If you’ve got ovaries that ovulate, it is highly likely that you develop an ovarian cyst at sometime in your fertile years. You may not even notice the ovarian cyst symptoms or it may be very painful depending on the type and size of the cyst.
Each ovulatory cycle, an egg matures inside of a follicle. Then the follicle bursts open and the egg gets released. Next, either you become pregnant, or your period arrives. After that, the follicle forms the corpus luteum, which is a cluster of cells in the ovary that starts producing progesterone – although not everybody produces enough progesterone.
Sometimes, parts of this process become problematic. For example, if the follicle doesn’t release the egg…The follicle grows and turns into a follicular cyst.
Or, a corpus luteum cyst forms because the follicle bursts open as it would every month, but then it fills with fluid and sticks around a little longer.
When we’re talking about these two types of cysts, they can also be called simple or functional cysts. Two different names for the same condition.
Often, these cysts simply shrink and then disappear. They come and go and you don’t realize that they’ve even been hanging around in your ovaries.
Other times, these cysts become enlarged. This can cause pain and other complications. Sometimes, cysts rupture and can even damage the ovary.
What Are Ovarian Cysts?
Ovarian cysts are fluid-filled pouches that form in or on the ovary. They can range in size from less than 1cm to 10cm. In some cases, there are no ovarian cyst symptoms and in others there may be pelvic pressure or pain.
What Are The Types Of Ovarian Cysts?
Simple cysts aren’t the only kinds of ovarian cysts. There are also complex cysts.
Complex cysts include endometriomas, cystadenomas, and dermoids.
These are cysts that sometimes occur in women with endometriosis. This happens when tissue that is similar, although distinct, to the uterine lining invades the ovaries. These are sometimes referred to as chocolate cysts.
These cysts are pockets of mucus, fluid, and ovarian tissue on the outside surface of the ovary. They are usually benign growths but they can get rather large.
Dermoid cysts, also known as teratomas, commonly occur in the ovaries. In fact, they are one of the most common kinds for women between 20 and 40 years old. These may contain ovarian germ cells and tissues like teeth, hair, or fat. While they may not sound benign, they are for the most part and are rarely cancerous.
While these complex cysts can and do cause problems for many women, in this article, I’ll be focusing on functional cysts.
Ovarian Cysts Symptoms and Signs
If you have a cyst that simply shrinks and fades away, you may never even know that it was there.
However, if your cyst is problematic, there are several symptoms you may experience:
- Pelvic pain (especially around ovulation)
- Irregular cycles
- Spotting mid-cycle
- Lower back pain
- Abdominal bloating
- Feeling full or heavy
- Painful bowel movements or urination (the cyst can put pressure on the bowel or bladder)
- Lack of ovulation
- Fertility struggles
- Painful sex
If you’re experiencing any of these symptoms, and especially if they’re accompanied by sudden pain or fever, it’s important to contact your doctor right away.
Do Ovarian Cysts Hurt?
Most cysts won’t cause a bit of pain — you won’t even know they are there. But if they become enlarged, they most certainly can become painful.
Many women complain of lower back pain, abdominal pain, and pelvic pain associated with ovarian cysts. Still, cysts aren’t always painful – even large cysts can go unnoticed.
Can Ovarian Cysts Cause Bleeding?
Mid-cycle bleeding is a common symptom of ovarian cysts. But it can also be a normal indicator of ovulation, or a symptom of many other conditions. If you ever experience vaginal bleeding and you know it’s not time for your period, it’s important to contact your doctor to get checked out.
Can Ovarian Cysts Cause Back Pain?
In my practice, I’ve seen many women experience a dull, aching lower back pain if they’re experiencing complications due to ovarian cysts. Some women describe hip and pelvic pain as well. Definitely consult with your physician if you’re experiencing pain and you’re not sure why.
Can Ovarian Cysts Cause Bloating?
It might be difficult to distinguish garden variety bloating from bloating caused by an ovarian cyst, but if your bloating is accompanied by pain, discomfort, or bleeding it could be that a cyst is causing your problems.
Can Ovarian Cysts Cause Weight Gain?
Sometimes, as ovarian cysts grow large, women feel like they are ‘gaining weight.’ This isn’t weight gain in the traditional sense. If you have a large cyst, you aren’t putting on body fat. You may experience bloating from the cyst and that can cause water weight to accumulate.
