This one kills me! Why can’t the ED or radiologist tell them this is like finding stool in the bowels? Women with natural periods have cyst every month! These women come in frightened that they have some type of cancer. I must explain to them, “yes you do have an ovarian cyst every month and they typically alternate ovaries”.

Simple ovarian cyst or follicles usually release the egg contained inside once it reaches about 2.2 cm. The water inside the follicle is maturing the egg. Once released the shell of the follicle, corpus lutem, releases progesterone. This is often referred to as the “hemorrhagic cyst”. It may take up to two months for this to fully resolve. This is not an abnormal finding. Much like after a tooth is pulled there is a pocket left.

Excess estrogen is one of the most common types of hormonal imbalance which can cause the disruption of ovulation. This can cause the follicle to grow too big.  When the cyst becomes too large or has not burst, surgery may be needed. However, most of the time they resolve on their own. A repeat sono in 3-4 months may show the resolution of the cyst.

I often start by asking what brought them in to the emergency room to start. They talk of pelvic pain that is usually one sided. They point to where it hurts. Most always it is in combination with abdominal bloating, constipation or diarrhea. We talk about if this is always occurring about two weeks after her period. Most of the time it is random or constant for a week or two. I will start talking to them about the small intestines and how they empty into the large intestine on the right lower abdomen. This is a place noted for spasms. This part of the bowels then moves up to the transverse colon and down to the descending colon. If the pain appears to move with time this maybe IBS or spasms. If the pain originated on the lower left side this maybe constipation or again rectal spasms.

If the pain is more central, start thinking about a UTI, IC or an infection. I once had a nulliparous woman sent to me for recurrent pelvic pain. On discovery, she had a complete hysterectomy. She had been sent to psychiatry because she experienced still pain. Her PCP sent her to me. After her telling me her symptoms I had her lay back for an exam. When I palpated her bowels no pain. But when I palpated her bladder she jumped, “That is where it hurts!” Turns out she IC and NO one looked at the bladder. Now this 28-year-old woman will never have natural children because no one bothered looking at her as a whole.

Balancing hormones with estrogen+progesterone contraceptives usually help diminish ovulation from occurring. So, fewer ovarian cysts are formed. The progesterone-only forms may have higher incidences of cyst. If you are prone to having painful ovulation, perhaps combination estrogen and progesterone is a better choice. In the pas,t combination pills were used to shrink ovarian cyst, but this has not showed to be any more effective than time. Reassurance and NSAIDs may be the best therapy.

See Shelagh Larson, WHNP, NCMP speak in 2017 with Skin, Bones, Hearts & Private Parts in Orlando (April), Myrtle Beach, San Antonio, and Las Vegas.