#160: What Causes Ovarian Cysts?

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. Thank you. Hello. Okay, this week I'm going to talk about ovarian cysts. I keep getting a lot of requests on this. Thank you so much if you are the one who asked me to talk about this. And I just saw a patient recently who had this scenario. So she has come to me because her gut is a mess. She was diagnosed with celiac and her periods are irregular. They're really painful. They were heavy and kind of irregular. They weren't coming, you know, every 28 days. And so we've been working on healing her gut. She did stool testing, food sensitivity testing. She's doing a gut healing regimen while we remove her trigger foods and heal her gut so that her immune system can calm down and get back into balance. In the meantime, she went to her OB-GYN for her annual exam. And they did an ultrasound, and she had cysts on her ovaries, many little follicles. And they checked a few labs, and her testosterone was on the high end of normal. Her estrogen was pretty average, her progesterone was nonexistent, and her DHEAS was normal. So The OB-GYN said, "You have polycystic ovarian syndrome, and you need to go on a birth control pill because you are at risk of developing cancer in the future, and you need to suppress your hormones." So she saw me and said, "Is this true? Is this what's happening?" And unfortunately, there are many issues with. her scenario. Okay? I want you to go back and listen to episode 130 about PCOS because PCOS is a metabolic dysfunction. It's a metabolic condition, meaning that it's associated with insulin resistance and elevated blood sugar and oftentimes cholesterol issues like elevated lipids and things like that. And she had none of this. Her fasting insulin was 3. Her hemoglobin A1C was, I don't know, 4.9 or something less than 5. Perfect, perfect. You want both of those to be 5 or less. She has no metabolic issues. Her DHEAS level was normal. She had a slightly elevated testosterone. That does not give you the diagnosis of PCOS. Because she had some cysts on her ovaries, that is why they were saying she has PCOS. So here's the deal, ladies. Cysts on your ovaries happen for so many reasons. It's not just one reason. And having cysts on your ovaries does not mean you have Polycystic ovarian syndrome. I wish they wouldn't have called it that when they came up with this syndrome, I don't know, 20 years ago or whatever. First, let me just mention that a syndrome is a constellation of symptoms that cannot be attributed to anything else. So you usually have androgenic issues like acne, chin hairs growing, loss of hair on your head, dark hair growing on your belly above the pubic line like a man's would. Those are androgenic type issues. Carrying weight around the midsection, being shaped like an apple instead of a pear. Those are hirsutism, androgen type symptoms that are associated with high levels of testosterone and DHEA. She did not have any of those, by the way. Cysts can be on your ovaries. Like I said, for multiple reasons. She is having all these little cysts on her ovaries because she's not ovulating consistently every month. So you have millions of eggs inside your ovary, and every month a bunch of little tiny follicles, which is what the egg lives in, they grow and try to mature. And the one who matures Releases the egg and the fallopian tube grabs it. That's ovulation. What's left over is a broke open cyst or follicle. Those words are often used interchangeably, and that little area inside the ovary produces progesterone for the second half of the month to help your uterus take that egg if you get pregnant and implant it and hold it as a pregnancy. If your ovary doesn't allow any follicles to mature, nothing stimulates that cyst or follicle to grow big enough and release the egg, then they just stay there. And if you look at it on ultrasound, you see all these little follicles or cysts. That is something that's associated with PCOS. But just having that does not mean you have PCOS. It means that you are not ovulating. And there's other reasons that we don't ovulate. Also, you can have cysts and have ovulated. So you can have a cyst, you get these little cysts, sometimes they bleed into themselves. That's called a hemorrhagic cyst. Those are the ones that can often lead to an emergency room visit because the bleeding might not stop. And as the cyst fills with blood, That physical stretching of the ovary is really painful, or it might rupture open and leak blood into your pelvis, which is laying, you know, covering your bowels and your uterus. And that is very irritating and it feels very uncomfortable. And so those women often end up in the emergency room or calling their doctors after hours because it's so uncomfortable. And you can either continue bleeding or the bleeding stops and your body reabsorbs it and you heal and you're good, or you need surgery to remove it. There are cysts that come from the serous fluid that is normal to that little cyst or follicle every month. It's a clear fluid. It, it's almost the color of straw, like a thin yellow. And sometimes that continues to produce too much, and that can grow into a cyst that's often called a simple cyst. And those are really common for women. A simple cyst almost always ruptures and gets reabsorbed by the