How Do You Know If An Ovarian Cyst Has Ruptured?
Ovarian cysts can rupture without your knowledge. Usually, though, most women will feel pain or discomfort if their cyst ruptures. Sometimes fever or chills accompany a rupture. Complications may arise if the cyst is infected or the weight of the cyst causes the ovary to twist, known as ovarian torsion. Definitely contact your medical professional if you suspect that your ovarian cyst has ruptured, or if you’re experiencing lower back or pelvic discomfort, with or without fever and chills.
How Are Ovarian Cysts Diagnosed?
Ovarian cysts can be tricky to diagnose, especially since many times they don’t cause overt symptoms.
Sometimes, your doctor might discover one during your annual pelvic exam. This can usually be confirmed with an ultrasound. If you have a corpus luteum cyst, you might actually produce a false positive pregnancy test, so doctors often use this method to arrive at a diagnosis. That said, a home pregnancy test alone isn’t enough to diagnose a cyst. Ovarian cysts are also common during pregnancy, so your provider will likely test you.
In postmenopausal women, CA 125 is often ordered to assess an ovarian cyst. CA 125 testing is sometimes ordered in cases of ovarian cysts that are large in premenopausal women. It is not enough on its own to diagnose ovarian cancer and may also be elevated in cases of endometriosis, fibroids, liver or kidney disease, and cases of heart failure.
Ovarian Cysts Vs PCOS
It may seem like polycystic ovarian syndrome (PCOS) is the same thing as ovarian cysts. But they are actually two different conditions with similar names.
In women with PCOS, multiple follicles keep growing, which do not release eggs, and multiple cysts can form in the ovary. PCOS is considered a metabolic condition that is characterized by hormonal imbalances.
Ovarian Cysts Vs Fibroids
Functional cysts are normally filled with fluid, while fibroids are typically denser. Fibroids occur on or in the uterus and cysts occur on or in the ovaries.
Ovarian Cysts Vs Endometriosis
Endometriosis is a condition where tissue similar to the lining of the uterus abnormally grows outside of the uterus. Sometimes, if endometriosis affects an ovary, that ovary can fill with blood. This is called an endometrioma, or a complex ovarian cyst that’s filled with blood. They are also referred to as “chocolate cysts.”
What Causes Ovarian Cysts?
There’s no one singular cause for problematic ovarian cysts.
Technically, they can start with ovulation, but we can’t really define that as a “cause” of the cysts becoming irregular.
Some of the common reasons cysts develop include:
- Pelvic infection: sometimes infections can travel to the ovaries, resulting in cysts
- Endometriosis: complex cysts may develop as a result of endometriosis
- Pregnancy: in early pregnancy, a cyst forms to help nurture the pregnancy while the placenta develops. It can stick around on the ovary for longer than it’s supposed to.
- Estrogen dominance: the hormonal imbalances that result when estrogen levels are high or high in relation to levels of progesterone can cause cysts to develop.
Does the Mirena® IUD Cause Ovarian Cysts?
According to the package insert, about 8% of women using Mirena® develop ovarian cysts. If you have a history of ovarian cysts and you’re considering an IUD, ask your doctor if there are concerns about exacerbating the problem.
How Ovarian Cysts Are Treated
For the most part, ovarian cysts seem to resolve themselves. Especially if they are asymptomatic, they may just disappear and you’ll never even know they were there.
For this reason, many doctors take a “wait and watch” approach before resorting to any sort of invasive treatment for ovarian cysts.
Often, your doctor will suggest pain medications like ibuprofen or non-steroidal anti-inflammatories (NSAID) as a treatment for the pain caused by ovarian cysts. If you have a cyst or suspect you might, get a thorough evaluation and your doctor can advise you on the best course of action.
How Are Ovarian Cysts Removed?
If an ovarian cyst is causing significant pain, is larger than 5 cm in diameter, or appears related to endometriosis, your doctor may recommend surgery to have the cyst removed. Your doctor may also suggest surgery if she suspects that it may be cancerous.
The typical surgeries performed to remove ovarian cysts include:
- Laparoscopic cystectomy. This is where a small incision is made to remove the cyst with the assistance of a small camera.
- Oophorectomy. This procedure is the removal of the ovary.
- Hysterectomy. This is the removal of the uterus, ovaries, and possibly fallopian tubes.
