Corpus Luteum Cysts
Another type of physiologic or functional cyst is known as a corpus luteum cyst (CLC). These are less frequent than a follicular cyst but can cause more problems and emergencies, especially internal bleeding. Why do you need to know the difference? Because your doctor is likely to throw names around that distinguish between these cysts and the specific dangers and treatment options. These cysts also produce different hormones that affect your body and hormone balance. If you don’t know the difference, you can be fooled into thinking something is safe when it is not or getting a surgery that you don’t need.
You can get some of these cysts during early pregnancy, which is perfectly normal. They usually go away by the second trimester. Some do not, and if they do not look suspicious on the ultrasound, it is safe to leave them alone. In most cases, they eventually go away after pregnancy.
How do you know if you have a CLC?
A missed period followed by some spotting, one-sided pelvic pain and a pelvic examination, which finds a tender ovarian mass, suggest that a persistent CLC is the culprit. It is important to make sure, however, that a pregnancy test is ordered, because these same findings may be there for an ectopic pregnancy (tubal pregnancy). An ultrasound may not be able to tell these two apart and the treatment would be completely different. There is another nonphysiologic cyst, which can cause similar symptoms, called an "endometrioma" that you need to be familiar with. That is treated in yet another way, often involving surgery, and is a whole separate topic.
When a CLC ruptures, the amount of bleeding and/or pain may cause this to be a surgical emergency. This is unusual, but there are medications and herbs you may be taking that could make it much worse. In particular, these include aspirin, non-steroidal anti-inflammatory drugs (e.g. ibuprofen), Vitamin E and ginko biloba. There are others, but basically stay away from anything that may "thin the blood" and cause easy bruising or bleeding. Review all the medications, herbals and supplements you are taking with your regular doctor and/or nutritionist or naturopathic doctor.
Unfortunately, one third of women (33%) who have a problem with bleeding from a CLC will have it happen again, possibly over and over. So knowing what to avoid can save more than one trip to the operating room or possibly even your life.
By the way, pelvic pain with or without ovarian cysts being present does not mean the pain is coming from a gynecologic organ. In other words, there are other things down there in your pelvis. You could have appendicitis or other bowel problems, which have nothing to do with your gynecologic organs.
If surgery is necessary because of bleeding, it is often possible to do it through a laparoscope (bandaid surgery). Usually the ovary does not have to be removed. Only the cyst is removed and bleeding stopped.
If the cyst is NOT ruptured, and there is no bleeding or torsion, it is reasonable to avoid surgery and “wait it out." Why? Because surgery, no matter how small, causes scars or adhesions to form. You want to avoid surgery if your doctor thinks it is safe based on all of the things you just read about.
Theca Lutein Cysts
The least common type of physiologic or functional cysts are called "theca lutein cysts" (TLC). The key difference is that these are usually multiple, on both ovaries, and occur all at the same time. Each of these cysts can be 1cm to 10cm in size, so if there are multiple cysts, the ovaries can be massively enlarged: up to 20 to 30cm (about 10 inches or more) on both sides. How does this happen? The answer is simply hormonal overstimulation of the ovaries due to pregnancy.
Most often this occurs due to very high beta-hCG levels (a hormone of pregnancy) often seen with twins or abnormalities called "molar pregnancy," where the placenta develops but the fetus does not. This is a highly oversimplified explanation, but the point is that high levels of hCG stimulate the ovary. The reason for this overstimulation should be evaluated. Sometimes these cysts can even look like cancer to the untrained eye. Quite a scare, but usually you just need to ask the right questions and in most cases it is not cancer.