Difference Between Ovarian Cysts & Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is often linked to the presence of ovarian cysts. Learn the key differences, including symptoms and treatment.

By OBGYN and fertility expert Dr. Kenosha Gleaton

Ovarian cysts vs. polycystic ovarian syndrome (PCOS)— one isn’t always indicative of the other, even though they do share some common features. Here’s your guide to the similarities and differences of ovarian cysts and PCOS. 

What are ovarian cysts, and how do they relate to PCOS?

An ovarian cyst is an air or fluid filled sac that forms on one or both ovaries. It’s estimated that up to 20% of people assigned female at birth will have an ovarian cyst at some point in their lifetime [2-3]. Cysts alone aren’t necessarily harmful, although there is the potential that a cyst ruptures or twists, which can cause pain and internal bleeding [2]. 

PCOS is a condition that is related to the endocrine system. PCOS is a syndrome, meaning it is a cluster of different symptoms. In order to diagnose PCOS, two out of three specific symptoms must be met. These symptoms include irregular menstrual cycles, increased testosterone levels, and polycystic ovaries [4-5]. Polycystic means “many cysts” and for the sake of diagnosing PCOS, refers to ≥12 follicles in each ovary measuring 2–9 mm [5]. 

While ovarian cysts can be related to PCOS, it’s important to note that they are not directly linked to one another. Someone can have ovarian cysts and not have PCOS, and someone may be diagnosed with PCOS without having cystic ovaries. 

Causes of ovarian cysts and PCOS

Ovarian cysts may be caused by a few different things. What most people don’t realize about ovarian cysts is that it’s relatively common for cysts to form as a result of the normal reproductive cycle (often referred to as functional cysts) [1-2]. For example, follicular cysts form when an ovarian follicle doesn’t open the way it’s supposed to around ovulation. Luteal cysts, also known as corpus luteum cysts, form when ovulation occurs and the ovarian follicle reseals itself. 

Other causes of cysts include hormonal changes, conditions such as PCOS and endometriosis, pelvic infection, and more. If you have frequently recurring cysts or have cysts that are abnormal in size or location, your healthcare provider may need more details to determine a cause.

We aren’t sure exactly what causes PCOS, but we do know that various genetic and environmental factors can play a role in the development of PCOS [5]. Most PCOS symptoms are a result of abnormal hormone levels, including polycystic ovaries. 

PCOS symptoms

As previously mentioned, PCOS is a syndrome, meaning it’s characterized by a cluster of different symptoms. In order to diagnose PCOS, someone must experience at least two out of three specific symptoms:

• Irregular menstrual cycles/ovulation

• High levels of male hormones (androgens)

• Polycystic ovaries

There are other signs and symptoms of PCOS that occur as a result of abnormal hormone levels and polycystic ovaries, such as [6]:

• Infertility

• Unwanted hair growth, specifically on the face, chest, and thighs

• Acne

• Oily skin

• Weight gain

• Insulin resistance

Shop products to support cycle regularity

Ovarian cyst symptoms

Ovarian cysts that aren’t caused by any underlying condition are more likely to be asymptomatic [1-2]. If someone is experiencing symptoms related to an ovarian cyst, they may notice [2]:

• Unilateral (one sided) pain or pressure in the lower abdomen

• Heavy or irregular periods

• Spotting between periods

• Pain when urinating, swollen abdomen, or pressure of the abdomen are associated with large cysts

• Sudden pain, cramping, nausea, vomiting, and increased pulse may be indicative of a ruptured or twisted ovary or cyst. 

More often than not, those with ovarian cysts aren’t aware that they have them. If you are experiencing concerning symptoms or believe you may have a cyst, you should see a healthcare provider for confirmation. 

Cyst treatment options

Treating ovarian cysts is dependent on the type of cyst and any potential complications. For most ovarian cysts, no treatment is necessary and the cysts will disappear on their own [2]. In some cases, regular monitoring every month or so may be recommended. Any pain or discomfort caused by a cyst can usually be managed with over-the-counter medications such as ibuprofen [2]. If cysts are lingering for a long time or have persistent symptoms, your healthcare provider may want to perform a laparoscopy, which is a minimally invasive procedure that involves inserting instruments in the abdomen to view the cyst(s).  

In some cases, surgery may be recommended to remove any cysts, although it's possible that new cysts will develop in the future. In very extreme and rare cases, one or both ovaries may be removed [2]. 

Unfortunately there isn’t a way to get rid of PCOS, but you can manage PCOS symptoms through hormones, diet, weight loss, supplements, etc [6]. Your treatment plan will vary depending on your health and symptoms, as well as your fertility goals. 

Effects on Fertility

So how do ovarian cysts impact fertility? This depends on the cause of the cyst(s) and whether or not they require any treatment [1-2]. The major causes of infertility include lifestyle factors, age, hormonal imbalances, and structural problems [7]. Ovarian cysts that are not caused by an underlying condition are typically caused by the regular menstrual cycle, will go away on their own, and aren’t likely to impact fertility. If a cyst is cancerous, extremely large, or is related to PCOS or endometriosis, it may make it difficult for you to conceive. If ovulation is impacted by PCOS or recurrent ovarian cysts, fertility treatment options such as ovulation induction may be useful for stimulating the ovaries and supporting regular ovulation.

Some women with PCOS may benefit from a d-chiro-inositol supplement as it has shown promising results in improving hormonal balance and ovarian function. If you are hoping to conceive and are having difficulty, be sure to speak with your healthcare provider for their recommendations on next steps.

Key takeaways

• Ovarian cysts refer to fluid or air filled sacs found on the ovaries.

• Ovarian cysts may be stand alone cysts or could be correlated to underlying conditions, such as PCOS.

• PCOS is characterized by having a hormonal imbalance, irregular menstrual period, and/or polycystic ovaries (more than twelve cysts).

• Symptoms of PCOS include hair growth, acne, weight gain, and irregular periods. 

• Ovarian cysts are often asymptomatic, but may cause pain or discomfort in the abdomen, irregular periods, spotting, and sometimes pain and nausea if a cyst ruptures or causes the ovary to twist. 

• PCOS can’t be cured, but symptoms can be treated through medications, supplements, fertility treatments, diet, and weight loss. 

• Cysts often don’t require treatment, but over-the-counter painkillers may be used to manage any discomfort. In rare cases, surgery may be necessary. 

• Ovarian cysts aren’t likely to impact fertility unless they are extremely large or associated with an underlying condition such as PCOS.

• Infertility caused by irregular ovulation may be treated through ovulation induction medication.  

References:

1. Mobeen S, Apostol R. Ovarian Cyst. [Updated 2022 Jun 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 

2. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Ovarian cysts: Overview. 2019 Mar 28.

3. Collée J, Mawet M, Tebache L, Nisolle M, Brichant G. Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments. Gynecol Endocrinol. 2021;37(10):869-874. doi:10.1080/09513590.2021.1958310

4. Bani Mohammad M, Majdi Seghinsara A. Polycystic Ovary Syndrome (PCOS), Diagnostic Criteria, and AMH. Asian Pac J Cancer Prev. 2017;18(1):17-21. Published 2017 Jan 1. doi:10.22034/APJCP.2017.18.1.17

5. Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020;13(4):261-271. doi:10.4103/jhrs.JHRS_95_18

6. Rasquin Leon LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/

7. Deshpande PS, Gupta AS. Causes and Prevalence of Factors Causing Infertility in a Public Health Facility. J Hum Reprod Sci. 2019;12(4):287-293. doi:10.4103/jhrs.JHRS_140_18