Reviewed by Veena Angle, MBBS, MD and Physician Chu I Ta

What Are Ovarian Cysts and Should You Worry About Them?

Published August 11, 2022| 8 min read

Ovarian cysts are masses in or on the ovaries, which are usually benign. However, they may cause problems at times. Here is all you need to know.

Young woman holding her abdomen and grimacing

Did you know almost 20% of women develop an ovarian cyst or pelvic mass in their lifetime? Ovarian cysts are masses that grow on or inside the ovaries. There are as many as 30 different types of ovarian cysts. It might sound scary but most of them are functional cysts related to normal ovarian functions and not malignant in nature. However, at times, they can also be a sign of diseases such as polycystic ovarian syndrome (PCOS) or ovarian cancer.

Ovarian cysts seen in women of childbearing age are usually benign and do not require surgical treatment. However, they can lead to complications such as cyst ruptures, pelvic pain, blood loss and ovarian torsion that require prompt treatment.

Causes and Symptoms of Ovarian Cysts

Young asian woman suffering form stomach ache while sitting on couch at home — Any sign of discomfort or pain in the pelvic area should be checked out by your doctor.

The exact cause of ovarian cysts is usually not known but certain risk factors may predispose you to them. These include undergoing infertility treatments, pregnancy, having a low thyroid hormone, cigarette smoking and tubal ligation surgery.

Traditional Chinese Medicine (TCM) recognises ovarian cysts as zheng jia (症瘕) or abdominal mass. According to Real Health Medical Chief Physician Chu I Ta, the description of ovarian cysts has been recorded in the oldest written work of medicine, the Yellow Emperor of Canon Medicine thousands of years ago. “Zheng Jia refers to a lump in the lower abdomen that is accompanied by a feeling of pain, swelling, fullness and in extreme cases, bleeding”, he explains.

The main organs involved are the Liver, Kidney and Spleen. Pathological factors responsible for ovarian cysts include:

Blood Stasis due to Qi Stagnation

Internal emotional injury causes a depression of Liver qi, resulting in obstruction of the channels, and impeded flow in collaterals and blood circulation. The Stagnation of qi and blood leads to the formation of lumps.

Accumulation of phlegm-Dampness

Irregular eating and drinking result in depressed Spleen yang (active energy). The Spleen is unable to function effectively resulting in phlegm and Dampness. The imbalance in these factors leads to the obstruction of qi and blood.

Stagnation of Damp-Heat

During menstruation and after delivery, the uterine vessels are empty and deficient. As a result, there is insufficient healthy qi. Pathogenic Damp-Heat can invade in these conditions. It mingles with residual blood, stagnating in the uterus, and can result in an abdominal mass.

Most functional ovarian cysts are asymptomatic and may not be detected. Symptoms include one-sided pain or pressure in the lower abdomen. The pain may be sharp or dull and may be continuous or appear intermittently. If a cyst ruptures or undergoes torsion, a patient may suddenly experience severe pain with nausea and vomiting. Menstrual irregularities and abnormal vaginal bleeding could also be symptoms of ovarian cysts.

Treatment of Ovarian Cysts

Doctor performing a transvaginal ultrasound on a young patient — Conservative treatment of ovarian cysts involves closely monitoring the patient with serial ultrasonography tests.

If a doctor has detected you have an ovarian mass, they will first ask you to undergo tests to rule out pregnancy and ovarian malignancy. CA-125 is a biomarker that is raised in most cases of ovarian cancer. It is more accurate in diagnosing cancer when used along with ultrasonography of the pelvis, particularly in menopausal women with ovarian cysts.

Management of ovarian cysts depends on the type and size of the cyst, the patient’s age, menopausal status, and if there is any suspicion of malignancy.

Conservative treatment

Single ovarian cysts of less than 10cm in diameter are usually benign, regardless of the age of the patient. Hence, if you are asymptomatic, you’ll usually only be monitored with regular ultrasound examinations. Most functional ovarian cysts disappear spontaneously after several menstrual cycles.

Your doctor may prescribe birth control pills to prevent new ovarian cysts from occurring. Consult with them for a proper prescription.

Surgical treatment

Large ovarian cysts, cysts that don’t go away, or those that cause more severe symptoms might need surgery. The surgery may entail removing only the cyst or an entire ovary, depending on each individual case.

Herbal remedies

TCM remedies can be used for functional cysts which are asymptomatic. Based on each case presentation, a TCM physician will be able to do a syndrome differentiation and formulate the right treatment.

Some of the remedies used by Physician Chu include:

Cang Fu Dao Tan Wan (苍附导痰丸): Used in cases of accumulation of phlegm-Dampness. The formula transforms phlegm and eliminates Dampness, promotes blood flow and disperses conglomerations.
Main ingredients: Poria (fu ling, 茯苓), prepared pinellia tuber with Alumen radix glyrrhigae calcaren (fa ban xia, 法半夏), dried tangerine peel (chen pi, 陈皮), liquorice root (gan cao, 甘草), Atractylodes Rhizome (cang zhu, 苍术), Nutgrass Galingale Rhizome (xiang fu, 香附), Bile arisaema (dan nan xing, 胆南星), bitter orange (zhi ke, 枳壳), fresh ginger (sheng jiang, 生姜), and medicated leaven (shen qu, 神曲).

