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Ovarian cysts occur in women from birth to menopause, but most of the time they are not treated because they cause no symptoms.

The cysts that occur with PCOS (polycystic ovarian syndrome) do not become cancerous and do not necessarily interfere with normal menstruation and fertility. In PCOS, symptoms are caused by hormonal imbalances throughout the body rather than just the presence of cysts.

Cysts caused by PCOS can be treated with diet or hormone therapies, only rarely by surgery. Certain kinds of cysts, however, may require medical treatment, and if they are ruptured, the may trigger a medical emergency. Here are three kinds of ovarian cysts that every woman needs to know about.

The most common kind of cyst not caused by PCOS is a functional cyst. PCOS is a condition of too much testosterone and luteinizing hormone (LH), but a functional cyst is caused by too much follicle stimulating hormone (FSH). FSH is needed for a follicle to mature so it can release the egg. When there is too much FSH, or the ovaries are too sensitive to FSH, the follicle can just keep growing. It protects the egg inside it with more and more mucus-filled fluid.

The follicle becomes a cyst that can grow to 3-4 inches (75-100 mm) or more in diameter. A functional cyst can be painful, but it will not cause a crisis if it breaks, since it is not filled with blood. And since it will not become cancerous, most doctors will just leave it alone unless it becomes very large. A majority of functional cysts drain on their own in a few weeks to a few months.

The second most common kind of cyst not caused by PCOS is an endometrial cyst. This is a tiny piece of the lining of the uterus that somehow got torn away and ended up in an ovary, usually through a process called retrograde (backwards flowing) menstruation. Like the rest of the endometrium, or lining of the uterus, the endometrial cyst, or endometrioma, is stimulated by estrogen during the first 14 days of a woman's menstrual cycle. That means that for 14 days out of every 28 it is stimulated to grow larger and larger. Surgery may help with symptoms but the relief is usually temporary, only a year or so.

The third kind of ovarian cyst that may require treatment is a cystadenoma. It is basically a bag of mucus. Cystadenomas may grow as much as 1 foot (300 mm) across. Because they can twist the ovaries, cutting off circulation and causing gangrene, cystadenomas often require surgical treatment.

How can a woman know if a cyst has ruptured and requires emergency medical treatment?

The key to differential diagnosis is the timing of the pain. If a woman feels a "rupture" about the fourteenth day of her menstrual period, that may simply be the expected sensation of a healthy follicle, which is also a kind of temporary "cyst," breaking to release the egg during ovulation. However, if there is abdominal pain just before, during, or just after (within a day) of a woman's period, the pain may be a ruptured cyst. Ruptures are most likely to occur during heavy exercise or as the result of vigorous sexual intercourse. Especially if there is loss of blood or a "springy" feeling in the abdomen, emergency medical care is essential.

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