I have ovarian cysts, does that mean I have PCOS?

If you’ve ever heard of or experienced ovarian cysts, you might immediately think they have something to do with polycystic ovary syndrome (PCOS) and vice versa. The two, however, aren’t exactly the same thing. 

If you’ve been dealing with health problems like ovarian cysts or PCOS or think you may have symptoms of either, Maple can help. Maple is a virtual health platform that gives you access to Canadian-licensed doctors and specialists, such as gynecologists and endocrinologists online. 

So, what are the differences between ovarian cysts vs. PCOS and can you have both? If you’re already a bit confused, don’t worry, we’ll explain it all. 

What are ovarian cysts, what causes them, and what are the symptoms?

Ovarian cysts are fluid-filled sacs that reside in the ovaries. They’re typically 1-3cm in size, but sometimes can be up to 10cm, and often go away on their own. The difference between ovarian cysts and PCOS is that ovarian cysts are either already present at birth, or form on their own as part of normal hormone changes. Cysts from PCOS form because of the hormonal imbalance as a result of the condition. 

Taking fertility drugs and getting pregnant change your hormone levels, which may also result in ovarian cysts. As well, lifestyle factors can influence the incidence of cysts. 

There are different types of ovarian cysts, too. The most common types are functional cysts. They’re called this since they’re caused by the functioning of your reproductive system, and because your ovaries continue to function with the cyst. The two varieties are: 

• Follicle cysts — cysts from a follicle that didn’t break open to release a matured egg during the menstrual cycle. These most often have no symptoms and go away in a few months.
• Corpus luteum cysts — cysts that form after the follicle breaks open to release a matured egg, but the sac doesn’t shrink as it’s supposed to. Instead, it reseals and fluid builds up inside. 

Less common types of ovarian cysts include: 

• Dermoid cysts — cysts that are made of bits of embryonic tissue 
• Cystadenomas — water or mucous-filled cysts that grow on top of an ovary
• Endometriomas — cysts made of endometrial tissue that have migrated outside the uterus

Common symptoms of ovarian cysts are weight gain, pain during your period, in your lower back or thighs, or during sex, difficulty emptying your bladder, and breast tenderness.

While most cysts are common and painless, it’s possible to have a ruptured ovarian cyst. This may occur during intense exercise or sexual activity. However, if bleeding from the ovarian cyst and severe pain in the lower abdomen occurs, you should see a doctor right away for treatment. 

Can ovarian cysts cause hormonal imbalance?

Ovarian cysts aren’t usually something to worry about, but they can lead to problems with the menstrual cycle. This includes heavy or irregular periods or spotting and occurs if the cyst produces sex hormones that cause the lining of the womb to grow. 

What is polycystic ovary syndrome, what causes it, and what are the symptoms?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects the female reproductive system. You’d think the name is pretty self-descriptive. You must have multiple cysts on your ovaries to qualify for a PCOS diagnosis, right? 

Not quite. Having cysts on your ovaries is only one of three qualifying criteria doctors use to diagnose PCOS. The three most common are the Rotterdam criteria. 

The Rotterdam criteria are:

• Having irregular periods
• Elevated androgen levels
• Having one or more ovarian cysts 

As you can see, if you have high androgen levels and irregular periods, then you can be diagnosed with PCOS as long as other conditions have been ruled out. Ovarian cysts and PCOS aren’t the same — having ovarian cysts is a symptom of PCOS, not a cause. 

So then, why call this condition polycystic ovarian syndrome? There’s a lot of controversy amongst both doctors and patients surrounding the name. Doctors argue that PCOS is a misnomer. Cysts aren’t required for a diagnosis, and the “cysts” found in PCOS are not true cysts, but ovarian follicles. 

Patients want the condition to be renamed with a title that accurately describes their experience. Having a lifelong condition that is misleadingly named can lead to difficulty accepting a diagnosis and receiving proper support from family and friends.  

For now, polycystic ovary syndrome is the accepted name for a hormonal disorder that’s associated with high androgen levels. Androgens are hormones that cause male characteristics. 

The female reproductive system naturally produces them in small amounts. People with female reproductive anatomy usually have a dominating balance of estrogen to androgen. When androgen levels rise, it can throw off typical ovulation rhythms. Unpleasant physical symptoms can ensue from there. 

What hormones are imbalanced with PCOS?

PCOS causes a hormonal imbalance in women which can include raised levels of testosterone, luteinizing hormone (LH), and prolactin, and decreased levels of sex hormone binding globulin (SHBG). It’s still unclear why these hormone imbalances occur, but previous research has suggested the imbalance may begin in the ovaries, other glands that produce the hormones, part of the brain that controls their production, or from insulin resistance.

Research is ongoing about PCOS and hormonal imbalances. There’s even a link, for example, between hypothyroidism and women with PCOS. The thyroid gland is part of the endocrine system and is responsible for regulating specific hormones. 

