How do you find out what the complex cyst is?

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Long story short.. In February I had a pelvic and transvaginal ultrasound. I found out I have pcos (more than 12 simple cysts in each ovary), enlarged ovaries, and a 2.4cm complex cyst.. Which is exactly what my Dr repeated. She then said follow-up ultrasound in 6 months, and put me on bc for the pcos.. I've been having a lot of cramping so I made a appt with her to get the referral for the ultrasound. She didn't have anything in my file, and didn't even know why I was there. I will be switching obs after I get the results from this one, and also sent the results to my primary (who I love and trust 100%).. Anyways. How do you know what cyst it is? Does it say on the radiologist report? Did your Dr look at the images? Further testing? My dr just blew it off.... So this ultrasound I made sure the tech knew my ob was useless. Didn't explain anything to me, had nothing in my file. I made a comment about a dermoid cyst, she said my last one was not that. Whew! Hopefully it will be in my report this time. She also typed a sentence in yellow, which I haven't seen before. I am extremely anxious for this report. I'm 26, no family history of ovarian cancer, so I am not too concerned with cancer. But not knowing and having a lazy ob is a uncomfortable feeling..

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  • Posted

    In order to see what type of cyst it is, sometimes an ultrasound will clear that up, but I see you already did that. If the cyst on the ultrasound has white inside of it, it's probably a complex. If it is black, it's probably a simple cyst. Your doctor should have told you what type it is by looking at the images.

    However, in my case, they misdiagnosed my cyst. They had originally said it was a simple, but three months later it turned out to be a dermoid that needed surgery!

    Sometimes they can't tell what the cyst is, and the only way to find out what type it is would be surgery.

    I think it's good you're switching OB's. This one seems a little lazy! Hope I answered your question, and I wish you the best of luck! -Kellin

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  • Posted

    I know it's a 2.4cm complex cyst. I have a bunch of smaller simple cysts as well, from the pcos. But I don't understand why it wouldn't have said what kind of complex cyst. Oh I also have a small cyst on my cervix. Had to Google that as well.. She didn't even mention that one... Back in 2006, I had a complex cyst in my thyroid. They ran a bunch of tests. I ended up having the right side of my thyroid removed along with the cyst. Because I was young and it was a solid cold cyst, I think they were worried it might have been malignant. I do not remember what it came back as.. I don't know if that has any correlation.

    My dr is horrible! Endocrinologist treat the cause of pcos, and obs really only treat the cysts that linger from pcos. She didn't tell me that either. So after my results, I'm going to hunt for a endo.. I always leave her office with more questions than answers. My last appt, I mentioned a bubble popping sensation that randomly happens. She giggled and said "let's see what the ultrasound says"... She giggled!? I've had that since my son was born.. Just ridiculous.

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    • Posted

      This should be no giggling matter. If they haven't told you what kind of complex cyst it was, it could be because they weren't able to tell. Sometimes, you can only know with surgery. But I'd definitely get a second opinion from a more professional doctor. Jeez! She sounds terrible!

      Sorry about all of the pain this is causing you, message me if you'd like to talk about anything, I'm always here smile


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  • Posted

    They often can't tell for definite with a complex cyst until it's ultimately removed and sent to a lab. Often they will monitor ones under 5cm as sometimes they will often disappear of their own accord x

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  • Posted

    A simple cyst is a functional cyst = just liquid inside (black on ultrasound), either follicle cyst prior ovulation before it bursts/releases the egg or luteal cyst


    a luteal cyst, it can have blood in it after ovulation. (hemorrhagic cyst)

    Those cysts are normal up to a size of 2-3cm.

    Simple cysts can even be bigger and could influence the hormone production of the ovary or become heavy (twist), hence are monitored and sometimes removed (even just being a functional, benign, simple cyst) if they are persistent.

    Sometimes the fibrin (from blood clotting) can give little white stripes in ultrasound pic in an otherwise normal hemorrhagic simple luteal cyst.

    So it is hard to see on ultrasound, if the 'structure' in an otherwise 'black = liquid' cyst,

    is just normal fibrin of a luteal (hemorrhagic) cyst,

    or clots from multiple bleeing in an endometrioma (which is benign, but not normal, not functional and never will disappear on its own)

    Clear 'white' structures are growths, which can be benign or malignous. (sometimes though fibrin/blood clots can be mistaken for growths, always depends how big they are)

    Whenever any structures (white) are found in a cyst,

    it is called 'complex', since it is not simply only liquid.

    As I said beforehand there is a range of reasons why there is something else inside and often enough very hard to distinguish one reason from another.

    Ultrasound and MRI give clues as what the structures can be.

    Ultrasound has the benefit of doing doppler mapping (blood flow measurement)

    Only a removal and histological (microscopic) assessment can determine 100%, what exaclty is inside, if it was growth.

    BUT sometimes waiting and monitoriing helps, too. If it was functional: it will disappear most likely on its own.

    My story: I had a 3cm simple cyst, year later the same ovary had a 5cm simple cyst, a year later it was 9cm, so called simple cyst since gyn doc only saw black liquid, time to remove it due to size anyway, in the hospital same week the ultrasound in 9cm cyst revealed a 'growth' inside (some white structures, not fibrin clot looking), that did not look benign, said doc (?)....I brushed them off to not do pre-assumtions and rather do a good histology of removed tumor before explaining removal of ovaries, uterus, lymphnodes. I got no MRI prior. I wanted to know grading, type before going on with invasive surgery. Also could see it sitting nicely inside a cyst, didn't look invasive, boarder crossing, infiltrative.

    And what was it? It was benign: a dermoid cyst, teratoma with bones, nerves, hair and all. (which could be seen during operation, so hopefully even with preassumtion of cancer would not have gone on with invasive surgery.)

