Ovarian Cysts

What are ovarian cysts?

Ovarian cysts (cystadenomas) are normal ovarian follicles that have overfilled with fluid from the presence of too much estrogen. With an ovarian cyst, a normal ovarian follicle fails to burst on time to release the egg, and continues growing beyond its normal size. Instead, it’s stalled in the pre-ovulatory phase for too long, growing between 2cm and 10 cm in size. When cysts grow large enough they can start to impact the other pelvic organs, pushing against them, or causing bloating, nausea, pain, or irregular spotting. If a large ovarian cyst bursts, this can cause severe acute pain and give you the symptoms of an infection, like fever and vomiting.

Causes

  • Estrogen is known to stimulate cell proliferation, and an excess of estrogen may lead to abnormal growth of ovarian cells, potentially contributing to the development of cysts.

    When estrogen cannot exit the body through healthy estrogen metabolism, it recirculates, causing excess estrogen in relation to progesterone.

    Learn more about estrogen metabolism here.

  • Serous cystadenomas typically arise from the cells lining the surface of the ovary, known as ovarian surface epithelial cells. These cells are part of the ovarian epithelium.

    The fluid within the cyst is usually serous fluid, which is a clear, watery fluid. The cyst develops as a result of abnormal growth and proliferation of these surface epithelial cells. The exact mechanism leading to the accumulation of fluid within the cyst is not fully understood, but it is associated with changes in the normal regulation of cell growth and differentiation.

  • Hormonal IUDs are known for causing ovarian cysts in 5-10% of users. 

  • Environmental factors, lifestyle choices, and certain medical conditions can contribute to endocrine disruptions, affecting estrogen metabolism. These disruptions may impact the normal regulation of ovarian function and increase the risk of cyst formation.

Symptoms

  • This is one of the most common symptoms. The pain can range from a dull, aching sensation to sharp and intense pain. It may be more noticeable during certain activities, such as sexual intercourse or physical exertion. Some with ovarian cysts may experience a sensation of pelvic pressure or fullness, especially if the cyst is large.

  • Ovarian cysts, particularly larger ones, can cause the abdomen to feel bloated or swollen.

  • Cysts may affect the menstrual cycle, leading to irregular periods or changes in the duration and flow of menstruation.

  • People with ovarian cysts may experience increased menstrual pain.

  • Some people may feel pain during ovulation, known as mittelschmerz, and ovarian cysts can contribute to this discomfort.

  • Cysts may cause pain or discomfort during sex.

  • Large cysts can put pressure on the bladder, leading to an increased urge to urinate.

  • In some cases, cysts may exert pressure on the rectum, causing discomfort during bowel movements.

Diagnosis

  • This is the most common and effective imaging tool for diagnosing ovarian cysts. Transvaginal ultrasound, where a probe is inserted into the vagina, provides detailed images of the ovaries and helps determine the size, location, and characteristics of the cysts.

  • In some cases, an abdominal ultrasound may be performed to visualize the ovaries from the outside of the body.

Treatment

  • Conventional treatment for ovarian cysts is similar to fibroids in that there is nothing typically recommended if a cyst is smaller than 5 cm.

    Most patients are counseled with a wait and see approach. Sometimes birth control is recommended to suppress follicular growth. However, this does nothing to address estrogen metabolism.

    Burst ovarian cysts are treated with pain medication. Surgical removal of cysts is not typically recommended.

  • At the root of all of this is prevention. We are trying to restabilize the normal path of estrogen metabolism so that estrogen can come in, do its job, and properly be excreted afterwards.

    Be gentle with your liver during the healing process and avoid alcohol, which can vastly increase your exposure to estrogen. Support your liver with herbs like milk thistle, dandelion and burdock. These can be taken as infusions or tinctures. Or you can try taking glycine.

    Work on healing your gut by eating a gentle diet, dealing with gut permeability, histamine intolerance, or gut dysbiosis where bad bacteria are able to wreak havoc allowing estrogen to be reabsorbed in your body.

    Support your gut with gentle warming foods like bone broth and other animal foods like meat, shellfish, fish, eggs, animal fats, fermented foods like kimchi and kefir, fruit and cooked vegetables. Sugar, grains, beans, legumes, and raw vegetables, should be avoided during gut healing protocols.

    Avoid antibiotics and pharmaceuticals if possible, which can damage healthy gut bacteria

  • Reduce inflammatory foods like sugar, gluten, Holstein conventional cows dairy, and other histamine containing foods to avoid the effects of insulin resistance and histamine intolerance

    Take magnesium and zinc to reduce inflammation.

  • A major risk factor for ovarian cysts is thyroid disease and specifically hypothyroidism. If you have recurrent ovarian cysts, thyroid investigation is useful. Correcting the underlying thyroid problem can be key to eliminating the future growth of ovarian cysts. 

  • Progesterone naturally counteracts the effects of estrogen. Maintaining a healthy ovulatory cycle will help prevent reoccurrence.

  • Work with B-vitamins, calcium d-glucarate, selenium, and eat iodine rich foods.

    Take a probiotic containing lactobacillus casei

    Try micronized progesterone in the post-ovulatory phase to help counterbalance the effects of estrogen.

  • Similar to fibroids, avoiding alcohol and xenoestrogens is useful, and focusing on liver and gut health will help you get your estrogen metabolism back on track. 

How Charting Helps with Ovarian Cysts

  • Use your charts to describe the color and consistency of your blood and bleeding patterns

  • Use cervical fluid as a diagnostic sign to measure estrogen levels throughout the cycle

  • Look for multiple patches of cervical fluid that are sporadic or extend beyond the fertile window

  • Some people observe mucus every single day, identifying high estrogen

  • Monitor basal body temperatures to better understand if your cycles are ovulatory and if you are making adequate progesterone

  • Collect other kinds of health data and symptoms. If you notice tender breasts, or heavy bleeding, premenstrual irritability, and even depression are other markers of estrogen excess

  • Follow the healing process and changes in your charts after improving estrogen metabolism, supporting progesterone, and reducing exposure to xenoestrogens

Other Types of Cysts

  • Contain tissue such as hair, skin, or teeth because they develop from cells that produce human eggs.

  • Form in people with endometriosis, a condition where tissue similar to the lining of the uterus grows outside the uterus.

Clearing the Confusion With Cysts

  • Two normal parts of the menstrual cycle are also called cysts.

  • Functional cysts include the pre-ovulatory ovarian follicle that produces estrogen, and the post-ovulatory follicle that produces progesterone

  • Harmful cysts include cystadenomas, dermoid cysts, and endometriomas

  • PCOS “cysts” refers to multiple ovarian follicles that are in various stages of underdevelopment, combined with androgen excess

  • It can be normal to see multiple follicles on the ovary during an ultrasound