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What causes ovarian cysts and can they harm my fertility?

What causes ovarian cysts and can they harm my fertility?

Nicole Knight, AHCJ | May 1, 2020 | Getting Pregnant
Medically reviewed by: Dr. Don Aptekar, MD, FACOG

Ovarian cysts are often normal and usually nothing to worry about. Most women get them. In fact, you may make at least one ovarian cyst every month as part of your menstrual cycle and not even realize it unless the cyst causes symptoms (1). 

Still, you may wonder: Can ovarian cysts cause health problems or affect my fertility? The short answer is that it depends on the kind of cyst (2). Here we explain everything you need to know about these very common growths.

 

What are ovarian cysts?

An ovarian cyst is a fluid-filled sac that develops on or in your ovary. Cysts can vary in size from under a half an inch to four inches in size (3). 

Most ovarian cysts are “functional” cysts. These cysts are menstruation-related and tend to go away naturally. The most common types of functional cysts are follicle cysts and corpus luteum cysts (1). Both are related to the egg, which develops in a follicle in your ovary each month.

 

How do ovarian cysts happen?

When the egg matures, it’s released from the follicle and that is ovulation (4). However, if the follicle fails to break open and release an egg, fluid stays in the follicle and forms a cyst (4). This is called a follicular cyst. These cysts often have no symptoms and disappear in 1-3 months (1).

The second type of menstruation-related cyst, a corpus luteum cyst, occurs after the follicle breaks open and releases the egg (1). The empty follicle sac is supposed to shrink down, but sometimes it instead reseals itself and fills up with fluid, making a corpus luteum cyst (1). 

Ovarian cysts also form during fertility treatment. For example, taking the fertility medicine makes you develop more than one egg and therefore, you have more than one cyst (5).

 

Can ovarian cysts affect my fertility?

Follicle cysts and corpus luteum cysts are normal and will likely not affect your fertility (2). Cysts related to polycystic ovary syndrome (PCOS) or endometriosis, however,  may have some affect your fertility (2). Women with PCOS may have small ovarian cysts, along with other symptoms, such as irregular or nonexistent periods, weight gain, and excess hair growth (9). 

Endometriosis may cause a type of cyst called endometriomas (6), also called chocolate cysts, because they contain old blood that becomes brown like chocolate (7).

 

Are ovarian cysts dangerous?

Ovarian cysts usually aren’t cancerous and only rarely need to be surgically removed. Some women of reproductive-age women may develop large cysts that need treatment (1). 

That said, an ovarian cyst that breaks open and bleeds or twists your ovary can cause excruciating pain and other symptoms. You might experience (10):

  • Sharp, sudden pelvic pain
  • Sudden, severe abdominal pain
  • Pain with vomiting or a fever
  • Faintness or weakness
  • Rapid breathing

Any of these symptoms might mean your cyst has ruptured and is bleeding. Contact your healthcare provider right away.

In rare cases, your ovarian cyst may be cancerous (1). The risk of malignant ovarian cysts increases with age (1). Ovarian cancer is found in 1.8-2.2 cases per 100,000 women between the ages of 20 and 29, but rises to 9.0-15.2 cases per 100,000 women between the ages of 40 and 49 (11).

Not sure what’s normal and what’s not in the menstrual cycle? Read about the Phases of the Menstrual Cycle.

 

What can I do about ovarian cysts?

Normally, if you’re ovulating, you may get cysts, but these are normal. However, if they are painful, you can suppress ovulation and prevent forming these cysts by using hormonal birth control (1). 

Generally, your provider tailors your treatment to your symptoms, such as if the cyst is painful (6). If the cysts don’t cause any problems, your provider may suggest monitoring you over a few menstrual cycles using ultrasound — what’s known as “watchful waiting” (6).  Normally these will go away (6). 

The largest study to date shows that most ovarian cysts go away naturally (12). The paper, published in The Lancet Oncology, followed nearly 2,000 women who had been diagnosed with a noncancerous ovarian cyst. 

In the majority of women cysts either disappeared without treatment or didn’t cause symptoms requiring treatment (12). Few women needed their cysts surgically removed (12). Out of the nearly 2,000 women, 12 women who were initially diagnosed with noncancerous ovarian cysts were later diagnosed with ovarian cancer (12). 

However, this doesn’t mean you should worry that a benign ovarian cyst may turn cancerous down the line (12). When scientists reviewed their data, they couldn’t definitively say whether the 12 women were initially misdiagnosed or whether the noncancerous cysts had in fact turned cancerous (12). 

The bottom line is your cancer risk with an ovarian cyst is super low.

 

What are the surgeries for ovarian cysts?

Typically women do not need to have surgery to remove an ovarian cyst (1). The decision to have surgery depends on several factors, including (6):

  • Size of the ovarian cyst
  • Whether you want to become pregnant
  • Your age
  • Family history of ovarian or breast cancer

Your provider might suggest surgery to either remove the cyst or to remove your entire ovary. 

In some cases, your provider may recommend removing an ovary in a procedure called unilateral oophorectomy (UO) (14). The good news? If you have to have an ovary removed, it should not affect your fertility if all else is normal (15).

If you think you have an ovarian cyst, try not to worry. Instead, be proactive and contact your healthcare provider — and get the peace of mind about your health that you deserve.



References

  1. https://www.womenshealth.gov/a-z-topics/ovarian-cysts
  2. https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/expert-answers/ovarian-cysts-and-infertility/faq-20057806
  3. https://www.uptodate.com/contents/ovarian-cysts-beyond-the-basics
  4. https://medlineplus.gov/ency/article/001504.htm
  5. https://www.fertstert.org/article/S0015-0282(01)02283-X/fulltext
  6. https://www.acog.org/Patients/FAQs/Ovarian-Cysts?IsMobileSet=false
  7. https://www.uptodate.com/contents/endometriosis-management-of-ovarian-endometriomas
  8. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome  
  9. https://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS?IsMobileSet=false
  10. https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/symptoms-causes/syc-20353405 
  11. https://www.uptodate.com/contents/approach-to-the-patient-with-an-adnexal-mass
  12. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30837-4/fulltext
  13. https://www.medscape.com/viewarticle/777490_6
  14. https://www.fertstert.org/article/S0015-0282(13)03279-2/pdf 
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336490/
  16. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14913