Ovarian Cysts
Introduction:
Ovarian cysts are common due to the fact that a woman in the reproductive phase of her life goes through cyclical hormone changes where in the first 2 weeks of the menstrual cycle a follicle (=a mini-cyst) develops. This ruptures midway between two periods during ovulation when the egg is released.
In the second half of the hormone cycle (in the 2 weeks before the menstrual period) progesterone type hormones are produced in the former cyst where the egg had matured. Variations of this normal situation lead to ovarian cysts or persistent follicles, which are quite common.
Polycystic Ovary Syndrome
Polycystic ovary syndrome is associated with a more profound change of the entire metabolism. There is now evidence that polycystic ovary syndrome is often associated with the syndrome of insulin resistance or metabolic syndrome (Ref.1). About 7% of women in the reproductive age have this syndrome.
There is a subtle change in the ratio of LH/FSH hormone. These patients have a changed metabolism with insulin and testosterone overproduction. They are usually also overweight and the body appearance is different. They have smaller breasts, a male pattern hair distribution (hirsutism) and are missing their periods or are completely anovulatory and infertile. One of the symptoms is ovarian fullness due to a multitude of cysts, which come from the luteinizing hormone (LH) overproduction. These cysts can rupture and produce a clinical picture similar to a single ruptured ovarian cyst. However, the other physical findings would help with the diagnosis. Also, blood tests would help the physician, where a lipid profile, testosterone level and an increased LH/FSH ratio would confirm the diagnosis of polycystic ovaries (for more info on insulin resistance asssociated with polycystic ovary syndrome, click on this link).
Treatment: In the case of polycystic ovary syndrome a comprehensive treatment protocol is required. A referral to an endocrinologist would be desirable. The endocrinologist will likely suggest some weight loss to help the syndrome of insulin resistance. This has recently also been treated successfully with Metformin, an oral hypoglycemic agent. Progesterone and Spironolactone are also used for this condition.
Ovarian cysts
There is a big difference between single ovarian cysts or polycystic ovary syndrome. The former is usually a follicle that persisted, in other words it did not burst at the time of ovulation. It can produce hormones and lead to irregular periods.
It also can rupture and discharge some blood into the abdominal cavity.
Symptoms:
This would cause abdominal pain, which would come on suddenly. It is located in the right or left lower abdomen depending from which ovary the symptoms arose. As there is pelvic irritation all of the symptoms described for PID or for appendicitis could be there (pain followed by vomiting).
Treatment:
A single ovarian cyst often can be treated conservatively. However, the treating physician must rule out any other more serious cause of abdominal pain such as appendicitis or an ovarian tumor. Often a diagnostic laparoscopy has to be done by a surgeon or gynecologist.
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