Can ovarian cysts cause night sweats?

Can Ovarian Cysts Cause Night Sweats?

Ovarian cysts themselves do not typically cause night sweats, as this is not a recognized presenting symptom of benign ovarian pathology. However, night sweats may occur in the rare context of malignant ovarian tumors or specific functional tumors with hormonal activity.

When Night Sweats May Be Associated with Ovarian Pathology

Malignant Ovarian Tumors

• Gastrointestinal stromal tumors (GISTs) and other malignancies can present with non-specific systemic symptoms including night sweats, weight loss, and fever 1
• While this guideline discusses GISTs specifically, the principle applies to other malignant pelvic masses that may present with constitutional symptoms 1
• In postmenopausal women over 50, symptoms of weight loss, persistent abdominal distension, early satiety, pelvic pain, and urinary urgency should raise concern for malignancy 2

Functional Ovarian Tumors

• Sex cord-stromal tumors (granulosa cell tumors, Sertoli-Leydig cell tumors) can be hormonally active and may cause systemic symptoms 1
• These rare tumors may secrete estrogen, androgens, or cortisol, potentially causing hormonal symptoms that could include vasomotor symptoms 1
• Carcinoid tumors of the ovary can cause carcinoid syndrome without liver metastases, as the ovarian vein drains directly into the vena cava 1

Typical Presenting Symptoms of Benign Ovarian Cysts

The common presenting symptoms of benign ovarian cysts include pelvic pain, pressure symptoms, menstrual disturbance, and abdominal discomfort—not night sweats 2

• Functional cysts may cause irregular vaginal bleeding or menorrhagia 2
• Ovarian torsion presents with sudden onset severe colicky unilateral pain radiating from groin to loin, with nausea and vomiting 2
• Most ovarian cysts in premenopausal women are functional and benign, with a malignancy risk of approximately 1:1,000, increasing to 3:1,000 at age 50 2

Clinical Approach When Night Sweats Are Present

Red Flag Assessment

If a patient presents with an ovarian cyst AND night sweats, evaluate for:

• Weight loss, persistent abdominal distension, early satiety, or pelvic pain—these suggest possible malignancy 2
• Age over 50 years (higher malignancy risk) 2
• Complex cyst features on ultrasound: multilocular, septations, papillae, solid components, or increased vascularity 3

Diagnostic Workup

• Transvaginal ultrasound with color Doppler to characterize the cyst and assess for concerning features 4
• CA-125 measurement in women with concerning symptoms or postmenopausal status 2, 5
• Consider other causes of night sweats (infection, lymphoma, hyperthyroidism, menopause) as these are far more common etiologies than ovarian pathology

Management Based on Risk Stratification

• Simple cysts ≤5 cm in premenopausal women require no additional management 6
• Simple cysts >5 cm but <10 cm should have follow-up ultrasound in 8-12 weeks 6
• Any complex cyst with concerning features or elevated CA-125 requires gynecologic referral 2
• Postmenopausal women with symptomatic cysts, cysts ≥5 cm, or raised CA-125 should be referred to secondary care 2

Key Clinical Pitfall

Do not attribute night sweats to a benign-appearing ovarian cyst without thoroughly investigating other causes. Night sweats are a non-specific constitutional symptom that warrants evaluation for systemic illness, malignancy (including but not limited to ovarian cancer), infection, or hormonal disorders. The presence of an incidental ovarian cyst does not explain night sweats unless there are features suggesting malignancy or a rare functional tumor 1, 2.