OVARIAN CYSTS
The term cyst implies a fluid-filled sac. Ovarian cysts refer to follicles that are underdeveloped, not containing or releasing eggs, or not collapsing after ovulation (egg release), therefore leading to their non-functional persistence as a cyst.
Cysts in the ovary may be present part of the normal course of the menstrual cycle (functional cysts) and may not cause symptoms or require any intervention. These can also occur normally during pregnancy. Many of these cysts disappear spontaneously.
CAUSES
PCOS and endometriosis are two different conditions causing period (menstrual) problems in women, and sometimes ovarian cysts.
In spite of the name, many women with PCOS may not have ovarian cysts. In those that do, the cysts themselves usually do not cause symptoms or problems.
Endometriotic ovarian cysts are also called chocolate cysts due to the presence of old blood in them, and these cysts cause symptoms especially when large.
Apart from PCOS and endometriosis, other causes of ovarian cysts include ovarian or pelvic infections, trauma, some fertility drugs, and certain tumors of the ovary.
How to Differentiate the Cause of the Ovarian Cyst.
Polycystic Ovary Syndrome (PCOS) is a condition that affects the normal functioning of the ovaries, and ovulation. PCOS occurs possibly due to an increase in the level of androgens (male hormones) over and above the small amount that all women naturally have, and often there is underlying insulin resistance (body not responding well enough to insulin).
Endometriosis is a condition where the lining tissue of the uterus (endometrium) grows outside of it in other organs like the ovary, fallopian tube, associated spaces or support ligaments and rarely the intestines, rectum, diaphragm, etc. The cause of this is linked to excess estrogen (female hormone).
PCOS and endometriosis can occur together also.
SIMILARITIES between PCOS and endometriosis in their presentation are as follows:
Menstrual Problems in the form of irregular cycles, heavy bleeding and painful periods are present in both conditions.
Age groups affected can include mid-teens to mid-40s, and in both conditions, the irregular cycles and impact on the functioning of the ovary can create some challenges in getting pregnant.
Both conditions can have an adverse psychological impact, affect daily routines and activities, as well as reduce the quality of life.
DIFFERENCES in the manifestation of PCOS and endometriosis give a clue as to which is the condition:
Pelvic pain
PCOS: Pain (dysmenorrhea) and heavy bleeding may be present during periods. But otherwise, pain is rare.
Endometriosis: Pain is the hallmark symptom that is usually sudden, shooting or cramp-like that comes at any time not essentially related to the period but can worsen around that time. Pain can also be present during sexual intercourse, urination, and bowel movement.
Menstrual pattern
PCOS: Delayed periods, prolonged absence, or missed periods and/or unpredictable irregular periods are hallmark symptoms.
Endometriosis: Periods may be heavy and painful, and there may also be bleeding in between periods.
Other symptoms
PCOS: Increase in body hair (coarse hair on the face, chest, abdomen, or upper thigh referred to as hirsutism), hair fall sometimes leading to male pattern baldness, and oily skin or severe acne not responding to usual treatments, may be seen, often along with weight gain or inability to lose weight.
Endometriosis: Bloating and indigestion may be seen, but the signs mentioned for PCOS above are usually not present.
RISK FACTORS
PCOS- family history, rapid weight gain or being overweight or obese, and presence of diabetes or insulin resistance (body is unable to effectively use insulin).
Endometriosis: early onset of menstruation (<11 years of age), periods which are frequent (<27 days) and/or heavy/prolonged (>7 days) and presence of infertility or never giving birth.
There may be a slightly increased risk of cancer (ovarian/uterine) with both these conditions.
MANAGEMENT
Diagnosis is usually made by history, clinical examination and ultrasonography. Other tests include a BP check and blood tests (complete blood counts, sugar and insulin levels, lipid profile, thyroid check, along with hormone levels, and sometimes inflammatory markers like CRP and tumor markers like CA-125).
A balanced nutritious diet and regular exercise are recommended, with the use of medicines for pain (over-the-counter analgesics) when needed.
Oral contraceptives (estrogen-progesterone combination) are commonly prescribed in both conditions to regularize hormone levels. Other hormonal treatments may also be used. Fertility medicines/treatment is given to those desiring pregnancy.
The ovarian cysts in PCOS itself usually require no intervention. In endometriosis, surgery, to remove the endometrial growth, or symptomatic large endometriotic cysts (sometimes the affected ovary itself) may be performed. In case of high-risk or suspected cancer, removal of the ovaries with or without the uterus is also considered, especially when nearing menopause.
COMPLICATIONS
When the cysts are large and also cause enlargement of the ovary, which is seen mostly with endometriotic cysts, there can be complications like rupture of the cyst or torsion.
Rupture can happen due to rigorous physical activity or intercourse, leading to severe pain and sometimes internal bleeding (hemorrhage).
Torsion is due to an extra mobile large ovary twisting itself, leading to abrupt and severe pain, sometimes along with, nausea and vomiting. Torsion can lead to loss of blood flow to the ovary. Such complications should be treated immediately as an emergency.
Also read:
Endometriosis: 5 Important Points for Understanding and Awareness