Ovarian Cysts: Common Types of Ovarian Cysts

By Arlene Franks (New York Staff Writer)

Some ovarian cysts are not cysts at all, but rather are “tumors”. Those can be benign or malignant…..and usually require surgery as part of treatment. All the natural treatment in the world won’t get rid of them, BUT here’s the good news…. 97% of ovarian masses are “cysts” that you CAN get rid of and prevent “naturally”. Here’s a primer about this group of “physiologic” or “functional” cysts….

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. This is an ultrasound showing a simple ovarian follicular cyst (the black egg looking area). Notice it has nothing inside it…no solid parts, no separations (called septations).

Follicular cysts are not “tumors”, which are actual abnormal cell growths or lumps on the ovary. You need to know the difference. Before deciding upon what treatment is needed, it is crucial to understand the difference between different types of cysts and to understand that some of them are not cysts at all. Some are actually tumors that are hollow and look like cysts on an ultrasound or other scan. Rarely, some can even be CANCER, and you do not want to mess around with wrong treatments for that. It’s far more effective and safer, to find a natural approach to treatment when you know what you have!

How do you know if you have a follicular cyst? The best test is a pelvic ultrasound. Just like the one above.

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 in any one person. There are literally millions of hormone dependent biochemical processes active in your body. From time to time, any one of these could go slightly astray and cause problems, including ovarian cysts. If cysts keep arising, then there may be more serious metabolic problems in your body that require attention. In any case, we know enough to give you VERY good ideas about what you can act on starting right now!

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, like a pressure feeling in the pelvis, and some are basically surgical emergencies, like torsion. That is a twisting of the ovary on it’s own blood supply. You should know about this and act on it rapidly or you can lose one of your ovaries if you delay.

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. The trick is how you can make them go away faster and how to prevent it from happening again.

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. But there are some pretty good signs 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 a bigger surgery if you delay. So, it’s VERY important to know what it what.

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, or CLC for short. 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 into surgery that you don’t need.

You can get some of these cysts during pregnancy, and they are normal. The question is how do you know if this is that kind of a cyst or something you need to worry about. It is all based on what is seen on the ultrasound and symptoms and signs you may be having.

So, 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 Corpus Luteum or CLC is the culprit. However, it is important to make sure a pregnancy test is ordered because these same findings may be there because of 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 non-physiologic 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 Corpus Luteum or CLC ruptures, the amount of bleeding and/or pain may cause this to be a surgical emergency. That’s unusual but there are medications and herbs you may be taking that could make it much worse. You should get to know what these are and what the problems might be.
Unfortunately, one third of women (33%) who have a problem with bleeding from a Corpus Luteum or a CLC will have it happen again, possibly over and over. Knowing what you can do to prevent these 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 or 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 20-30cm on both sides. How does this happen? The answer is simply hormonal over-stimulation of the ovaries, usually 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 over-stimulation 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.

As always, you need to have a trusted healthcare practitioner with whom to discuss all of these issues. Only someone who is taking care of you and can examine you and look at all of your records can render a complete opinion about your best options. Use this information as guidance only and find yourself a doc you can trust!

Hope this helps get you going in the right direction. Truly, this topic has had many books written on it, unfortunately most of which are medical textbooks or are written by well-meaning people that simply don’t know enough to separate scientifically based truth from hype. This can become a bit misleading.