The aim of the study was to perform a comprehensive comparison of the histological, immunohistochemical, and molecular characteristics of benign unspecified ovarian tumors (BUOTs), considering their proliferative activity, inflammatory microenvironment, angiogenesis, and clinical impact on ovarian reserve. The study covered four main morphological types of BUOTs: endometriotic, dermoid, serous, and mucinous cysts. Methods. A total of 120 histologically confirmed cases of BUOTs in women of reproductive age were analyzed. Light microscopy, immunohistochemical assays (Ki-67, HE-4, CD10, VEGF), determination of pro-inflammatory cytokines (IL-6, TNF-α), and assessment of the insulin resistance index (HOMA-IR) were used. Results. Endometriotic cysts were associated with high inflammatory and angiogenic activity, accompanied by a decline in ovarian reserve even in the absence of surgical intervention. Serous cystadenomas demonstrated increased proliferative activity based on Ki-67 expression. Dermoid cysts showed minimal proliferative and metabolic potential. Mucinous cysts had a complex architecture but low biological activity. Conclusion. Distinct morphofunctional and immunohistochemical differences were established among the types of BUOTs, which determine clinical management strategies and emphasize the need for a personalized approach to fertility preservation, particularly in cases of endometriosis-associated cysts.