Hormonal Birth Control For Ovarian Cysts
It’s quite possible your doctor will recommend hormonal contraception to treat an ovarian cyst. The idea is that if ovulation is suppressed, cysts won’t form, right?
Early formulations of the pill were associated with a lower rate of functional cysts, which many physicians took to mean it could treat ovarian cysts causing them to adopt this treatment practice in the 1970’s. While this approach has shown to be ineffective, it hasn’t really stopped physicians from using it as a treatment. Plus, it can’t shrink or affect an existing cyst in any way. And, keep in mind that birth control options (especially progestin-only options) do not necessarily stop ovulation from happening.
According to a 2014 Cochrane Review, there is no evidence that oral contraceptives cause the resolution of ovarian cysts any faster than what would happen naturally. “Therefore, birth control pills should not be used for this purpose. A better approach is to wait two to three months for the cysts to disappear on their own.”
Plus, we know that the pill can possibly cause a whole host of other unpleasant hormonal side effects. Even if hormonal contraception seemed to work, once you quit taking the pill, your cysts are likely to return if you haven’t addressed the root cause,.
If you’re struggling with any pill-induced discomforts, I’d invite you to check out my best-selling book, Beyond the Pill.
Understand that cysts that do not self resolve often require surgical intervention.
Natural Remedies For Ovarian Cysts
If you’re experiencing pain from an ovarian cyst, there are plenty of natural things you can do to help ease the pain.
Some of my patients swear by taking Epsom salt baths or using a heating pad to help deal with the pain.
But what about getting to the root of the problem, the whole reason cysts are developing in the first place?
Since cysts can often be caused by an overabundance of estrogen, focusing on ways to support estrogen breakdown in the liver and excretion through the digestive system can help treat ovarian cysts.
Some of the things I recommend for women in my clinical practice:
Increase Your Plants
Vegetables and fruits are rich in antioxidants that support ovarian health. They also contain important vitamins and minerals for supporting hormone health. Aim to eat leafy green daily and cruciferous vegetables at least three times a week. Cruciferous vegetables contain nutrients that your body can convert into DIM, a molecule that supports estrogen metabolism.
You can grab my free meal plan and recipe guide to help you begin incorporating these into your diet today.
- Vitex (Chaste tree berry) supports progesterone production, which can help counter estrogen.
- Green tea extract is a potent antioxidant, which may help protect ovarian health. In one PCOS rodent study green tea was shown to reduce the rate of cysts.
- Diindolylmethane (DIM) supports estrogen metabolism and promotes 2-hydroxyestrone, a more favorable estrogen metabolite.
Balance Women’s Hormone Support is a formula that contains ingredients which may help harmonize hormones, and could help your liver process excess estrogen
Eat Your Fiber
I regularly encourage my patients to load up on vegetables for fiber. You need a healthy gut to get estrogen out and fiber can really help encourage frequent elimination, plus support a healthy microbiome.
Replenishing the gut with friendly microbes can lead to happy hormones. That’s because your gut is a crucial organ in helping you eliminate excess hormones. As it turns out, those gut bugs interact with your estrogen as what is known as the estrobolome. I recommend MegaSporeBiotic to my patients.
This time-tested practice may encourage hormone balance by balancing beneficial estrogens with flax and pumpkin seeds in the first half of your cycle. Then in the second half of your cycle (after ovulation) you encourage progesterone with sesame and sunflower seeds. Check out my seed cycling article with all the details here.
Ovarian Cysts And Pregnancy
Ovarian cysts are common in early pregnancy. Because you’re getting so many ultrasounds during this time, you may be more likely to find cysts that you wouldn’t otherwise notice.
For the most part, they are nothing to worry about and will resolve on their own. But do bring up any concerns or symptoms to your OB/GYN.
Can Ovarian Cysts Cause Infertility?
On the other hand, endometriomas (cysts that are associated with endometriosis) can spawn fertility struggles. But, it’s not clear whether this is a direct result of the cyst itself, or if the underlying issues that caused the cyst are responsible for fertility problems.
Also, if surgery is required to remove a cyst, there is concern that it could interfere with future fertility. But research suggests that in women who undergo in-vitro fertilization (IVF) treatment, surgery to remove ovarian cysts doesn’t impact the chances of achieving pregnancy.
There are minimally invasive options to remove non-cancerous cysts that shouldn’t affect the ovaries. Mention your family planning goals to your doctor when discussing treatment options.
