Lately, I’ve seen a lot of misconceptions and questions regarding PCOS cysts. Many women believe they are the same as ovarian cysts, that they can grow and rupture. The same women believe it is their PCOS cysts that are causing them pain. The misconception comes mostly from the name of the syndrome – polycystic ovarian syndrome – which basically tells you that you have multiple ovarian cysts. Doctors should know the truth, but many send women home after their diagnosis without explaining too much. Here’s what you need to understand about each type of cysts.
What are PCOS cysts?
First of all, PCOS cysts are not actually cysts. In each cycle, during the follicular phase, your ovaries will start making follicles. If everything goes well, your luteinizing hormone (LH) will rise mid-cycle, triggering ovulation. At this moment, one of the follicles becomes dominant and releases the egg, while all the other follicles dissolve and disappear until the next cycle. In women with PCOS, this process doesn’t always take place as it should. The causes of late ovulation or anovulation vary, but the result is usually the same – the famous string of pearls (polycystic aspect) seen on the ovaries during an ultrasound. Those “cysts” are simply follicles that remain in the ovaries because none of them can mature enough to release an egg. They will not grow in size and they can not rupture, like classic ovarian cysts.
What are ovarian cysts?
Ovarian cysts are fluid-filled sacs that form on the ovary. They usually cause no symptoms. They can grow in size, but they can also dissolve on their own. For this reason, the usual approach is “watch and wait”. If they grow to a worrisome size or start causing pain, surgery might be needed. These cysts can also rupture in rare cases, causing acute pain that sends women to the ER in most instances. Symptoms of ovarian cysts include bloating, lower back pain or lower abdominal pain.
These types of ovarian cysts are common. They are a sign of a potential hormonal imbalance, but at the same time, unless they cause problems, grow to worrisome sizes or rupture, they are not really a cause for concern. They are, after all, called functional cysts. Also, they are benign and even if you have several cysts over time, that do cause pain or other symptoms, it is not a sign you will get cancer.
There are also cysts that are not filled with fluid, but instead are solid, containing things like hair, skin, bone, and more. These are called dermoid cysts. These grow slowly, will not dissolve on their own, and many will require surgery to have them removed, depending on the size of the cyst and the symptoms they cause. While they can be qualified as tumors, they are almost always benign and not a precursor to ovarian cancer, as some wrongly believe.
Functional ovarian cysts with PCOS. Is this possible?
Yes, you can have functional ovarian cysts with PCOS. The two are unrelated, though some might say the hormonal imbalances that come with PCOS might put you at a bigger risk. Studies are, however, still unclear on how much PCOS increases the risk of ovarian cysts, if at all.
You can have ovarian cysts without having PCOS. But they can also co-exist.
I was told I have PCOS but not polycystic ovaries. Am I misdiagnosed?
Not necessarily. You can have PCOS without cysts. The Rotterdam criteria for diagnosing PCOS says only 2 out of 3 conditions must be met:
- irregular/absent periods
- high androgens
- polycystic ovaries
You can have PCOS without having polycystic ovaries.
As you can see, you can have PCOS without polycystic ovaries. In fact, many suggest that if only conditions 1 and 3 are met, further investigation is necessary, because they can be found in other conditions such as hypothalamic amenorrhea. Whether you have functional ovarian cysts or not is not dependant upon your PCOS diagnosis.
Ovarian pain with PCOS
Another “monster” in the room that should be addressed is ovarian pain that sometimes women with PCOS feel. Most are told this is due to their cysts, even though the only cysts that their doctor had seen were the PCOS ones. However, most medical professionals will agree these cysts do not cause pain. So what happens to these women?
There are a few possibilities, but they usually all go around the fact that the ovaries are trying to work. If you practice the fertility awareness method, you might notice that the pain comes at times when you appear fertile, i.e. you have a lot of fertile cervical mucus. In this case, you pain could be ovulation pain. Sadly, in PCOS an ovulation attempt doesn’t always mean ovulation actually occurs. So you might get multiple instances of this pain, instead of just one round like common mittelschmerz. The other possibility is that you did in fact develop a functional ovarian cyst that grew in size and is now causing symptoms. If your pain lasts for longer than a day, is not relieved by painkillers, is unbearable (even if it only just started, don’t wait a day for sharp, acute pain!), go see your doctor!
Ovarian cysts and PCOS cysts are different. For your ovaries to be truly polycystic, in a PCOS definition, new studies suggest you need over 25 follicles that can be counted on ultrasound. It is, however, entirely possible to have PCOS without polycystic ovaries. Ovarian cysts are entirely different. It is believed that the majority of women will have an ovarian cyst at some point in their lives. They will not necessarily have any symptoms. Are you at a greater risk of developing functional ovarian cysts if you have PCOS? You might be. Or you might not. Science is sadly unclear on the matter. Some say you are, but there are also those who swear by the fact that you are not. When in doubt, always seek medical attention.