Written by: Dr. Olivia Carpinello, reproductive endocrinology and infertility specialist at CCRM Fertility of Northern Virginia
If you have ovaries, chances are you’ll have an ovarian cyst at some point in your life. Fortunately, most ovarian cysts are harmless, don’t cause any symptoms, and will go away on their own. Some ovarian cysts can cause pain and bleeding, and in some instances, they can affect your fertility. Whether or not a cyst will impact your chances of pregnancy depends on the type of cyst, the size of the cyst, and if surgery is required.
Here, we’ll discuss the different types of ovarian cysts, what affect cysts can have on fertility, and the treatment options available.
What is an ovarian cyst?
Ovarian cysts are sacs filled with fluid or a semi-solid substance that form on or in the ovaries. Often, ovarian cysts form as part of the normal menstrual cycle. Some cysts produce hormones, while others do not.
Types of ovarian cysts
Ovarian cysts fall into two categories: functional and nonfunctional. Functional cysts are more common than nonfunctional cysts and occur as a normal part of the menstrual cycle. Functional cysts are rarely cause for concern and typically don’t impact fertility.
Types of functional ovarian cysts
Follicular cysts
At the start of a normal menstrual cycle, a group of eggs has been pre-selected from the overall pool of eggs, and each egg is contained in a fluid-filled sac, called a follicle. One follicle is selected to be the dominant follicle, which will ultimately ovulate its egg. The dominant follicle grows and accumulates more fluid throughout the follicular phase (prior to ovulation). While it grows, it produces increasing amounts of estrogen. This dominant follicle may be referred to as a cyst, but is actually a very normal part of the menstrual cycle. If the follicle fails to ovulate its egg, it continues to swell and can develop into a larger follicular ovarian cyst. Follicular cysts are typically 3-5 cm in size and go away on their own, but occasionally they can grow larger in size. In that rare instance, they may require surgery.
Corpus luteum cysts
After ovulation, the empty follicle forms the corpus luteum, which is a hormonally active cyst on the ovary. The corpus luteum produces progesterone and estrogen to help prepare the uterus for pregnancy. If fertilization doesn’t occur, the corpus luteum breaks down, and the decrease in estrogen and progesterone triggers menstruation. Occasionally, the corpus luteum doesn’t break down as it should and ends up closing and filling with fluid to form a corpus luteum cyst. While corpus luteum cysts typically go away on their own, they can grow large in size causing pelvic pain and bleeding.
Types of nonfunctional ovarian cysts
Hemorrhagic ovarian cysts
If corpus luteum cysts rupture or bleed, they’re known as hemorrhagic cysts. Some people experience vaginal bleeding and pelvic pain with hemorrhagic cysts, but you may not notice any symptoms. In the most severe cases, persistent bleeding from the cyst into the pelvis may require surgery. While they don’t tend to cause fertility concerns, surgery to treat this type of cyst may affect fertility.
Ovarian cystadenomas
Cystadenomas are fluid-filled growths that can grow to be greater than 10 cm in size. They don’t cause infertility, but they may need to be surgically removed. Although sometimes referred to as a tumor, they are usually benign, meaning they aren’t cancerous.
Ovarian dermoid cysts
Ovarian dermoid cysts consist of cells that were present during fetal development and might contain skin, oil glands hair, or even teeth. While dermoid cysts are typically benign, they don’t resolve on their own and can grow large in size. Large dermoid cysts can cause ovarian torsion, and they can also rupture causing infection, so surgical removal is often necessary.
Endometriomas
Endometriomas, also known as endometrioid cysts, are caused by endometriosis. This is when tissue similar to the uterine lining (endometrium) grows outside the uterus where it doesn’t belong. The tissue that grows on the ovaries (referred to as “chocolate cysts”) cannot shed during menstruation, which may cause pelvic pain, and could impact your ability to conceive.
Polycystic ovaries
Some individuals develop numerous, small cysts on their ovaries, which are referred to as polycystic ovaries. These cysts are follicles. Each follicle contains a microscopic egg. Individuals with polycystic ovary syndrome (PCOS), tend to have trouble ovulating, so there are lots of follicles waiting to be “selected” as the dominant follicle for ovulation. Individuals with PCOS may have irregular periods, hormone imbalances, and trouble getting pregnant due to problems with ovulation. Certain lifestyle changes (diet and exercise), as well as medications can help manage PCOS symptoms.
Malignant ovarian cysts
This rare type of cyst is seen when you have ovarian cancer. Ovarian cancer mostly affects older women. If you do have ovarian cysts, it’s important to address them with your doctor in order to make sure they aren’t cancerous.
Symptoms of ovarian cysts
The symptoms you can have with ovarian cysts depend on the type of cyst and can range from mild to severe. Some common symptoms of ovarian cysts can include:
- Pain in the lower abdomen
- Irregular or heavy periods
- Spotting
- Pain with urination
- Constipation
- Feeling bloated
- Cramping
When to see a doctor
If you experience any of the following symptoms, please see your doctor right away. The symptoms could be a sign of a cyst rupturing or ovarian torsion:
- Sharp, sudden, severe pain
- Severe abdominal cramping
- Nausea and vomiting
- Dizziness, feeling faint
- Rapid heartbeat
How do cysts impact fertility?
If you have an ovarian cyst, it doesn’t mean you’ll have difficulty getting pregnant. In certain cases, it’s not necessarily the cyst itself that causes fertility issues, but rather what is causing the cyst to form. For example:
With PCOS, hormone imbalances prevent ovulation from occurring. Without releasing an egg, you can’t get pregnant.
With endometriosis, not only do cysts form, but the condition itself can affect how the uterus, fallopian tubes, and ovaries function. This can make it more difficult to get pregnant.
In other cases, the treatment of the cyst with surgery can affect fertility. No matter how skilled the surgeon, removal of a cyst results in some damage to the remaining ovarian tissue. This can decrease the size of the remaining pool of eggs a woman has. Women are born with all the eggs they will ever have, so once they are gone, there is no way to get them back. Some women pursue fertility preservation with egg freezing prior to undergoing surgery for cysts for this very reason.
Treating ovarian cysts
Most ovarian cysts are harmless and resolve on their own. In fact, treatment is only necessary in about 8% of premenopausal women with ovarian cysts. After your doctor confirms you have ovarian cysts (typically, through a pelvic exam and/or ultrasound), they will provide recommendations for treatment depending on the type, size, and the symptoms the cyst may be causing.
You may be prescribed hormonal birth control to help reduce the size of cysts or prevent more from forming. If ovarian cysts are causing pain, you may take over-the-counter pain medication or prescription pain medication.
In some cases, cysts can grow larger, don’t go away, are painful, or cause some other concern and your doctor might recommend surgery. Your doctor will go over the risks and benefits of having surgery to remove ovarian cysts.
Unfortunately, there’s not a lot you can do to prevent ovarian cysts, but if they continue to form, you may need to take hormones to prevent ovulation from occurring, which can decrease your chances of getting cysts.
Talk with a fertility doctor if you have a history of ovarian cysts and are having difficulty getting pregnant, or if you currently have a cyst and are contemplating surgery to remove it. You and your doctor can develop a personalized treatment plan in order to give yourself the best possible chances of conceiving.
Contact us today to make an appointment with a CCRM Fertility specialist.
