What is pelvic pain like when it is due to ovarian cysts?
Many episodes of ovarian cyst formation not due to PCOS occur on one side or the other but usually not on both ovaries simultaneously. The pain is most often either in the right lower abdominal or left lower abdominal area.
If the pain presents on both sides of the abdomen at once in the "ovary" area, there is the possibility of cysts on both ovaries, but it is more likely that the pain is due to vascular congestion, endometriosis or large bowel problems such as irritable bowel, lactose intolerance etc.
Pelvic congestion is often associated with a polycystic appearance of the ovaries on ultrasound (3).
Most non-PCOS ovarian cyst formation comes and goes. The natural history of follicular cysts is that about 50-70% regress in 2 months and about another 5% in 3 months (4).
On infrequent occasions, ovarian cysts can rupture, causing internal bleeding. This is somewhat more frequent in women over 30 years of age and involves a follicular cyst less often than a corpus luteum cyst (5).
Do birth control pills or DepoProvera® make cysts go away?
No. they don't seem to have any effect once the cyst is formed.
Do oral contraceptives or injectable progestins (DepoProvera®) prevent the formation of ovarian cysts?
Oral contraceptives are known to block ovulation in women with polycystic ovarian syndrome as well as lower the circulating androgens which can cause excessive hair growth (6). They are also used as pretreatment to decrease cyst formation when giving LHRF for in vitro fertilization (7). Thus they can be used to lessen the risk of new ovarian cyst formation even though they will not suppress any currently existing cysts.
Neither oral contraceptives nor injectable progestins totally suppress all follicle development but they do suppress large follicles in the range of 3.0 cm (8).
Should ovarian cysts be aspirated or removed or is it best to just wait and see if they regress?
There seems to be little difference as to whether the cysts are aspirated under ultrasound guidance or followed (9). About half of the cysts regress by themselves. The rest may need to be explored surgically and cystectomies performed.
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