Most of us by now have heard of polycystic ovarian syndrome (PCOS), a hormonal and metabolic condition that affects 10% of women. Irregular or missing periods aside, one of the key symptoms of PCOS is – surprise! – polycystic ovaries. That’s usually described as having a string of pearls on each ovary. But while polycystic ovaries are a key feature of PCOS, you don’t need to have PCOS to have ovarian cysts.

In fact, most women have a cyst or two and unless you have an ultrasound to check for something else (fertility or period issues, for example), you’d probably never know you had one. But if you do have cysts, do you need to do anything about them – and if so, what?

To find out more, we’ve been chatting to two experts about what ovarian cysts actually are, how they affect fertility and whether they can just disappear on their own.  

“Ovarian cysts are fluid-filled sacs that develop on or within an ovary,” explains Dr Amit Shah, leading gynaecologist and co-founder of Harley Street clinic Fertility Plus. “They’re quite common and usually form during the ovulation process.”

There are different types of cysts, the most common ones being functional cysts which include:

1. Follicular cysts: these develop when the follicle, which contains an egg, doesn’t release the egg and continues to grow
2. Corpus luteum cysts: which form after the egg’s been released and the follicle reseals and fills with fluid

Then you’ve got less common pathological cysts, which form because of abnormal cell growth. You might have read horror health stories of someone who grew a cyst that contained hair, skin or teeth – that’s a pathological cyst which has formed from cells that produce eggs. If you’ve got endometriosis, you might have endometriomas; those happen when womb-like tissue develops outside the uterus. And then you have cystadenomas, which form from cells on the surface of the ovary and can be filled with fluid. 

Yes – Dr Shah says that most of us will have at least one during our lifetime. “Functional cysts, in particular, are very common and often resolve on their own without causing symptoms or requiring treatment.”

So far, so fine. But if it’s normal to have cysts, then at what point do we become polycystic? Dr Shah tells Strong Women that it’s not the number of cysts that matter but the size, type and persistence of cysts that matter. “For example, multiple large cysts or cysts that persist over several menstrual cycles may require medical attention,” he says. Having multiple small cyst-like sacs can be a sign of PCOS, he explains, but it’s the associated hormonal imbalance and symptoms that cause issues rather than the cysts themselves.  

“PCOS and cysts are often confused, but they’re different,” explains Hannah Alderson, registered nutritionist whose clinical specialisms are PCOS, endometriosis and fertility. “Contrary to popular believe, PCOS doesn’t actually involve cysts.” She says the string of pearls you see on an ultrasound scan shows follicles getting stuck on the ovaries.

“You can have cysts without having PCOS and you can have PCOS without having cysts – they’re not the same thing.”

In other words, PCOS is a hormonal condition that causes follicles to get stuck on the ovaries. 

Because they’re often linked to our menstrual cycle, functional cysts can indeed come and go. They form and resolve as part of the monthly merry-go-round. But that’s not to say that external factors can’t influence their development and resolution, says Dr Shah.

“Hormonal fluctuations, changes in menstrual cycle patterns, pregnancy and certain medications can all contribute,” he says. Pathological cysts, however, are different. Depending on your systems and the nature of the cyst, you might need medical intervention to get rid of it.

Now, you might be thinking ‘if cysts can come and go, why isn’t PCOS curable?’ That’s because PCOS is a chronic condition in which cysts develop on the ovaries over time – they don’t just develop or subside as regular functional cysts might. Your symptoms might fluctuate or actually go into remission with certain lifestyle tweaks, but Dr Shah says that the underlying hormonal imbalance usually remains. 

So, you’ve got some cysts. They’re normal, they come and go – but will they impact on your ability to get pregnant? Well, they might – depending on their type and size. “Functional cysts don’t generally cause fertility issues and oven resolve on their own,” Dr Shah stresses. However, if your cysts are linked to hormonal conditions like PCOS or endometriosis, then they might.

“Endometriomas, which are associated with endometriosis, can impair fertility by affecting the normal functioning of the ovaries and fallopian tubes,” he says. Large cysts may require surgery and that can also have implications for fertility, depending on the kind of surgery required and the health of the remaining ovarian tissue. 

As with all health issues, you’re always best off going to talk to your GP if you think anything’s wrong. It’s simple to ask for an ultrasound; they’ll refer you to your local radiology department and you can ask whether the sonographer can see any cysts while you’re having the scan done. If there’s anything amiss, the sonographer will write to your GP with a report and you’ll be invited to talk through the results.

Images: Getty