When it comes to reproductive health, two terms that often cause confusion are PCOS and ovarian cysts.

Although both include the word “cyst,” they are distinct in their causes, symptoms, and treatment approaches. Knowing the difference is important for anyone dealing with reproductive health concerns.

Polycystic ovary syndrome (PCOS) and ovarian cysts are two separate conditions that can impact a woman’s fertility, hormone levels, and overall reproductive health.

In some ways, they can overlap. However, they differ in significant ways that need to be addressed with the right care and treatment.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects around 1 in 10 women of reproductive age. PCOS causes an imbalance in the hormones that regulate the menstrual cycle.

The disorder is often diagnosed when a person has at least two out of three symptoms: irregular periods, excess androgen levels, or polycystic ovaries. However, it is important to note that not all women with PCOS will experience all these symptoms.

Irregular periods and ovulation are some of the first signs of PCOS. Women with this condition may skip periods for several months or experience very long cycles.

This is because PCOS interferes with the normal ovulation process. It becomes difficult for eggs to mature and be released during the menstrual cycle.

Elevated androgen levels, also known as male hormones, can lead to symptoms like hirsutism (excessive body or facial hair), acne, and thinning scalp hair. While androgens are present in both males and females, women with PCOS often have higher levels. This can result in these visible symptoms.

Another hallmark of PCOS is polycystic ovaries. Despite the name, the term “polycystic” does not mean that these ovaries contain actual cysts.

Rather, women with PCOS have a larger-than-normal number of small, fluid-filled sacs (follicles) around their eggs, which are often immature. These follicles are unable to release eggs regularly. This can contribute to infertility in some cases.

While PCOS can impact fertility, it is not impossible for women with the condition to get pregnant. Treatment options, including medication to regulate ovulation, can help women with PCOS conceive. In addition, lifestyle changes such as a healthy diet and exercise can help manage the symptoms.

What Are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that develop on or inside an ovary. These cysts are very common, with many women developing at least one ovarian cyst in their lifetime.

In most cases, ovarian cysts are benign and do not cause significant symptoms. Many women with ovarian cysts do not even know they have them until they undergo an ultrasound for another issue.

There are several different types of ovarian cysts. Not all of them are related to the menstrual cycle. The most common type of ovarian cyst is a functional cyst. It forms part of the normal menstrual cycle.

A functional cyst may develop when a follicle (a sac that contains an egg) does not release the egg as it should, causing it to continue growing. In most cases, functional cysts are harmless and will go away on their own within a few months.

Other types of ovarian cysts include dermoid cysts, cystadenomas, and endometriomas.

• Dermoid cysts contain tissue like hair, skin, and sometimes teeth, and are usually present from birth.
• Cystadenomas form on the outer surface of the ovary and can grow large. However, they are usually non-cancerous.
• Endometriomas are cysts caused by endometriosis–a condition where tissue similar to the lining of the uterus grows outside of the uterus.

While most ovarian cysts are harmless, they can cause symptoms like pelvic pain, bloating, or irregular periods. In rare cases, ovarian cysts may need to be removed if they are large, persist for a long time, or become painful.

A medical provider can often determine the presence of an ovarian cyst using a pelvic ultrasound, and sometimes, a blood test is required to assess the type of cyst.

Differences Between PCOS and Ovarian Cysts

The biggest difference between PCOS and ovarian cysts lies in the underlying cause and the way each condition affects the ovaries.

In PCOS, the ovaries contain a higher-than-normal number of small follicles. These follicles are often too immature to ovulate properly. As a result, women with PCOS may experience irregular periods and difficulty getting pregnant.

It is important to note that PCOS is a hormonal disorder. This means that it is characterized by hormonal imbalances and not the presence of actual cysts.

On the other hand, ovarian cysts are typically fluid-filled sacs that form within the ovary. These cysts can result from the normal menstrual cycle (functional cysts) or other causes, such as endometriosis. While ovarian cysts may occur in women without PCOS, having polycystic ovaries is a common feature of PCOS.

However, polycystic ovaries are not the same as ovarian cysts. The follicles in polycystic ovaries are typically small and immature. Meanwhile, ovarian cysts are larger and contain fluid.

Can PCOS Affect Fertility?

One of the most significant impacts of PCOS is its effect on fertility. Since women with PCOS often do not ovulate regularly, it can be difficult to conceive.

Women with PCOS may also have higher levels of insulin. This can lead to weight gain and metabolic issues, further complicating the fertility process.