body on its own. That's pretty normal. It's not very often that it continues to grow and get big and cause issues. Any cyst, if it gets too big, has the potential to flip because the ovary and the fallopian tube are connected to the uterus and to the artery and vein coming out of your pelvis, but they have an open end and so they can turn and flip. And if it gets too heavy, you potentially can flip that cyst in that ovary and that can twist the blood supply and kill the ovary and the fallopian tube potentially. And that's called a torsion. And so that's what gynecologists are usually worried about when a woman comes in in acute pain with a large ovarian cyst is, oh my gosh, did the blood supply get cut off from a torsion? Is she going to lose her ovary and/or her tube? So that's usually our biggest concern. So we look on the ultrasound and see if there's still blood flow to that area. So back to the cysts. You can also get cysts that develop from the actual germ cells of the ovary. So the germ cells are all of the DNA and everything in the eggs that have the potential to create a fetus, a new life, right? And those germ cells sometimes start to grow abnormally, and they will grow a dermoid. So a dermoid is a cyst. If you aren't grossed out and you really think medical stuff is cool, You can Google a dermoid cyst image and see they're oftentimes filled with teeth or hair or fat or different types of tissues that, you know, make up human beings. So dermoids are really, really cool unless obviously you have one, then it's not so cool. But just as a science nerd, I think it's cool. So those ones, those usually don't regress and go away on their own. They almost always have to be removed surgically. And those are more obvious on ultrasound. Those are called complex cysts. They often can tell that it's a dermoid because of the calcifications from the teeth and things like that. So that one, you're probably going to have to have a surgical consult. Okay, so there's a lot of different types of cysts, and it really does matter what type you have. Having cysts on your ovaries does not mean you have polycystic ovarian syndrome. That is a metabolic issue that is completely different. It could be that your menstrual cycle is just out of balance, that you're not making estrogen and progesterone in the times that you're supposed to, in a balanced way, to keep that ovary doing its job correctly. Normally, your brain and your ovary are constantly talking to each other. Your brain releases FSH and LH, and it tells the ovary, make more estrogen right now, make more progesterone right now. And if your ovary doesn't respond, Then you get into this dysfunctional pattern and these cysts are more likely to develop. So OB-GYNs have learned over time, just incidentally seeing women on birth control pills since like the '60s, that they tend to have less ovarian cysts because they're on the birth control pill. So eventually the American College of OB-GYNs said, Okay, well, if that's the case, then a birth control pill is the treatment for ovarian cysts. So if you have cysts, you should go on a birth control pill. That would seem like common sense, but it's not. It's not at all the answer. And there's many, many issues with going on a birth control pill when you don't need it for birth control. The birth control pill shuts down your hormone production. It stops that communication between your brain and your ovaries, so you are no longer making your own estrogen, progesterone, and testosterone. The problem with taking those hormones synthetically and not making your own is multiple fold. First, if you try to go off the birth control pill. That communication might not come back online. You might not make your own hormones, and you might struggle to ever be able to get pregnant. So post-pill amenorrhea, meaning no periods after you come off the pill, is a real problem. And we have a real infertility problem in this country because of birth control pills. So just know that birth control pills also prevent your ovary from ovulating. And so you don't ovulate each month. That's why you don't make progesterone. But when you don't ovulate each month, you are not giving the ovary a chance to do what it's normally supposed to do through its life cycle. And there's a lot of evidence that this can impact you long term. This can have consequences. And we're now seeing women who are going into premature ovarian failure or premature menopause. They're, they're going through the menopausal phase in their 40s rather than their 50s. So if you're waiting to have children until your life is established, your career is established, all of these things, and you're a little bit older when you start, this could be a real impact for you. There's another issue. Birth control pills prevent you from absorbing your B vitamins. Okay, so you've probably heard me in other episodes, but B vitamins are necessary for estrogen metabolism. They donate a methyl group. If you've taken chemistry, that means a carbon and a hydro— hydrogen group connected together to connect onto that estrogen molecule to deactivate it, to send it out of the body. to get rid of it because you're done using it. If you don't have enough B vitamins, then you can't do that process effectively, and you are going to keep that estrogen circulating and very