Ovarian Cysts After Menopause
Up until this point, we’ve been primarily discussing ovarian cysts that develop in women of childbearing age, who are still ovulating.
But if ovarian cysts develop after menopause, it’s a slightly different circumstance. Since women who are post-menopausal don’t ovulate, the appearance of functional cysts will likely make your doctor want to investigate further.
Post-menopausal cysts may be benign, but your doctor will likely want to run a few tests to determine what’s going on. Research indicates most simple post-menopausal ovarian cysts either resolve on their own or stay the same.
In most cases, your doctor will want to perform both an ultrasound and CA 125 to screen for cancer before proceeding to a “watch and wait” stance.
Can Ovarian Cysts Be Cancerous?
Typically, ovarian cysts are not cancerous, but it can still be scary to hear the news that you have one. If your doctor is concerned that you possibly have a cancerous ovarian cyst, it’s likely that she will order bloodwork to determine your cancer antigen 125 (CA 125) levels. This blood test can help your physician understand the likelihood of ovarian cancer.
Certain factors put you at higher risk for developing ovarian cancer:
- Family history of ovarian cancer
- Previous history of breast cancer
- Previous history of gastrointestinal cancer
Support Your Hormones (And Ovaries) Naturally
Believe it or not, painless, easy menstruation is completely possible. PMS, bloating, acne, and even ovarian cysts can be a thing of the past…you just need a blueprint for success.
Which is what I’ve created for you in my Hormone Starter Kit to help you get started on the right path.
This completely free resource is absolutely packed with hormone education and even includes a complete 7-day meal plan. It’s literally everything you need to start down the path to hormonal harmony. Download your free copy here.
- Ovarian Cysts. OASH Office on Women's Health.
- InformedHealth.org. Ovarian cysts. Cologne, Germany: Institute for Quality and Efficiency in Health Care.
- Ross J, Judlin P, Nilas L. European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2007. 18. 662-666.
- Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010. 116. 223-236.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol. 2007. 110. 201-14.
- Muto, M. Patient education: Ovarian cysts (Beyond the Basics). UpToDate.
- Hennebold, J. D.. Corpus Luteum. Science Direct Topics.
- Valea F, Mann W. Oophorectomy and ovarian cystectomy. UpToDate.
- Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews. 2014.
- Trudel D, Labbé DP, Bairati I, et al. Green tea for ovarian cancer prevention and treatment: A systematic review of the in vitro, in vivo and epidemiological studies. Gynecologic Oncology. 2012. 126. 491-498.
- Ghafurniyan H, Azarnia M, Nabiuni M, Karimzadeh L. The Effect of Green Tea Extract on Reproductive Improvement in Estradiol Valerate-Induced Polycystic Ovarian Syndrome in Rat. Iran J Pharm Res. 2015. 14. 1215-1233.
- Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017. 103. 45-53.
- Gomez R, Schorsch M, Gerhold-Ay A, et al. Fertility After Ovarian Cystectomy: How Does Surgery Affect IVF/ICSI Outcomes?. Geburtshilfe Frauenheilkd. 2019. 79. 72-78.
- Conway C, Zalud I, Dilena M, et al. Simple cyst in the postmenopausal patient: detection and management. J Ultrasound Med. 1998. 17. 369-374.
- Legendre G, Catala L, Morinière C, et al. Relationship between ovarian cysts and infertility: what surgery and when?. Fertil Steril. 2014. 101. 608-614.
- Borgfeldt C, Andolf E. Transvaginal sonographic ovarian findings in a random sample of women 25-40 years old. Ultrasound Obstet Gynecol. 1999. 13. 345-350.
- Naem A, Kouba L, Al-Kurdy B. An unusual appearance of a serous ovarian cyst coexisting with endometriosis: A case report. International Journal of Surgery Case Reports. 2020. 67. 130-133.
- Haan J, Verheecke M, Amant F.. Management of ovarian cysts and cancer in pregnancy. Facts Views Vis Obgyn. 2015. 7. 25-31.
- Conway C, Zalud I, Dilena M, et al. Simple cyst in the postmenopausal patient: detection and management. J Ultrasound Med. 1998. 17. 369-374.
- Alcazar JL, Martinez N, Juez L, et al. Ovarian simple cysts in asymptomatic postmenopausal women detected at transvaginal ultrasound: A review of literature. World J Obstet Gynecol. 2015. 4. 108-111.