Is every cyst and fibroid worth panicking over? We investigate.

Terms like ‘cysts’ and ‘fibroids’ can often push us into fear, given how potentially menacing they can be. Is the fear-mongering justified entirely? 

As compared to around two decades ago, today, the awareness about menstrual health and care and common conditions like premenstrual syndrome (PMS), dysmenorrhea, menopause and perimenopause and even PCOS/PCOD has augmented considerably. While doctor-turned-influencers like Dr Tanaya Narendra (@dr_cuterus), Dr Divya Vora (@thegirldocnextdoor) and Dr Yuvraj Jadeja (@doctoryuvi) are striving to make conversations around women’s health more mainstream and open, the explosion of the sexual and menstrual health products category is equipping women across age groups to address basic concerns. 

That being said, there exists a lot of ambiguity regarding the nitty gritty of conditions unique to women. Although the diminished taboo around menstrual concerns has familiarised people with conditions like PCOS, there is still a lack of knowledge when it comes to phenomena like cysts and fibroids. But, is the presence of a cyst or fibroid always alarming, and what do they actually mean individually? We asked the experts to help us understand both the concepts and when exactly one needs to worry.

What are cysts?

“A cyst can be of many kinds,” says Dr Tanaya Narendra a.k.a Dr Cuterus, a doctor and sex educator, “you can have a bladder cyst, ovarian cyst and a hundred others.” An ovarian cyst is a fluid-filled cyst that develops in either of the ovaries, affirms Dr Hemant G. Deshpande, professor and head of the Obstetrics and Gynaecology department of DY Patil Hospital at Pimpri in Pune. Speaking of ovarian cysts, they can also be of different kinds. “A functional ovarian cyst is very normal to have; the other one is an endometrial cyst,” explains Narendra. According to Deshpande, while the first type of cyst develops naturally during the menstrual cycle or pregnancy, the second type, also known as chocolate cysts, forms as a result of abnormal cell growth or in the case of endometriosis, which can either be benign or turn into malignant tumours in some cases. “Malignant ovarian tumours usually occur after menopause or may be seen in teenage girls, so it’s best to never ignore the ovarian tumours in the post-menopausal and teenage phases. Needless to say, they can only be diagnosed through ultrasound examination,” adds Deshpande.

Polycystic ovary/ovarian syndrome, also known as PCOS, which is said to affect one in every ten women, also shares a link with ovarian cysts, albeit, not in all cases. In one of her blogs, Dr Laura Nicholas, a Vancouver-based naturopathist who works closely with expert reproductive endocrinologists and gynaecologists, articulates, “Despite the name, women with PCOS don’t need to have ovarian cysts. Only two of the following three criteria are required in order to be diagnosed with PCOS: amenorrhea or oligomenorrhea which means no period for at least three months or thirty-five-plus day cycles that are either regular or irregular, hyperandrogenism which includes symptoms of high androgens such as acne, oily skin, facial hair or blood work confirming high testosterone, DHT, DHEA-S and polycystic ovaries on ultrasound — twelve of more follicles per ovary or an ovarian volume of more than 10ml, to be precise.” Since the “cysts” in PCOS are not true cysts but immature follicles that collect in the ovary and have not ovulated, you may have PCOS without any cysts at all, opines Nicholas. According to Deshpande, polycystic ovaries are seen in young as well as middle-aged females and are usually caused due to obesity, genetics or hereditary diabetes and can be characterised by hirsutism and acne. 

What are fibroids?

Fibroids, in contrast, are a collection of muscle cells, says Narendra. “The muscle cells become like a bit of a ball and form this mass. They occur very normally in people with uteruses and usually, they don’t really pose major issues,” explains the doctor. However, for some people, fibroids can lead to “heavy uterine bleeding, concerns with fertility, or an increased drive to pee and poop as it puts a lot of pressure to the pelvis, but by and large, half the time people don’t even realise that they have a fibroid—it only comes to one’s notice during an ultrasound, that is, if someone opts for one.”

The benign tumours composed of smooth muscle and fibrous connective tissues (read: fibroids), are the most common tumours among women during their reproductive years, believes Deshpande. “They are found in approximately one out of every four women. Uterine leiomyoma, also called uterine fibroids, are symptomatic in 50 per cent of the women, with the peak incidence of symptoms occurring in their 30s and 40s,” says the gynaecologist. “Only 50 per cent of fibroids are asymptomatic. It is key to note that menarche at an early age increases the risk of developing fibroids.” 

Some women get fibroids, some don’t; it’s not a mandate and nor can one really determine if a fibroid will contrive in a woman’s body, says Narendra. “While one’s family history does play a small role here, it doesn’t work as a reliable indicator of the fact that you will develop a fibroid,” she says. Stating the factors that typically make a woman susceptible to fibroids, Deshpande mentions obesity teamed with Type 2 diabetes, hypertension and a deficiency of vitamin D in the body. 

Are they always a cause of concern?

As mentioned earlier, not all cysts are pernicious. And, similarly, not all fibroids are dangerous. “There is a very small percentage of fibroids, or leiomyoma, that can actually be problem-causing or harbour cancer, which is also called leiomyosarcoma. But that’s not very common,” states Narendra. “Aside from being cancerous, fibroids can be dangerous for some people if they’re very huge as they increase the surface area of the uterus which means there’s more uterus to bleed from which means that it could cause heavy menstrual bleeding or changes in the menstrual pattern. This could also lead to excessive blood loss, anaemia in some cases,” she further explains, indicating that the size and placement of the fibroids play a key role in determining whether or not a fibroid can be potentially harmful. “In some cases, if the fibroid occurs inside the cavity of the uterus (the little place where the embryo sits), that can cause trouble too. Take your bedroom for example; if an enormous elephant also enters your room, there won’t be sufficient space for you to live comfortably.”

Listing the red flags, Narendra mentions cases of excessive/abnormal uterine bleeding, changed menstrual patterns, infertility, a sensation of dragging or heaviness felt in the pelvis, any struggle or pattern changes with peeing or pooping (as a large fibroid could impose a lot of pressure on the bladder or rectum), it is best to consult with a gynaecologist. “In fact, if you notice any irregularities or abnormalities in your body, visit the doctor immediately.” To decipher if an ovarian cyst is causing trouble, be mindful of symptoms such as abdominal and pelvic pain, vomiting, abdominal discomfort, menstrual abnormalities and infertility, says Deshpande. “In case an ovarian cyst undergoes torsion or ruptures or enlarges grossly or is malignant, it is bound to cause symptoms.”

“From prescribing medicines to employing intrauterine devices to reduce the size of the fibroid, there are a couple of ways to address a menacing fibroid. In some cases, a small open surgery may also be advised, depending on the size or location of the fibroid,” shares Narendra. “While pathological cysts can be surgically removed laparoscopically, PCOS can be managed by a medical line of therapy or may need ovarian drilling,” concludes Deshpande.

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