no one will be able to tell you what it is 100%, only have clues and 'most likely' ideas due to imaging.

    I feel you are in pretty good hands and in a very tight control loop.

    I had a 3cm 'simple' cyst, a year later was 5cm 'simple' cyst (doc and I saw only a liquid filled blob without any structures in it), a year later was 9cm 'simple' cyst.

    Due to remove it surgically since not going away and over 6cm

    it turned out at hopspital the 9cm was a 'complex' cyst with white structures in it all along not looking like fibrine or clots

    and unfortunately had a very stupid doc.

    She dared to say it didn't look benign.


    It was a benign dermoid cyst at the end!

    So imaging and docs' experiences might give a direction, 

    until it comes out, no one can tell you, what it is. There are clues, but nothing is 100% except for histology or when it simply disappeared.

    Being on the 'blood' side if hemorrhagic or endometrioma look is already promising.

    Being controlled and checked is good too. There is no hurry, the boarder of cyst seems regular and not suspicious, the structures seen inside cyst seem not suspicious. The size is within limits.

    Knowing and checking via ultrasound what your cyst is doing, is enough at the moment and your are in a very tight loop (look at my yearly check ups even with 5cm....).

    So nothing will escape their eyes.

    You are in good hands and monitored!

    Wishing you that it was a purely hemorrhagic cyst, that will rupture on its own within months and gone one day at a check up.

    If not, see it positively:

    you are checked and controlled. It can't surprise you like having an e.g. 26cm cyst all of a sudden with loads of symptoms and a big belly like so many others have due to no prophylactic check ups or coincidental finding.

    All the best!

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    • Posted

      I just don't feel comfortable with how it seems like the NPs are shrugging it off. On the phone they said it grew slightly, when it really grew 1.6 cms.. I get it, they don't want to do surgery unless it's necessary, but I also don't want it to burst causing pain and blood to spill into my abdominal cavity, that doesn't sound like the best idea either.

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    • Posted

      Yes, I know, for most it is. 

      Every case is different.

      Honestly said ca 1,6cm cyst (liquid filled) growth in 5 months (was it?) is not much, BUT yes, if it was one and the same cyst, it seems to be a 'stayer'.

      The longer they stay, the less likely they will rupture, those little buggers.

      My daughter constantly formed hemorrhagic ca 3cm cysts (on constant pill now to avoid new ones), that would rupture into her abdomen, for years. The burst can hurt, but does not have to. Some notice like sharp pain (my daughter did), which passes after hours (or naproxen helped), some don't notice.

      As to the liquid, we seem to be built to deal with it to some extend, docs are not taking minimal free pelvic fluid in women with functioning ovaries serious at all for that reason (very frustrating, but it is).

      It does get absorbed, get new fluid at the next cyst rupture of follicle or hemorrhagic cysts.

      Hence having some ml of pelvic free fluid is normal.

      If it is within ml amount, no one will be concerned. It's not like ascites in liter amount. Yours is still in that size area of 'minimal free liquid'. No concern for spontaneous rupture allowance.

      If free fluid was hurting or not is another speculation. (My daughter's minimal pelvic free liquid is now gone, the pain stays, so really seems not minimal free pelvic liquid related for us)

      By nature the content should be sterile unless you had a pelvic infection crept up from vagina, uterus, tubes, that could feast on it then, but would have shown up beforehand (fever, pain...).

      Surgery is the only way to get rid of it, if it doesn't go away by itself. 

      Sorry to say.

      So you rather wish for a rupture now, a little pinch and absorbtion and that it was a plain simple hemorrhagic cyst only, having said though, the laparoscopic removal of my dermoid cyst was not a big deal either.

      You have no option but to get used to both ideas (rupture - best functional outcome; or surgical laparoscopic removal - best assessment histological)

      Think if you went next week for ultrasound, what would you do if it was same size? If it grew 1cm? Will you opt for surgery then? Will they offer surgery then? Can you get a second opinion before your other ultrasound is scheduled (for me here it is awfully long waiting list in public system and awfully expensive - about 300AUD was the last one- in private system)? Would you like that? Then go for it, ask somewhere else to get an ultrasound before your other monitoring check was scheduled.

      But play the szenario through what it would mean for you, what you would do differently. If they say exactly the same numbers and suggestions, what will you do? Wait? Surgery?

      I hope for you no matter if you do it next week or in 6 weeks, that it is simply gone and frees your mind.

      Monitoring can get a burden psychologically since you constantly think of it.

      All all the best!!

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  • Posted


    Although your cyst continues to grow, it is fairly slowly. I know monitoring is stressful but you are not being sent home to wallow in pain.

    One thing to consider with birth control, it is often prescribed to help regulate your cycle. It can also help minimize the risk of developing additional cysts and/or have a favorable effect on the cyst.

    That said the cyst is a complex cyst that continues to grow. They typically do not go away on their own. I would suggest discussing with your Dr. the risk of removing it now while it is smaller.

    I see benefits, 1. less damage to ovary and 2. greater opportunity to remove cyst without having to remove ovary also.

    It is normal to have multiple cysts at various stages because they form naturally as part ofvour cycle. This was caught early as a result of your MRI. Your gynecologist is monitoring it to see how it responds before progressing to the next step.

    If you haven't asked her have the likelyhood of cancer conversation. I'm sure if she thought you were at risk she would have recommended surgery already.

    I had huge cysts on both ovaries that were over looked by 3 different Drs. Over the course of 6 months I sought treatment for symptoms and was dismissed as normal and sent home. Once diagnosis was made things progressed quickly to surgical outcome. But your situation is completely different. You have received prompt care and are being monitored.

    So talk to your Dr. about the surgery option and if you still are not comfortable seek a second opinion.


    Congratulations on your fortunate early detection! And best wishes for continued good health!!

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  • Posted

    Hello Holly,

    Definitely, every case ia different. As for the altrasound, I think it is just the best estimate on the size of your cyst. When I know I had a cyst on my left ovary, they said it is "probably " a paratubal cyst. I had a missed period by the time I had the US. The size is 8x 7x 4 cm. After my period, about 18 days from my first US, I decided to see another doctor for a second opinion on my cyst and size now is 8.6x 8.4 x6. To make the story short, I had a surgery to remove the cyst and found out the cyst is actually 10 x 8 x 6 cm.

    It is always best to have another opinion. smile

    Good luck and always pray.

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