Ovarian Symptom and Physiologic or Functional Cysts

Not Tumors and Certainly Not Cancer

Blend Images - Jose Luis Pelaez Inc/Getty Images

Ovarian Cancers, Tumors OR ... Simply Cysts

Some ovarian masses are not tumors at all, rather they are cysts. This site mainly talks about cancerous tumors, but even noncancerous or benign tumors can be harmful and usually require surgery to remove them. All the medical or natural treatment in the world won't get rid of benign or cancerous tumors, BUT here's the good news. Almost 97% of ovarian masses, or suspected tumors, are "cysts" that you CAN get rid of and prevent "naturally." Here are some very common cysts and most asked questions about them.

Follicular Cysts

Follicular cysts are hands down the most frequent types of cysts that occur in the ovaries. These cysts can often be found more than one per ovary and measure from a few millimeters (tiny) to a 15-centimeter (6-inch) cyst. They are best diagnosed with ultrasound an because your doctor can see inside it to make sure there are no suspicious solid areas.

Why do follicular cysts form?

The short answer is, although we can explain what is going on, we don’t really know why it happens only some of the time. The long answer is beyond the scope of this article, but the details can be found in books on reproductive physiology. There are a lot of normal physiologic hormonal cycles in your body — many of which interact with each other. The main hormones, estrogen and progesterone, go up and down during the month in a very specific pattern. Slight changes in the timing of these cycling hormone levels can cause cysts to form.

What are the most common symptoms of follicular cysts?

In addition to the pain from fluid or blood leaking out and the abnormal uterine bleeding (abnormal periods), other symptoms can occur. Some of these are annoying, such as a pressure feeling in the pelvis, and some are basically surgical emergencies such as torsion (twisting of the ovary on it’s own blood supply), which is a wrenching pain that can double you over, cause nausea, then let go, only to repeat itself over and over.

If this happens, you should act on it rapidly or you can lose one of your ovaries because the blood supply to it is cut off.

How are follicular cysts treated?

The truth is that if you wait, almost all ovarian follicular cysts will just go away. Surgery is not needed in most cases, and most often your doctor will simply repeat the ultrasound in about 6 to 8 weeks. In the vast majority of cases, the cyst disappears on its own by silently leaking and rupturing.

What happens if the cyst does not go away?

While your doctor can take a good professional educated guess, there is no way to know for sure if the persistent ovarian cyst is a physiologic cyst or an ovarian tumor. There are some pretty good signs, though, that you have a cyst rather than a tumor. You do not want to miss the boat and be treating a “tumor” with natural means that will never work. You can even risk your life or at least cause a bigger surgery if you delay. So it’s VERY important to know which it is.

What about birth control pills?

Do they help treat functional follicular cysts?

The short answer is no. They only help prevent future cysts from forming. How does this work? There is a complex reaction between your body and the synthetic hormones in birth control pills. They work. They do prevent cysts, just like they prevent pregnancy. There are also shortcomings of synthetic hormones, and it’s important to know those as well so that you can make the best decision for YOUR body. Unfortunately, at this time, there are no "bio-identical" or natural birth control pills.

Corpus Luteum Cysts

Another type of physiologic or functional cyst is known as a corpus luteum cyst (CLC). These are less frequent than a follicular cyst but can cause more problems and emergencies, especially internal bleeding. Why do you need to know the difference? Because your doctor is likely to throw names around that distinguish between these cysts and the specific dangers and treatment options. These cysts also produce different hormones that affect your body and hormone balance. If you don’t know the difference, you can be fooled into thinking something is safe when it is not or getting a surgery that you don’t need.

You can get some of these cysts during early pregnancy, which is perfectly normal. They usually go away by the second trimester. Some do not, and if they do not look suspicious on the ultrasound, it is safe to leave them alone. In most cases, they eventually go away after pregnancy.

How do you know if you have a CLC?

A missed period followed by some spotting, one-sided pelvic pain and a pelvic examination, which finds a tender ovarian mass, suggest that a persistent CLC is the culprit. It is important to make sure, however, that a pregnancy test is ordered because these same findings may be there for an  ectopic pregnancy (tubal pregnancy). An ultrasound may not be able to tell these two apart and the treatment would be completely different. There is another nonphysiologic cyst, which can cause similar symptoms, called an "endometrioma" that you need to be familiar with. That is treated in yet another way, often involving surgery, and is a whole separate topic.

When a CLC ruptures, the amount of bleeding and/or pain may cause this to be a surgical emergency. This is unusual, but there are medications and herbs you may be taking that could make it much worse. In particular, these include aspirin, non-steroidal anti-inflammatory drugs (e.g. ibuprofen), Vitamin E and Gingko Biloba. There are others but basically stay away from anything that may "thin the blood" and cause easy bruising or bleeding. Review all the medications, herbals, and supplements you are taking with your regular doctor and/or nutritionist or naturopathic doctor.

Unfortunately, one-third of women (33%) who have a problem with bleeding from a CLC will have it happen again, possibly over and over. So knowing what to avoid can save more than one trip to the operating room or possibly even your life.

By the way, pelvic pain with or without ovarian cysts being present does not mean the pain is coming from a gynecologic organ. In other words, there are other things down there in your pelvis. You could have appendicitis or other bowel problems, which have nothing to do with your gynecologic organs.

If surgery is necessary because of bleeding, it is often possible to do it through a laparoscope (bandaid surgery). Usually, the ovary does not have to be removed. Only the cyst is removed and bleeding stopped.

If the cyst is NOT ruptured, and there is no bleeding or torsion, it is reasonable to avoid surgery and “wait it out." Why? Because surgery, no matter how small, causes scars or adhesions to form. You want to avoid surgery if your doctor thinks it is safe based on all of the things you just read about.

Theca Lutein Cysts

The least common type of physiologic or functional cysts are called "theca lutein cysts" (TLC). The key difference is that these are usually multiple, on both ovaries, and occur all at the same time. Each of these cysts can be 1cm to 10cm in size, so if there are multiple cysts, the ovaries can be massively enlarged: up to 20 to 30cm (about 10 inches or more) on both sides. How does this happen? The answer is simply hormonal overstimulation of the ovaries due to pregnancy.

Most often this occurs due to very high beta-hCG levels (a hormone of pregnancy) often seen with twins or abnormalities called "molar pregnancy," where the placenta develops but the fetus does not. This is a highly oversimplified explanation, but the point is that high levels of hCG stimulate the ovary. The reason for this overstimulation should be evaluated. Sometimes these cysts can even look like cancer to the untrained eye. Quite a scare, but usually you just need to ask the right questions and, in most cases, it is not cancer.

Continue Reading