The Difference Between PCOS Cysts and "Normal" Cysts

The word cyst can sound scary. Oftentimes they are nothing more than a normal part of ovulation or a fluid filled sac that has developed on an ovary. In some cases they can be caused by PCOS or can be malignant such as in ovarian cancer. Normal ovulatory cysts are not caused by PCOS and are typically completely normal and even expected.  

I will be briefly describing the various types of cysts, and at the end you will find a simple chart summary of the differences between "normal" ovulatory cysts and PCOS cysts.

Functional "Normal" Ovulatory Cysts

These are a completely normal part of ovulation. Each month when you ovulate a cyst forms outside your ovary. This cyst is called a follicle. It grows to about 20-25mm in size! Eventually the cyst opens and releases the egg into the fallopian tube for fertilization. 

Some women can actually feel the cyst opening. This has a fun name, it's called "mittelschmerz" pronounced MITT-ul-shmurz. It is a German word, meaning "little pain".

Since this is a normal part of ovulation, ovulatory cysts do not impact a woman's ability to get pregnant.

Pathological Cysts (Benign and Malignant)

Benign cysts grow slowly and are unrelated to ovulation. They can grow quite large, and sometimes need to be removed via laproscopic surgery if they become bothersome. They can be filled with fluid, endometrial tissue, or even tissues from organs like skin, hair, bone tissue, and sometimes internal organs!

Malignant cysts are the cause of ovarian cancer. These types of cysts can mimic benign cysts in size which can make them difficult to diagnose. Luckily less than 1% of ovarian cysts are malignant, and they typically occur in women over 50. Some symptoms to look out for include pain with intercourse, increased urination, issues with elimination/constipation, feeling a mass in your lower abdomen, bloating, and fatigue, but sometimes you can have no symptoms at all. 

In general, pathological cysts can and do have the capacity to impact your fertility negatively. 

PCOS Cysts

PCOS cysts are actually a bunch of immature follicles. In a woman with PCOS, LH (leutenizing hormone) and FSH (follicle stimulating hormone) are not active in the correct ratio for a normal ovulation. Normally the amount of LH and FSH circulating in the body are relatively close. In a woman with PCOS, FSH is lower and LH is higher. This is enough to not allow for proper ovulation. Instead many tiny immature follicles are made on the ovary. None of the follicles are mature enough to release an egg that can be fertilized.

It is important to note that 8-25% of women with normal ovulation may have findings on an ultrasound that are consistent with PCOS ovaries, and not all women with PCOS will have they typical polycystic ovaries at ultrasound. 

I like to describe PCOS as a syndrome and not a disease, as the symptoms and severity vary between women. PCOS is the number one cause of ovulation disruption and 1 in 12 women have PCOS.

Symptoms of PCOS include:

• Irregular periods
• Obesity
• Infertility
• Male pattern hair growth or hair loss
• Acne
• Oily skin
• Dark patches on skin

Lets compare "normal" ovulatory cysts to PCOS cysts: 

In Summary

PCOS is different in everyone, but in most causes ovulation is impacted because of hormonal imbalances causing follicles not to mature properly.

Treatment of PCOS requires lifestyle changes including, diet and exercise, there are also some natural treatments that can help balance hormones in women with PCOS these include; botanicals like vitex, cimicifuga, tribulus, glycyrrhiza, peony, and cinnamon, NAC for insulin irregularities, and myoinositol. Since PCOS is different in each woman, it is important to work with a clinician who is well versed so treatment can be tailored to your specific case. 

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