However, it is important to note that many women with PCOS can still get pregnant with the help of treatments. Ovulation-inducing medications like Clomid and Letrozole are commonly prescribed to stimulate regular ovulation.

In more severe cases, in vitro fertilization (IVF) may be recommended. Women with PCOS may also benefit from lifestyle changes, such as losing weight, improving insulin sensitivity, and maintaining a healthy diet.

Can Ovarian Cysts Affect Fertility?

In most cases, ovarian cysts do not affect fertility. The majority of ovarian cysts are functional cysts, which are part of the normal menstrual cycle. These cysts usually do not cause any issues with fertility and often resolve on their own within a few months.

However, some types of ovarian cysts, such as endometriomas (caused by endometriosis), can lead to fertility problems. Endometriosis can cause scarring in the fallopian tubes. This makes it harder for the egg to travel from the ovary to the uterus. In some cases, surgical intervention may be needed to remove the cysts and improve fertility.

If an ovarian cyst is large, persistent, or causes significant symptoms, it may need to be surgically removed. Laparoscopy, a minimally invasive surgical procedure, can be used to remove the cysts while preserving the ovary and surrounding tissue.

Symptoms of PCOS vs. Ovarian Cysts

While both PCOS and ovarian cysts can cause symptoms related to the menstrual cycle, their symptoms tend to differ.

Some common PCOS symptoms include:

• Irregular periods or missed periods
• Excessive body or facial hair
• Acne or oily skin
• Thinning hair on the scalp
• Weight gain
• Difficulty getting pregnant

On the other hand, ovarian cysts may cause symptoms like:

• Pelvic pain or pressure
• Bloating or swelling in the abdomen
• Pain during intercourse
• Irregular periods or heavier-than-usual bleeding
• Nausea and vomiting (if a cyst ruptures)

While most ovarian cysts are asymptomatic, they can become painful if they grow too large, rupture, or twist. In such cases, surgical removal may be required.

Diagnosing PCOS and Ovarian Cysts

The diagnosis of PCOS typically begins with a thorough medical history and a physical examination. Your ovarian cyst doctor may perform blood tests to check hormone levels, including androgens and insulin.

An ultrasound may be used to detect polycystic ovaries. This is not always necessary if other symptoms are present.

To diagnose ovarian cysts, your doctor will likely perform a pelvic exam and order a pregnancy test to rule out pregnancy-related complications. If the doctor suspects an ovarian cyst, an ultrasound will often be recommended to get a clearer picture of the cyst’s size, location, and type.

In rare cases, a laparoscopy may be used to examine the ovaries more closely.

Treatment Options for PCOS and Ovarian Cysts

Treatment for PCOS can vary depending on the severity of the symptoms and whether the woman is trying to conceive. Common treatment options include:

• Hormonal birth control pills to regulate periods and reduce androgen levels
• Ovulation-inducing medications to help women get pregnant
• Anti-androgen medications (like spironolactone) to reduce excess hair growth and acne
• Lifestyle changes such as exercise, weight loss, and dietary changes
• Insulin-sensitizing medications (such as metformin) to regulate insulin levels and improve fertility

For ovarian cysts, treatment may not always be necessary. If the cysts are small and do not cause any symptoms, they may resolve on their own. For larger cysts or those causing pain, treatment options can include:

• Pain management with over-the-counter medications
• Surgical removal of the cyst (especially if it is large, persistent, or causing complications)
• Monitoring with repeat ultrasounds to track the cyst’s growth
• Laparoscopic surgery for larger or complicated cysts

Understanding PCOS and Ovarian Cysts

While PCOS and ovarian cysts share some similarities, they are distinct conditions that require different approaches to diagnosis and treatment. PCOS is a hormonal disorder that impacts ovulation and can affect fertility. Meanwhile, ovarian cysts are fluid-filled sacs that often appear and disappear naturally as part of the menstrual cycle.

Understanding the differences between these conditions is important for managing symptoms and making informed decisions about treatment options.

For individuals experiencing irregular periods, pelvic pain, or difficulty conceiving, it is important to consult with a healthcare provider to get a proper diagnosis and a personalized treatment plan.

At Rosh Maternal & Fetal Medicine, we specialize in high-risk obstetrics, gynecologic care, and fertility support. We deliver both personalized pregnancy care and advanced pregnancy ultrasound services.

If you are concerned about PCOS, ovarian cysts, or any other reproductive health issue, we encourage you to schedule a consultation with one of our specialists at Rosh Maternal & Fetal Medicine.