Hypothyroidism occurs when there isn’t enough of the thyroid hormone released into your body. It can make the symptoms of PCOS worse and needs to be treated. However, sometimes this is missed in women with PCOS unless there’s a complete diagnostic evaluation. 

As well, research shows that women with PCOS who have high parathyroid hormone levels — caused by the parathyroid gland which regulates calcium — are more at risk of having abnormal blood glucose levels. 

There’s also interest in the connection between the adrenal glands and PCOS. The adrenal glands are part of the production of specific hormones and regulation of steroid levels in the blood, and the theory is that this may be affected in women with PCOS. One smaller study showed that while traditionally, treatment for PCOS has included modifying ovarian hormones, a subgroup of PCOS patients could benefit from the modification of adrenal hormones as well. 

Can you have ovarian cysts and not have PCOS?

Yes, you can have ovarian cysts without PCOS. In fact, ovarian cysts are incredibly common. Most people who ovulate will develop one minor ovarian cyst every month. The vast majority of ovarian cysts are benign, cause no symptoms, and go away on their own. 

Most cysts will come and go without you ever realizing it. If cysts become very large, they may present symptoms. 

Some large cysts need to be removed by surgery. If you experience sudden pain, faintness, nausea, or weakness, seek immediate medical attention. It may be an emergency situation.

Can you have PCOS without cysts?

The answer to this question is a resounding yes. Plenty of women with PCOS don’t have ovarian cysts. PCOS is an endocrine disorder rather than a condition solely involving your ovaries. 

Doctors describe PCOS as being a “constellation” of symptoms. If only the symptoms of PCOS were as beautiful as a galaxy in the night sky. PCOS can cause stubborn acne, excessive body hair growth, weight gain, high blood pressure, irregular or missed periods, and difficulty getting pregnant or infertility. These symptoms come from a systemic hormone imbalance in your body. 

Thankfully, medication like birth control can help treat PCOS, reducing many of its symptoms like irregular periods and acne. 

Does PCOS or ovarian cysts cause ovarian cancer?

There have been studies on the link between PCOS and ovarian cancer, but the evidence isn’t conclusive. Some research has shown more than double the risk of ovarian cancer in women with PCOS, but this hasn’t been confirmed in large population studies. And, to make things even more confusing, some studies reveal women with PCOS may have a decreased risk of ovarian cancer. 

There is an increased risk, however, of POCS and endometrial cancer. This is because of the prolonged exposure to endometrium caused by anovulation — a menstrual cycle without ovulation.

As for ovarian cysts, thankfully most are benign and tend to clear up on their own. Some ovarian cysts can become cancerous — more likely in post-menopausal women — but this is rare. If you feel symptoms such as intense abdominal pain, bloating, and pain during intercourse, it’s time to speak with a doctor. 

Can ovarian cysts or PCOS cause infertility?

Let’s start with ovarian cysts — the good news is that they don’t usually cause infertility, so yes you can get pregnant with ovarian cysts. We say “usually” because while ovarian cysts themselves don’t make it more difficult to conceive, if they’re caused by an underlying condition like PCOS or endometriosis, they can. However, it’s still possible to get pregnant in these cases, it just may make the process a bit more difficult. 

PCOS on its own is one of the most common causes of infertility. This is because the hormonal imbalance it causes disrupts normal reproductive functioning, preventing a mature egg to be developed and released. Fertility medicine has come a long way, however, and plenty of women with PCOS get pregnant with the help of fertility treatment. 

Do polycystic ovaries and ovarian cysts go away?

Yes and no. PCOS is a permanent condition. Through medication and lifestyle adjustments, many people with PCOS reduce their symptoms to the point they no longer interfere with everyday life. 

But, the underlying sensitivity will always be there. PCOS tends to emerge in puberty, around the time you first menstruate. There are also genetic factors to PCOS. 

Functional cysts present much less stress. They tend to go away on their own without medical intervention. Simply having ovarian cysts is usually not a cause for concern, unless they get so big that they start affecting the structures around them. 

When to see a doctor

Most ovarian cysts take care of themselves and don’t need medical intervention. But, if you think you may have symptoms of PCOS, or if you have PCOS and need help managing it, it’s best to turn to a specialist.

An endocrinologist is a doctor who specializes in the treatment of hormone-related conditions, including PCOS and infertility. Via referral, waitlists to see an endocrinologist are usually several months. With Maple, you can see a Canadian-licensed endocrinologist in 24 hours or less from your phone, tablet, or computer. They’ll work with you to reach a diagnosis and treatment plan, including any necessary prescriptions. 

There are lots of treatments out there to help manage PCOS and take care of your hormonal health — get in touch today to explore what may work for you.

This blog was developed by our team and reviewed by a medical professional.