Ovarian Cysts, Polycystic Ovaries and PCOS: What’s the Difference?

You’ve probably heard of ovarian cysts and polycystic ovaries, but do you know what they are, how they differ, and what symptoms to look out for? Don’t worry if not: we’re here to help.

Let’s start with the basics:

What’s in an ovarian cyst?

That depends what type it is.

Functional cysts are the most common. They form when the ovary releases an egg but the sac it comes in doesn’t break up as it’s supposed to.

Cystadenomas are made up of cells from the surface of the ovary which become filled with fluid. They can either be serous, which means the fluid is thin and watery, or mucinous, where the fluid is thicker and stickier. The latter can be 12 inches in diameter or larger.

Endometriomas are a complication of endometriosis: lumps of uterine tissue that grow on or in the ovaries and fill with blood. They can grow to the size of grapefruits and may cause pain and infertility.

Dermoid cysts are made up of cells from other parts of the body, so can contain skin, hair, and teeth. (Do yourself a favor: don’t image search them.) We’re born with them and they grow as we get older.

What are the symptoms?

You might not have any. Many of us will have a cyst without even realizing. If it keeps growing, ruptures, or becomes so heavy that it twists your ovary, however, you’ll know about it.

Ongoing symptoms can include: abdominal or pelvic pain; menstrual changes (such as a heavier flow); pain during sex; increased urination; pain during bowel movements; weight gain; and bloating, indigestion, or heartburn.

A sudden sharp pain might mean a cyst has ruptured or twisted, which could lead to an infection. See a doctor straight away, especially if you also have a fever, vomiting, or rapid breathing.

What’s the treatment?

If your cyst is causing pain or other symptoms, or growing quickly, you’ll probably need surgery, sorry. If your doctor discovers a cyst during a pelvic exam and it isn’t causing problems, he or she will probably just want to monitor it. They may also test your hormone levels to check it’s not cancerous, but don’t panic – that’s rare.

So, how do polycystic ovaries and PCOS fit in to all this?

Polycystic means “many cysts”, but it’s not just a case of having a lot of ovarian cysts. These are much smaller, more plentiful (usually at least 12), and form inside the ovaries when follicles fail to mature into eggs. They’re not necessarily a problem: as many as one in three of us have polycystic ovaries without any symptoms.

But one in ten of us has polycystic ovary syndrome (PCOS), which is diagnosed when someone has two of the following: polycystic ovaries; very irregular or non-existent periods; and an excess of testosterone. So you can have polycystic ovaries without PCOS and PCOS without polycystic ovaries. (Aren’t bodies fun?)

More about PCOS:

Symptoms often include irregular periods, excess body and facial hair, acne, weight gain, and fertility problems. People with PCOS are also more at risk of type 2 diabetes, high cholesterol, and high blood pressure. (Such fun.)

There’s surgery to remove or destroy part of an ovary, thus reducing the number of cysts, which can improve symptoms and make it easier to conceive. But the benefits might only be temporary. A doctor will probably recommend exercise and a balanced diet to help reduce symptoms, and possibly birth control pills, which block ovulation and stop more cysts from forming.

So there we have it: the wonderful, bamboozling, somewhat disgusting world of cysts. Hopefully you now have a better idea what can happen in and around your ovaries – and will remember to never, ever, image search a dermoid cyst. Seriously.