Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And joining me today to highlight treating ovarian cysts is Dr. Eung-Mi Lee. She's an assistant attending obstetrician and gynecologist at New York-Presbyterian Hospital Weill Cornell Medical Center, and an Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medical College-Cornell University.

Dr. Lee, it's such a pleasure to have you with us. And you and I talked a little bit about my ovarian cysts off the air. So, I always like to utilize these so that I can learn right along with my listeners. So, can you start telling us what are ovarian cysts? Are they something that necessarily leads to cancer? Are they something that many, many women have? How prevalent are they?

Dr. Eung-Mi Lee: Hi, Melanie. Thank you so much for these questions and thank you for having me. Those are some great things to talk about. And I know that those are questions that a lot of my patients often present with. So to start off, ovarian cysts are typically a growth on the ovaries. The ovaries are responsible for a couple of important things. One is that they help create some of the hormones that your body makes. The other thing is that they're responsible for maturing and growing the eggs that you're going to release. And because of this process that the ovaries are undergoing, oftentimes ovarian cysts are something that we see very commonly.

When they've done big studies looking at how many people at any point in time have an ovarian cyst, we found that about 35% of people who are premenopausal will have an ovarian cyst at any given time, whereas 17% of people who are postmenopausal will have an ovarian cyst. So, they're very common. And again, they're typically growths on the ovary. And in terms of thinking about ovarian cysts, there are several different types of ovarian cysts that can occur. And you brought up a good question about cancer, because I think a lot of people wonder, you know, if they have an ovarian cyst, if it's something that is worrisome, or it's something that could turn worrisome, and what we know is that the large majority of cysts tend to be benign, but there are certain features that we can look for on imaging that can help us sort of risk stratify and think, "This is something that looks like it's very common and benign, something that we see very regularly." And then, there are also features that we can look for where we say, "This doesn't sort of look the way that a normal cyst looks," and that can help us sort of think about next steps and whether or not it's something that needs to come out.

Melanie Cole, MS: What sort of imaging? Are you talking about transvaginal ultrasound? I mean, why would somebody need imaging? Are there symptoms that we would see or notice? Anything that you can tell us that would even send us to find out if we have them?

Dr. Eung-Mi Lee: Yeah, that's a great question. So oftentimes, the most common thing that people might experience is either some type of pelvic pain or pressure that's new. And so, if you're experiencing persistent pelvic pain or persistent pelvic pressure. Also, often if it's more to one side or the other, that could be a good starting point to think about whether or not you could have something like an ovarian cyst. And oftentimes, what will happen in the office is that your doctor may do a pelvic exam, so they may try to feel for any type of cyst, and sometimes they can feel it, sometimes they can't. And then oftentimes, what they'll do is send you for a pelvic ultrasound. You're right, that is the most common type of imaging that we do, and that imaging helps us to look to see whether you do have an ovarian cyst or not. And then if you do, it can help us look for features that can help us decide, is this something that looks very common and looks very benign, or is it something that has any type of worrisome features that require a little bit more workup?

Melanie Cole, MS: Okay. So, you've looked at them, maybe we came in because of pelvic pain, something along those lines. Do you determine the appropriate treatment or is treatment even necessary? You and I were discussing this. Do these always have to be treated?

Dr. Eung-Mi Lee: That's a great question. So it really depends, and it depends on a couple of things. So, the first thing that we sort of think about in the very beginning, again, is this question of does it look like something that is benign or worrisome? So, that's one decision point. The other thing too is how bothersome is this? Is this something that is really interfering with your quality of life? Is it something that is keeping you from doing the activities that you normally do? Or is it something where, you know, if your gynecologist hadn't sort of felt it on a routine pelvic exam, you wouldn't have known that it was there at all.

And so, those types of things can help us decide. So if it's something that is persistently causing problems, if it's interfering with your quality of life, if there are any features on it that we could think is potentially worrisome, those are all reasons that we might want to recommend doing some type of surgical treatment or intervention to remove the cyst. However, if it's something that we found sort of incidentally and it has a very normal appearance, usually these are things that can be left alone because many types of ovarian cysts, especially the ones that kind of come and go in the course of you creating and releasing eggs, tend to resolve on their own.

Now, that being said, there is an important caveat that there are certain types of cysts that don't go away on their own. So, these are things like what are called dermoid cysts, which are cysts that you're often born with and then they get larger over time or endometriosis lesions. So, an endometrioma, that's when you have an ovarian cyst that's full of endometriosis. These types of cysts don't tend to go away on their own. And so, we could always think about removing those. But in terms of other types of cysts, the ones that kind of happen when you're making an egg and releasing an egg, so what we often call functional cysts, those tend to resolve on their own.