often turn it into 4-hydroxyestrone, which is an intermediate metabolite that we don't want. That is what stimulates too much breast tissue growth and uterine growth. So This is a scenario I'm seeing a lot now— younger women on birth control pills who are vegan or vegetarian. So you're already having issues getting enough B vitamins because of the diet, and then being on the birth control pill is preventing any absorption of these B vitamins that you're taking in. So you're getting into major B12 deficiency, folate deficiency. Folate is a really big deal if you do get pregnant too, because your baby needs that to develop the spinal cord properly. That's a side note. So you need to be on B vitamins if you are on a birth control pill, and probably something with minerals as well, because they prevent you from absorbing your zinc and your magnesium efficiently. It really does affect Your whole gut digestive system, and so if you're on a birth control pill, it's imperative that you get on a high-quality multivitamin with methylated B vitamins. Get on Energy Lift, which is my favorite, or Multi Lift. Energy Lift is the best because it helps you metabolize your estrogens properly. If you're on a birth control pill, you're taking synthetic estrogen. You need to metabolize that properly. So get on Energy Lift. The other issue that birth control pills cause is leaky gut, so that can contribute to you developing IBS, irritable bowel syndrome. It can cause chronic constipation and diarrhea. It can cause dysbiosis, or the wrong bacteria living in your gut. It can cause yeast overgrowth in your gut. That's a really common one, especially if you're Eating a lot of carbohydrates, which I see in younger women because you have a great metabolism, you're young, you can handle it, you're super busy, you're on the go. So you're eating a lot of fruits, a lot of pasta, a lot of breads, or just simple carbohydrates, cereal, all of those things in boxes and bags. All of that That's a perfect setup for leaky gut, which can turn on autoimmune conditions, turn on or elevate yeast overgrowth in the gut, and all these other issues. And that is just a domino effect into new problems. So what I want you to take away from this episode is that having cysts on your ovaries almost never means you have PCOS. That's a totally separate thing. Listen to episode 130. Most cysts resolve on their own and are just what we call physiologic, quote unquote, meaning they're part of your normal ovarian cyst cycle and they're not a big deal and they're, you know, nothing needs to happen from them. Sometimes it's a surgical intervention that's necessary and birth control pills are not the solution. So Listen to episode 106, The Truth About Birth Control, to get more understanding and information about birth control. Because here's the deal. I love birth control. That's what got me through college. I had a baby in 11th grade, and I promise you, I couldn't have become a doctor, you know, go back, get my GED, go to a community college, get a 4-point for 2 years, go on to Michigan State, go on to medical school, do all of these things if I didn't have birth control. So I'm not saying don't use birth control, and— but there's a time and a place. And I wish I would have had true informed consent because I would not have stayed on the pill as long as I did. I would have sought other options. I probably would have gotten a ParaGard IUD. long-term. That's what I would have done because the birth control pill contributed to me developing my Hashimoto's, my Raynaud's, irritable bowel syndrome, chronic fatigue, all of these issues going forward. So I just want you to have full informed consent. You're not going to get that from most gynecologists, and that's okay. Don't be angry with them. They're surgeons. They don't know any better. But now that you know better, you can make better choices for yourself. So if you're on a pill, take the vitamins you need to hopefully prevent some of these conditions. Focus on having a healthy gut, eating a healthy diet, getting your vitamins and minerals. Consider a different birth control option. Like I said, listen to my other episodes about these in more detail. So Cysts are usually driven by inflammation in the gut and something else going on, or they're physiologic and they're not a big deal. So I hope that cleared up some things in your mind. If you have any questions about this, please reach out to me. If you know you're thinking of a girlfriend right now, like, oh my gosh, she's always telling me about her cysts, have her listen to this episode, have her listen to the other episodes. Like the more that you can be empowered with this knowledge and information, the better informed choices you can make and hopefully stop causing new problems from all this band-aid medicine approach. So let's figure out the root causes, address those, and you're gonna actually feel amazing. So I hope this was helpful. Let me know what else you want to hear about. Okay, ladies, I'm here for you. I'm here to serve you and to. help empower you to take back control of your health. You don't need the doctor to tell you what to do. It's all within you. I promise. God gave you the tools. You are fully equipped. You just need to listen to your body again and you've got this. So go have an amazing week, ladies.