Ovarian Cysts and Bleeding Between Periods: What You Need to Know

Women who have entered their reproductive years experience a monthly period. Your period (or menstruation) lasts for approximately 5-7 days and is the first of four phases of your menstrual cycle. During menstruation, the uterine lining and unfertilized egg shed through the vagina. This monthly form of vaginal bleeding is normal and completely expected.

There are a variety of reasons why you might experience spotting between periods. While it’s true that every woman’s cycle is different and fluctuations and irregularities are normal, regular heavy bleeding between your monthly menstruation could signify something is wrong.

Heavy bleeding goes beyond just spotting. It refers to any bleeding that requires the use of a pad or tampon. Many things might cause heavy bleeding between periods, including ovarian cysts. This article will explore the different types of ovarian cysts, causes, symptoms, treatments, and risk factors.

What Is an Ovarian Cyst?

Ovarian cysts are tiny fluid-filled sacs found in or on the ovaries. Sometimes, these sacs can also have some tissue or blood inside of them. 

Chances are, you’ve had an ovarian cyst at one point or another. According to the Institute for Quality and Efficiency in Healthcare, cysts on your ovary are not uncommon and affect an estimated 10% of women.

The majority of cysts are not harmful and are non-cancerous—you may not even notice you have them! They often go away on their own and, only in rare cases, require medication or surgical removal.  

Types of Ovarian Cysts

There are a handful of types of ovarian cysts, some more common than others. The most common types of cysts form during the menstrual cycle and are called functional cysts, as outlined by The Office On Women’s Health. 

Functional Cysts Are The Most Common 

Functional ovarian cysts are the most common type of cysts and form during the ovulation stage of your cycle. These types of cysts are almost always non-cancerous (benign) and go away on their own.

They include:

• Follicle cysts: Every month, your ovary releases an egg during menstrual cycle’s ovulation phase. This event occurs when an ovarian follicles rupture and releases an oocyte that travels to the fallopian tube and becomes a mature egg. When the follicle doesn’t rupture properly, and the egg isn’t released, it can continue to fill with fluid and form a cyst. Follicle cysts often have no symptoms and go away on their own within a few months.

• Corpus luteum cysts: After ovulation successfully occurs, the ruptured follicle shrinks down to become the corpus luteum—a structure that releases hormones to maintain the uterine lining in preparation for pregnancy. When the ruptured follicle doesn’t shrink properly, it can seal itself back up and fill with blood, forming a corpus luteum cyst. These cysts can grow quite large (up to 4 inches), and may cause some discomfort, but will usually go away on their own within a few weeks. 

Less Common Types of Ovarian Cysts

According to The Mayo Clinic, there are much less common types of cysts that aren’t related to your menstrual cycle. These cysts can sometimes be more noticeable and cause more pain.

They include:

• Dermoid cysts: Dermoid cysts contain tissue like skin, hair, and teeth and develop from embryonic cells. They are rarely cancerous.
• Cystadenomas: When benign tumors grow from ovarian tissue and fill with a mucus-like fluid, they are called cystadenomas. These can grow up to 12 inches in diameter!
• Endometriomas: Sometimes, uterine endometrial cells can grow outside of your uterus (known as endometriosis.) In rare cases, this tissue attaches to your ovary to form a growth forming what’s called an endometrioma.
• Cancerous cysts: Malignant cysts that would cause ovarian cancer are extremely rare and easily treated, according to The Cleveland Clinic.

Ovarian Cysts: Causes & Risk Factors

Cysts develop as a result of hormonal changes that occur naturally in your body. Some conditions, like endometriosis and pelvic inflammatory disease (PID), increase the chances of developing cysts. 

Other risk factors include:

• Hormonal factors: Women who take drugs for ovulation are more likely to develop ovarian cysts. 
• Pregnancy: It’s common for cysts to form in early pregnancy due to the disruption of ovulation and your menstrual cycle. They can sometimes last until late pregnancy.
• Having a history of cysts: Once you have one ovarian cyst, you’re more prone to develop them in the future.

Another major cause of cysts is a condition called Polycystic Ovary Syndrome (or PCOS).

Polycystic Ovary Syndrome (PCOS)

PCOS is a common hormonal condition characterized by the formation of many small cysts on the ovaries (known as polycystic ovaries), causing the ovaries to become enlarged and not function properly. 

According to the Canadian Women’s Health Network, approximately 6%-10% of women suffer from PCOS. Aside from polycystic ovaries, some of the other main symptoms of PCOS include irregular periods or amenorrhea, weight gain, and difficulty getting pregnant.

Ovarian Cyst Symptoms

In most cases, ovarian cysts go unnoticed and have no symptoms at all or only cause you to feel some slight discomfort in your pelvic area. However, sometimes cysts may cause pain. It’s good to know the signs to look for in the rare chance a complication occurs.