Melanie Cole, MS: You mentioned surgical intervention. Is there any medicational intervention that maybe makes them smaller or medications that we might be taking, whether someone is on hormone replacement, or in my case, anastrozole? Are there's any of these things that could make these cysts larger or smaller?

Dr. Eung-Mi Lee: That's a good question. So, we know that once the cyst is there, oftentimes there's no medicine that's going to make the cyst go away necessarily. But that being said, if you are someone who is very prone to developing cysts, there are medications that we can give you to try and suppress your ovaries from making those cysts. So again, as we talked about, a lot of these cysts occur in the normal process of maturing, growing, and releasing eggs. And so, if you're someone who is particularly prone to cysts that are bothersome and they're happening within that process, you can do different things like hormonal birth controls that can help suppress your ovulation or releasing an egg so that you don't develop those cysts. But unfortunately, once the cyst is actually there, there aren't any great medications that will necessarily make the cyst go away.

Melanie Cole, MS: You mentioned how common these are. Whether we are pre or postmenopausal, certainly, and after our reproductive years, that these are really, really common. Is there anything that we've done, lifestyle, behaviors, we look at risks for cancers, those sorts of things, is there anything preventive measures that we can do that would reduce our risk of getting cysts, whether it's on our uterus, our ovaries, fibroids, all the things that we get?

Dr. Eung-Mi Lee: That's a great question. So, I would say that in terms of ovarian cysts, so specifically cysts that grow on the ovaries, there is no sort of lifestyle change that you can make necessarily that will prevent ovarian cysts from happening. But that being said, I think that there are certain people who may be more prone to certain types of cysts. So if you have an underlying condition such as polycystic ovarian syndrome or endometriosis, these are conditions that sometimes run with certain kinds of ovarian cysts. It's important to make sure that you have a doctor who's following you and helping optimize your health for those things.

But outside of that, for any person who doesn't have those underlying conditions, and you're sort of thinking, are there any run-of-the-mill sort of lifestyle changes I can make to prevent getting an ovarian cyst? Unfortunately, there's nothing that we know of that will necessarily prevent that from happening, because again, a lot of these cysts just happen in the course of the normal process of making and releasing eggs.

I would also like to mention that if you have an ovarian cyst and you're experiencing severe pain, this is a reason to go to the emergency room because something that can happen when you have an ovarian cyst is that the whole ovary can twist, which is called an ovarian torsion and that is a surgical emergency. So if you're experiencing severe pain, then I do recommend going to the emergency room for a visit.

Melanie Cole, MS: Wow. This is really, really informative. You're a great educator, Dr. Lee. So as we wrap up, is there anything you would like women to know about our ovaries, ovarian cysts, the fear that we have, that all of us, I'm sure, have when we've been told that we have ovarian cysts, that now this is going to lead to ovarian cancer, which is really a scary one? Summarize it for us. Give us your best advice here.

Dr. Eung-Mi Lee: Absolutely. So, I think that if you've been diagnosed with an ovarian cyst, the most important thing that you can do is talk to your doctor, your gynecologist about it, because they can really help you interpret what's going on. When they find that you have that ovarian cyst on the ultrasound, again, that first thing they'll think about is are there features of this that look very normal and common? And if so, at that point, you can decide, is this something that's really bothering me that I want treatment for? Or is this something that we can watch for a while and see if it goes away on its own. So, there's that.

And then, if there are any features of the ovary that we think are worrisome at all, then that constitutes another discussion with your doctor. And, you know, at that point, you can decide together whether or not surgery is the right next step for you to help figure out exactly what's going on with those cysts, because we know that getting the actual histologic confirmation from surgery is what will help us identify it a hundred percent, you know, if you are really worried about something like cancer, oftentimes getting that histologic diagnosis is what will help us figure out whether or not for sure, whether it's something cancerous or not.

But I think outside of that, the most important thing again is just to be aware of your body, be aware of any changes that you're experiencing so that if you do have any type of new pelvic pain or pressure, you can talk to your doctor about it. And together, you can decide whether or not you want to take that first step and get some imaging. And then if there is, you have that open line of communication already to decide what to do next.

Melanie Cole, MS: Thank you so much, Dr. Lee. What great information. Thank you again for joining us. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health.

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