Prognosis

The majority of ovarian cysts resolve spontaneously in all patient groups. Without strong supporting evidence for malignancy, management hinges on determining the likelihood of natural resolution. Surgery provides an immediate solution, but each patient group heralds different risks for recurrence.

Premenopausal: simple cyst

Most are functional or physiologic cysts and are likely to regress without surgery. A study of premenopausal women with cysts <6 cm in diameter found a 50% rate of spontaneous resolution at 6 months and nearly 75% rate at 75 months.[3] One small study showed a recurrence rate of nearly 40%.[80]

Premenopausal: complex cyst

Fewer such cysts resolve spontaneously in comparison to their simple counterparts. An 8.3% spontaneous resolution rate is witnessed among premenopausal women after expectant management.[40] Recurrence rates after either laparoscopy or laparotomy are low. One study demonstrated a recurrence rate of 7.6% after laparoscopy and 0% after laparotomy.[73]

Postmenopausal: simple cyst

In one study, 69.4% of unilocular cysts resolved and 6.8% persisted as a unilocular cyst.[12] Thus, the risk of malignancy of such tumors measuring <10 cm in diameter is extremely low (<0.1%). Another study illustrated similar findings, with approximately 45% resolving on their own.[65]

Postmenopausal: complex cyst

The frequency of malignancy within multiloculated solid tumors is between 36% and 39%.[81] Physicians should not manage such ovarian cysts expectantly; thus, rates of spontaneous resolution are unknown.

Pregnancy

The majority of simple and complex masses will resolve spontaneously and present no risk to the pregnancy. One study of ovarian cysts in pregnancy illustrated a 70% rate of spontaneous resolution among complex cysts and a nearly 100% resolution of simple cysts.[77] The risk of ovarian malignancy is 1 in 12,000 to 47,000, and the risk of complications such as torsion or rupture range from 1% to 6%.​[14][77][78]​

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