By Joseph Feste, M.D., FACOG, AACS, AACG

Most ovarian cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one.

What is a functional ovarian cyst? There are usually two types of functional cysts, one called a follicle cyst the other a corpus luteum cyst. The cysts are called functional because they are normal but can develop into problems of pain, bleeding and missed periods. They are different from cancer and other ovarian tumors.

The follicle cyst develops as the ovary is stimulated by FSH (follicle stimulating hormone from the pituitary) and the ovum within the cyst is maturing to eventually be ovulated. An analogy is  a “bubble like structure on the ovary that is filled with fluid and estrogen.  As the ovum matures and the cyst grows, then the egg or ovum is released and the surface of the cyst closes and then begins to produce progesterone.  This cyst is then called the “corpus luteum”. For the most part both of these cysts cause no pain or problem but occasionally a woman will notice a little discomfort when the egg is released (ovulation).

What causes functional ovarian cysts? A functional ovarian cyst forms when there are functional changes in the way the ovary makes or releases the egg. Most follicle cysts are about 2 centimeters in diameter or a little larger. But when the ovary doesn’t release the egg the “sac” swells up with fluid and can become painful.  If the egg is released the “sac” fills up with fluid, containing progesterone, and is usually not large.  If it fills up with too much fluid then it becomes painful and is called a functional corpus luteum cyst;

What are the symptoms? Most functional ovarian cysts do not cause symptoms. The larger the cyst is, the more likely it is to cause symptoms. Symptoms can include:

  • Pain or aching in your lower belly, usually when you are in the middle of your menstrual cycle.
  • The cyst can twist on its pedicle and cause severe pain
  • A delay in the start of your menstrual period.
  • Vaginal bleeding when you are not having your period.

More severe symptoms include:

  • Sudden, severe abdominal or pelvic pain
  • Nausea and vomiting
  • Sudden faintness, dizziness, and weakness
  • Vaginal bleeding or symptoms of shock from heavy bleeding (hemorrhage) (very rare) 

How are functional ovarian cysts diagnosed? An ovarian cyst can be diagnosed during a routine pelvic exam. It also may be necessary to use a pelvic ultrasound to make sure that the cyst is not too large and filled with fluid and hasn’t ruptured. The ultrasound can also differentiate a functional cyst from an abnormal cyst or tumor in most cases.

 How are they treated? Most functional ovarian cysts go away without treatment. It will also help to use heat and pain medication to relieve minor pain. If a large cyst bleeds or is causing the ovary, because of the size of the cyst, to twist or bleed and causes severe pain it may require a laparoscopy (belly button surgery) to either remove it , untwist it or drain it out and/or stop bleeding.

Other ovarian growths: There are other types of ovarian cysts and growths caused by other conditions. An ovarian growth can be a noncancerous (benign) cystic tumor or related to endometriosis or cancer. In some cases, what seems to be an ovarian mass is actually growing on nearby pelvic tissue. This is why it’s important for you to have regular pelvic exams and for your doctor to carefully diagnose any cysts or growths felt on your ovaries.

Cysts after menopause.  After menopause ovarian cancer risk increases. This is why all postmenopausal ovarian growths are carefully checked for signs of cancer. Some doctors will recommend removing the ovaries (oophorectomy) when any kind of cyst develops on an ovary after menopause. But the trend in medicine seems to be moving away from surgery for small and simple cysts in postmenopausal women. In the 5 years after menopause, some women will still have functional ovarian cysts now and then. Some postmenopausal ovarian cysts, called unilocular cysts which have thin walls and one compartment, are rarely linked to cancer..

How can you prevent a functional cyst? Progesterone. Since it is unusual for most functional cysts to reoccur, one can usually not worry about a recurrence.  However, should one have recurrent functional cysts, birth control pills have been suggested but I prefer to use natural progesterone from day 14 to 28 of each cycle, 100mg twice a day. This will usually suppress the FSH during the two weeks after ovulation while on the progesterone and make the chances of follicle cyst unlikely during the first two weeks of the following cycle. Progesterone will also suppress the corpus luteum cyst after ovulation from getting two large.

Disclaimer: Much of the information in this blog is based on personal experience and on information gleaned from multiple scholarly articles. The information is believed to be factually accurate.

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