    I am therefore not a fan of any 100% fix diagnose/assumption prior histology of 'growth' in a complex cyst.

    Indications, likelyhood, ok, but nothing is 100%.

    I always watch during gyn ultrasound, too. You can see if it was a nice, encapsuled, sharp boardered, black (liquid) blob. That's always a good sign in general.

    A simple harmless cyst should be well be distinguishable from a complex cyst.

    Once it is a complex cyst, there is only histology that can determine, what exactly is inside if it didn't look like fibrin/clotting but growth.

    Good luck and keep printed records of your results yourself. You are entitled to have a print out of each and every report that is ever made.

    Hope you get hold of the ultrasound report and can read for yourself, if it was only a simple cyst.

    All the best!


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  • Posted

    I appreciate everyone's feed back smile. It was extremely informative. Definitely better than my doctors!

    My results came back, I read them myself. My complex cyst is gone. Yay!! My right ovary size has gone done, my left one (with the cyst) is way down! All the little follicular cysts are still there, my right one has more than before rolleyes. I was hoping that would have changed the most. It did mention a lesion. So now I guess on to the endo who can help get all my horomines under control, because obviously bc isn't a good option considering the above.

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    • Posted

      That's good news! What a relief.

      Ovaries are not still standing organs, they change, constantly, normally, due to their work. Functional cysts disappear on their own, so monitoring a 3cm blob is the first step. (unless it looked very oddly out of place)

      Yes, endo will be good to check for hormonal imbalance. (if FSH, LH, estrogene, progesteron are checked, pls make a note, when your menstruation occured in hindsight after blood sample to know, where you were at on day of blood test because mostly those who go for the test do not have a regular cycle, so it's better to calculate backwards. Testosterone is pretty uninfluenced anyway and THE parameter for PCO.

      Many women 20-25% have multiple small cysts in their ovaries, looking like a string of pearl without being PCO. Please keep this in mind.

      ( I had 'PCO like'  ultrasound look once with hormonal imbalance, then without hormonal imbalance and got pregnant in no time after restart with pill and change of diet.)

      Good luck!

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  • Posted


    Good girl!! Treated so poorly by another woman no less BAH!

    Great instincts and good plan. Since you have a GP you trust make sure you provide feedback to him/her.

    Yes, if you get a copy of the radiologist report it should say type if determined. Sometimes additional testing is required to determine or confirm.

    I went through 3 Drs. before I found one who I felt was professional and cared enough to be a health partner. (My term) 3 dismissed my symptoms the 4th gave me a diagnosis and treatment plan that made sense. All in my first visit with him and the test results that I had gotten from the other Drs. who had never even looked at them! Of course he ordered additional scans that supported his diagnosis.

    So keep up the fight for your health! Sorry about the PCOS. It can be managed, depending on severity and ask for a referral to a specialist. You need experience and compassion on your side.

    The techs aren't supposed to tell you anything so don't take that personally. They get feedback on Drs. all the time but they aren't diagnosticians. That's why a radiologist reads the scan and writes the report. I too think that's too much distance and too many hands but that's how it works. In my opinion a good Dr. will review the report and scan with you personally in the follow up.

    Your instincts are spot on, so keep up the good work! Get your referral and keep us posted.


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  • Posted

    Oh, I should have mentioned before lol. My testosterone is high. Its like 80 something. Im hoping the endo can treat that. My other hormones were fine. It was almost missed that my testosterone was high. The testosterone level was the deciding factor in the pcos. But I have no clue what the endo might say. Obviously the birth control isn't keeping the cysts under control like the ob thinks it will.

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    • Posted

      Uhm, I am surprised your ob thought that way.

      When we went for the pill to get ovaries to sleep

      (due to constant big-ish blood filled=hemorrhagic luteal cysts and huge additional pain during ovulation and menstruation),

      we were told by obigyni,

      that the contraceptive pill did not help for cysts, or resolution of existing cysts (and why should it....they are there already, made, done and dusted),

      but help stop or slow down formation of new functional cysts like follicle or luteal since there is no egg development/release anymore. (duh)

      So you are kind of stuck in time, with the start of the pill, influence in avoidance of new functional ones: yes. Influence as to what happens with the existing ones: no.

      The existing cyst (our biggy) had to go away on its own (and did) as they always tend to do within 8 weeks.

      The small ones are in there still (and ok) and good to know, no new ones will form most likely.

      The existing small pearl like cysts (prior pill) could grow though, but we were given a certain pill for that very reason,

      which tends to keep them more down in size, even keep endometriomas a bit more at bay (if functional; an e.g. dermoid cysts will just do what it wants to do anyway) as she explained and made sense,

      the conventional pill has no effect usually even on any existing normal cyst.

      We were given 'Levlen' for that reason.

      At the last check up no 3cm cyst was there anymore, but around 7 pearl like little ones and if they stayed like that, we are happy knowing no additional functional one will come.

      Your doc should have told you, that the pill only can avoid most likely the formation of new functional cysts (will avoid an ovulation, which it is made for), but not help with resolution of existing bigger cysts or any existing cyst or anyway any non-normal cyst.

      One sometimes wonder, ... don't we.


      Good luck with your endo and getting the testosterone down.

      80ng/dl I guess. Not too bad. Mine did not fall that much and yet my cycles are fine, pregnancy no problem, multiple cysts. ;-)

      Please search internet how to decrease testosterone since again it's a chronic condition = time in your hands and docs often not too good with chronic conditions.

      Some swear by some certain diets (sugar free, but eat nuts, brokkoli and cauliflower) for multiple ovarian benign cysts and testosterone influence.

      I am so bad with keeping the normal conventional sugar out of my diet, my bad.

      All the best!

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