• Heavy bleeding or spotting between periods.
• Swollen stomach or pain when urinating caused by an enlarged cyst pushing against your organs.
• Sudden lower abdominal pain or pelvic pain. This is sometimes, but not always, cause for concern.
• Sudden severe cramping and nauseous or vomiting. This can happen if a cyst gets large enough to pull on and twist the ovary (called ovarian torsion.)

What Happens When a Cyst Ruptures?

A cyst can burst for a few reasons. Sometimes they rupture because they grow too large. Intense exercise is also known to cause a cyst to rupture.

The idea of a cyst bursting inside of your body can be unsettling. But don’t worry—the growth, rupturing, and bleeding of cysts can be part of a normal menstrual cycle, according to The Cleveland Clinic.

As long as you don’t develop an infection, a ruptured cyst does not require surgery or treatment and will go away on its own. Over time, your body will absorb the fluids and material released by the burst cyst.

When Do Ruptured Cysts Require Medical Attention?

For the most part, some pain and bleeding from a ruptured cyst is nothing to worry about. But, in some cases, you may need to visit your doctor for treatment and advice.

Visit your doctor ASAP if you experience any of the following severe and sudden symptoms:

• Excruciating pain in your lower right abdomen
• Nausea and vomiting
• Fever (this can be a sign of infection)
• Dizziness or vision changes (this can be a sign of excessive bleeding in the abdomen)
• Rapid breathing

Diagnosis and Treatment of Ovarian Cysts

If you experience heavy bleeding between periods or any of the other symptoms mentioned above, seek medical advice immediately.

When you see your doctor, be prepared to answer the following questions:

• How long has this been happening? 
• When did you first start experiencing symptoms?
• Do you experience symptoms monthly or irregularly?
• If you’re experiencing heavy or irregular bleeding, have you noticed a pattern, or is it random?
• Does the bleeding last 1-2 days or more?
• How heavy was the bleeding: Did you use any protection? Was a panty liner insufficient?
• Describe the color, texture, and/or odor of the blood.
• Do you also experience pain while you bleed?
• Did the bleeding coincide with any increased physical exertion (sex, exercise, etc.)?

Diagnosis

In terms of testing and diagnosing ovarian cysts, the first thing your doctor will do is a pelvic exam to feel for any swelling in your abdomen. If she suspects you have cysts, she might run some more tests just to be sure, like an ultrasound to detect the size and location of the cysts, hormonal tests, and bloodwork.

She may also have you take a pregnancy test to rule out possible pregnancy. In very rare circumstances, your doctor may order a CT scan or do laparoscopic surgery (keyhole surgery) to locate and detect ovarian cysts.

Treatment

If you don’t experience any significant symptoms, your doctor will recommend taking a ‘wait and see’ approach when it comes to cysts. The majority of ovarian cysts will go away on their own and aren’t cause for concern.

In rare cases, they require medication or surgery. You can take over-the-counter pain relievers, like ibuprofen, if you feel mild discomfort due to ovarian cysts. Sometimes, your doctor may prescribe medication like NSAIDs (non-steroidal anti-inflammatory drugs) to treat more intense pain. 

According to The Winchester Hospital, your doctor will only recommend surgery if your cyst(s) are:

• Suspected to be cancerous (this is more likely in post-menopausal women).
• Very large.
• Hard and solid (rather than squishy and fluid-filled).
• Are extremely painful to the point that they interfere with your daily activities.

The Surgical Removal of Ovarian Cysts

The most common type of surgery used to remove ovarian cysts is called laparoscopic surgery. Laparoscopic surgery (a.k.a. keyhole surgery) is when a doctor makes a tiny incision in the abdomen and inserts a very thin instrument to carefully examine the cyst up-close and remove it, if necessary.

Complications with these types of surgeries are not common; however, all surgeries come with some risks. Before your laparoscopy, your doctor will review possible complications that include: Infection, bleeding, infertility, and blood clots. And there is always the possibility the cyst can come back, even after it’s removed. 

In some cases, your doctor may decide that removing the ovaries is the safest option, especially if they find the cysts to be cancerous. This type of surgery is a last resort since removal of the ovaries leads to early menopause, which can significantly affect a woman’s life—especially if she is still in the middle of her child-bearing years. 

In Summary

Ovarian cysts are very common and mostly go unnoticed. If you do experience symptoms from an ovarian cyst, you’ll likely feel some discomfort in the lower abdomen and some spotting between periods.

For the most part, ovarian cysts are not a concern and will go away on their own. However, UW Health suggests you should call your doctor immediately if you experience any of the persistent and severe symptoms mentioned above, or if you’ve recently developed very painful or irregular periods but aren’t close to menopause.