Da Huang Mu Dan Tang (大黄牡丹汤): Used in cases of Stagnation of Damp-Heat. This formula clears Heat and eliminates Dampness, resolves Stasis and disperses concretions.
Main ingredients: Rhubarb (da huang, 大黄), tree Peony bark (mu dan pi, 牡丹皮), peach seed (tao ren, 桃仁), Chinese waxground seed (dong gua ren, 冬瓜子), and sodium sulfate (mang xiao, 芒硝).

Acupuncture

Just like herbal remedies, acupuncture is also recommended only in functional cysts that are not likely to rupture or undergo torsion. A TCM physician is able to differentiate the syndromes and prescribe the right acupoints for needling during a session.

The acupuncture points Physician Chu recommends for his patients include:

For Blood Stasis due to Qi Stagnation: guan yuan (CV4, 关元), qi hai (CV6, 气海), qi chong (ST30, 气沖), san yin jiao (SP6, 三阴交), he gu (LI4, 合谷), xue hai (SP10), ci liao (BL32, 次髎), ge shu (BL17, 膈俞), shi men (CV5, 石门), and tai chong (LR3, 太冲)

Located along the midline of the lower abdomen, 4 fingers-breadth below the navel. It dispels pathogens for improved qi and blood circulation within the lower abdominal cavity and revitalises Kidneys’ yang energy.

Located along the midline of the lower abdomen, 2 fingers-breadth below the navel. It dispels pathogens for improved qi and blood circulation within the lower abdominal cavity and revitalises kidneys’ yang energy.

On the lower abdomen, two finger-breadths lateral to the midline, level with the superior border of the pubic symphysis.

An illustration of san yin jiao acupoint to help support the kidney in an osteoporosis alternative treatment — Sanyinjiao (SP6, 三陰交) is located on the inner lower leg, about 4-fingers-breadth above the tip of the ankle bone.

An illustration of a left hand, showing he gu (LI4) acupressure point — He gu is located on the back of the hand, between the 1st and 2nd metacarpal bones. It helps dispel pathogens and restores and enhances qi and blood circulation within the meridians.

To locate Xue Hai (SP10), flex the knee and press the spot 2 fingers-breadth above the superior medial border of the patella on the bulge of the medial portion of quadriceps femoris.

Ci liao is midway between the dimples above the buttocks and the lumbar spine, approximately one finger-breadth above the top of the buttock crease, and approximately one thumb-width on either side of the spine.

Ge she is 1.5 finger-breadths lateral to zhi yang (DU 9), at the level of the lower border of the spinous process of the seventh thoracic vertebra.

Shi men is n the lower abdomen, on the anterior midline, two finger-breadths inferior to the navel.

3D illustration of the Taichong (LV3) acupressure point — Located on top of the foot, in the depression closest to the first metatarsal space. It revitalises the Liver.

Accumulation of Phlegm-Dampness: guan yuan (CV4, 关元), qi hai (CV5, 气海), feng long (ST40, 丰隆), zu san li (ST36, 足三里), qu chi (LI11, 曲池), and di ji (SP8, 地机)

Located on the shin, eight fingers-breadth below the depression of the knee joint, two fingers-breadth from the anterior crest of the shin. It dispels pathogens to improve qi and fluid circulation within the meridians and strengthens the stomach’s function.

3D illustration of the zu san li acupoint — Located on the shin bone, four fingers-breadth below the depression of the knee joint, one finger-breadth (middle finger) from the anterior crest of the shin. It dispels pathogens to improve qi and fluid circulation within the meridians and revitalises the Spleen and stomach.

When the elbow is flexed, qu chi is in the depression at the lateral end of the transverse cubital crease, midway between chi ze (LU5) and the lateral epicondyle of the humerus.

Di ji is located on the inside of the ankle, in the depression between the ankle bone and the Achilles tendon.

Stagnation of Damp-Heat: yin bai (SP1, 隐白), tai chong (LR3, 太冲), shui dao (ST28, 水道), zhi gou, (SJ6, 支沟), and wai guan (SJ5, 外关)

On the dorsal aspect of the big toe, at the junction of lines drawn along the medial border of the nail and the base of the nail, approximately 0.1 finger-breadths from the corner of the nail.

On the lower abdomen, two finger-breadths lateral to the midline and three finger-breadths inferior to the navel.

Zhi gou is on the dorsal aspect of the forearm, three finger-breadths above the transverse crease of the dorsum of the wrist.

On the dorsal aspect of the forearm, on the line connecting yang chi (SJ4) and the tip of the elbow, two finger-breadths above the transverse crease of the wrist between the ulna and radius bones.

Functional ovarian cysts are more common than you think. Thankfully, there are several treatment options in Western as well as a traditional medicine that can help to resolve them. Do approach your TCM physician for an in-depth syndrome differentiation so that you can be guided regarding the right treatment.