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Scott Webb: Ovarian cysts are common in women and, most of the time, are harmless. But occasionally, they can cause discomfort or pain, and women may need to seek help. Ovarian cysts can also be cancerous, so regular gynecologist visits, knowing the signs and symptoms and just being aware of your own body are important to ensure good health.

Today, we'll learn more about ovarian cysts and when you should seek the guidance of a specialist from Dr. Tina Ayeni. She's a gynecologic oncologist with Franciscan Physician Network Gynecologic Oncology Specialists.

This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks so much for your time. Just as a starting point here, can you explain a little bit about the ovaries? You know, what do they do? What's their normal function?

Dr. Tina Ayeni: The ovaries are important organs in a woman's body. They are making the female hormones. They also make a little bit of male hormone. And they also house our eggs. So when it comes to the female hormones, predominantly, that's estrogen and progesterone, and those are important. They help for breast development. The softening of a woman's feature come from those hormones. But also, those hormones communicate with the uterus. And it's the release of those hormones that allow the uterus lining called the endometrium to proliferate to prepare for a pregnancy. So, estrogen is the dominant hormone that's doing that. It's thickening up that lining of the uterus. If there's no pregnancy, the ovary secretes an opposite hormone called progesterone, and that causes that lining to disintegrate, and that's what gives a woman her period every month. So, the ovaries are instrumental to telling the uterus what to do.

Scott Webb: That's interesting. That's a perfect way to put that, right? So obviously, yeah, very necessary and important functions. So, our topic today is ovarian cysts. So, what are they? Are there different types? Do we know how they develop?

Dr. Tina Ayeni: You know, I think that phrase, ovarian cyst, is a little bit of a catchall. When I think about cyst of the ovary, I'm thinking about two different categories. I'm thinking about the normal cyst, otherwise called functional cysts. Those are the cysts that your ovaries are making every month. Whenever an egg is released, actually it's a cystic entity that's holding that egg. So when that egg gets released each month, that cyst is left behind. And a normal ovarian function, that cyst is supposed to disintegrate and go away. So, those cysts are created every month. We call them functional cysts, and that's normal.

The other category of cysts that I think about are the pathologic cysts. Those are the cysts that are not normal. They are not cysts that the ovaries are trying to make. Essentially, pathologic cysts are tumors. Those are tumors that arise in an ovary. And a lot of times they have watery compartments to them, so they have a cystic look. But, you know, really you can have functional cysts and then you've got this other entity that's called pathologic cysts.

Scott Webb: Well, it's good to have your expertise because I think for most of us lay people, we hear cyst and we think, "Well, that's bad. You know, that can't ever be good. We don't want any of those." So, maybe you could talk about some of the risk factors for ovarian cysts.

Dr. Tina Ayeni: So when I think about risk factors, I'm thinking about that category of these pathologic cysts, the ones that your ovaries are not trying to make. We don't really know what the risk factors are for those cysts. A lot of them tend to be benign to be honest. But even if it is benign, it's still a growth. It's still an abnormal collection of tissue that is growing or has the capacity to grow over time and eventually cause symptoms. So even though, sometimes you think pathology, you think automatically cancer, that's not necessarily the case. So pathologic cysts, most of them are benign, some of them are kind of like a cancerous entity, but we don't really know what the risk factors are for that category of ovarian cysts.

Now, when I go to functional cysts, those again are the cysts that your ovaries are intentionally making on a regular basis, but sometimes those can cause problems. Sometimes they can actually not disintegrate and they can actually bleed into themselves and hang out, hang out, cause pain. Sometimes those cysts can burst open actually and release fluid or blood into the pelvis. So, they can definitely get symptoms from the functional cysts. And sometimes the risk factors with those are just a history of a problematic functional cyst. So, I think a more classic situation is a woman who has multiple functional cysts that are developed by the ovary, but they're not disintegrating and going away. Sometimes they burst, they can cause pain. And honestly, if you've had that happen once before in your life, you are at risk for that happening again into the future. That would be the risk factor for problematic functional cysts.

Scott Webb: Yeah. It sounds like the way you're describing it is most of the time, at least the functional cysts, they tend to go away. And it makes me think that maybe either type, but certainly the more problematic ones, the pathological ones, maybe just the signs and symptoms may just go unnoticed entirely. So, are there some signs and symptoms that women should watch out for for either type? And specifically, are there some symptoms they definitely shouldn't ignore, you know, that they really need to make an appointment with their gynecologist or possibly even go to urgent care?

Dr. Tina Ayeni: You know, I think that the most common symptoms and signs often are symptoms within the pelvis when we think about these types of ovarian cysts, a persistent, dull, pelvic discomfort or pressure. It may not even be bothersome to the point where it's affecting your day-to-day activities, you know. But if it's kind of this dull discomfort that just doesn't go away, that's just kind of abnormal. You know, even women who have symptoms with their menstrual cycles, usually those symptoms will end when the cycle ends. So if you're having just persistent symptoms and your cycle's already gone, that's a problem. And more so if you're a woman who's postmenopausal, meaning you no longer have periods anymore in your life. If you're having symptoms in the pelvis, they can be dull, just kind of annoying, not stopping your day-to-day activities. But if that is there, it shouldn't be. You know, you should just feel kind of normal and without any symptoms. So, that's one thing.

