Why Do Our Ovaries Make Cysts…..and Are They OK?

>> Friday, October 3, 2014

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Why do the ovaries make cysts? What do they mean? Does it mean cancer, or that you can get cancer easier than someone who never gets them?

Well, we have two ovaries and two Fallopian tubes that transport the egg or embryo from the ovaries to the uterus. Ovaries are small - about the size and shape of a pecan. Every single month, the eggs (or ova) start maturing and are released at ovulation. But, our hormones stimulate both ovaries, and they both start developing eggs. So, they race each other until one of the follicular cysts holding an egg pops, and the egg is released. At that moment, all the other follicular cysts carrying eggs shrivel up and go away. For example, there could be five cysts on your right ovary and four on your left ovary during any month. We can ovulate on our right ovary four months in a row and then maybe an egg on the left 'wins', so we ovulate on the left. That might happen three months in a row on the left, or it could switch back and the right ovary pops out the egg.

We may think, "Ohh, the ovaries switch back and forth every month from right to left; they take turns." But that's not how it really happens. It's a race, and our body doesn't care which wins, because the ovaries are identical and are both affected each month by the same hormones. They work like one organ even though they are two.

The follicular cysts, when mature, are about the size of a cherry just before the egg is released. They have an egg in them and are filled with clear, water-like fluid. As mentioned, once one ruptures, all the remaining ones shrivel and dissolve. The cyst that popped out the egg transforms into a Corpus Luteum cyst. This cyst then produces our female hormone called progesterone. Without progesterone, we would all miscarry every pregnancy. Progesterone has the job of keeping the uterine lining in place for exactly 14 days. At that point, if there is no pregnancy hormone in our blood stream, the Corpus Luteum cyst dissolves and our period comes as the uterine lining is released.

If there is pregnancy hormone present in the blood, the Corpus Luteum will stay to produce progesterone for about 13 weeks - the entire first trimester of pregnancy - so we don't miscarry. After 13 weeks, the placenta takes over this job, so the Corpus Luteum will dissolve. Some women never make this cyst or it will only stay for 14 days despite being pregnant, and they will, therefore, miscarry every pregnancy. Once we know this, we can supplement progesterone to make up for the absent Corpus Luteum.

Now the reason I took the time here to explain this to all of you is because I have so many patients who come into my office after having an ultrasound at the ER or primary care doctors office and have been told, "You have cysts on your ovaries." Then are instructed to go see their gynecologist. Some women were told this 10 years ago and come in for the exam and tell me they have a cyst but never went back to a doctor to follow-up. So they worry it is still there and getting bigger.

Remember, we form multiple cysts every single month, and as I explained above, these cysts form, and as we ovulate, they all dissolve away. Then it repeats the next month until we arrive at menopause. So all cysts are not bad, they are normal.

I hope this explains and helps you to understand why cysts are supposed to be there and come and go. I will continue this teaching with next blog because I'm not done. Okay?

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