There are definitely emergent type symptoms. Sudden increased pain, that's a classic one actually for some of those pathologic cysts where, you know, one minute you feel fine and, within the hour, you've got worsening pain, and a lot of times that pain is so severe it's bringing you to the local emergency department. If your thoughts process in your head is, "Oh my gosh, I need to go to the ER," go. Your body is telling you the right thing. Sometimes that pain is localized to the pelvis, sometimes it spreads into the abdomen. Sometimes there can be nausea or vomiting associated with those symptom. That's definitely more of a concern. And then also of a concern is if you're feeling lightheaded in any way. Sometimes these cysts can actually contain blood products and, if blood is leaking from a ruptured ovary, that can drop your blood counts and make you feel lightheaded.

One particular change I definitely want to emphasize, and this is more for women who are still having menstrual cycles. Sometimes the clue that there's a cystic problem with the ovary is your cycles are off. Every woman should really be having a regular menstrual cycle once a month. Let's say every four to five weeks, you should be having some type of a period. If you're having periods between your scheduled period; if you're losing months, meaning you're skipping months in your cycles; if you are having persistent bleeding above and beyond your normal, those are all changes that can be actually a sign of a problem in the uterus as it is a sign of a problem in the ovary. So, that's definitely an important one that I think sometimes gets a little bit overlooked.

Scott Webb: Yeah. And thanks to your expertise today, I have a better understanding. You know, the ovaries are sort of communicating and telling the uterus what to do and when to do it. And it just sounds like women, in general, maybe perhaps with most of the topics I cover here, but just listen to your bodies, right? If your body's telling you something's different, something's wrong, speak to someone, whether that's urgent care, your primary, your gynecologist, whomever. And wondering when we're thinking about treatment for cysts, you know, as you said, some are treated, some are not, maybe perhaps some are treatable and some are not. But in general, what type of doctor would a woman see if they need treatment for ovarian cysts?

Dr. Tina Ayeni: You know, the best physician to get an impression or consultation with is a gynecologist for starters. Sometimes when women are having repeated symptoms from the normal functional cysts, you know, the treatment option there is really some form of hormonal medication. We call them birth control pills. Birth control pills have many types of use. Of course, prevention of pregnancy is probably the most common way that those are interpreted. But there are other conditions that form of medication can be useful for, treatment of acne, treatment of symptomatic functional cyst, that's common as well. They prevent cyst formation, which is why women who are having repeated symptoms from cysts that don't go away, functional cys that don't go away, you can actually get alleviation of those symptoms if we can just prevent the cyst from forming to begin with.

When it comes to the treatment of the pathologic cysts, typically, it's surgery. Typically, it's surgical removal and starting off with your gynecologist is the best way because they'll be able to use tools like the physical exam and ultrasound and sometimes blood tests to determine is this pathologic cyst something that is likely benign. Most gynecologists do benign surgery on ovaries. If the gynecologist is suspicious for potentially a cancerous process, you can't know a hundred percent with just an imaging study or lab test. But if there's a suspicion, then that's oftentimes when my gynecology colleagues will refer those patients to me as a gynecologic oncologist, which is what I do. You know, I'm often treating women who have ovarian masses, pathologic changes. We don't know what those changes are until the ovaries removed. So, if there's a suspicion for cancer, my expertise can facilitate not only removal of the mass, but also just being able to explore the belly and determine has the cancer spread anywhere.

Scott Webb: Yeah. As we wrap up here, what are your takeaways that you want women to keep in mind about when we think about ovarian cysts, ovarian cancer, and so on?

Dr. Tina Ayeni: You know, I think that one of the things to think about is it's so important to have a gynecologic expert examine you and to help stratify what your risks are. You know, having that annual exam or every other year exam. Sometimes younger women don't necessarily need to come once a year, but maybe every other year. But having a an expert look at your family history, look at your gynecologic health history, that's really important for your overall gynecologic health and for understanding, "Okay. Is there a problem with my ovaries that I need to be made aware of? How can those symptoms present?" You know, just to kind of individualize your care and your case.

It's an opportunity to share with your gynecologist, "This is the family history of my mom, my sisters, my aunts." And sometimes that information is powerful to give your doctor a better sense for, "Okay, this is your state of your health now. Am I hearing anything in your family's history that makes me want to tailor your specific care in a different way over these next five to 10 years?"

So, I think you can't underestimate having a healthcare professional just do that initial or regular routine annual visit. It's not only just an exam, but also a check-in regarding what has changed in our understanding of certain diseases. Are there interventions that we do earlier or that we would offer now that maybe we wouldn't have offered five years ago? So, that regular care is important from many perspectives.

Scott Webb: Yeah. You can really see the value of, you know, a doctor getting a sense of your personal history, your family history, what's normal for you, what's normal for your family, what might be abnormal even for your family. So, so much value in those regular visits, examination, history. And then, as you said today, you know, then you can go next level and go to imaging and biopsies and all that medical stuff. So, thanks so much and you stay well.

Dr. Tina Ayeni: All right. Thank you so much.

Scott Webb: And for more information, visit franciscanhealth.org and search ovarian cancer. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.