A cyst on an ovary or when associated with other disorders of the hypothalamic-pituitary-ovarian axis, and many cysts are present, it is termed Polycystic Ovary Syndrome (aka Stein-Leventhal Syndrome). Ovarian cysts may be due to endometriosis, follicular or corpus luteum cysts, malignancy, or dermoid cysts. In Polycystic Ovary Syndrome, follicular cysts develop as a result of pituitary overproduction of LH to try to initiate ovulation. Ovarian cysts are products of failed or disordered ovulation. One or more ovarian follicles are developed monthly by the effects of follicle stimulating hormone (FSH). Luteinizing hormone (LH) promotes actual ovulation and the transformation of the follicle (after ovulation) into the corpus luteum which produces progesterone. In young women, during the early years of menstrual cycles, ovulation may coincide with a small amount of hemorrhage at the follicle site. This will cause abdominal pain, often with a slight fever, at the time of ovulation (in the middle days between periods) is commonly called mittelschmerz (German for “middle” and “pain”). Treatment consists only of mild analgesics, reassurance, rest, and perhaps a warm pack. It is unlikely to recur and portends no future problems. Later in life, usually after her mid-30’s, a woman may develop an ovarian cyst which may be asymptomatic or may cause variable pelvic pain. Palpation may detect a smooth, tender mass at one ovary site or a cyst may be found by sonogram visualization. The cyst may simply collapse and disappear after a month or two; or it may persist and increase in size and discomfort during succeeding months. Such cysts are caused by a failed ovulation in which, for reasons presently unknown, the ovulation did not proceed to completion. With each succeeding month’s surge of LH, the follicular site swells and stretches the surface membrane, causing pain and possible bleeding at the site. Some cysts may become as large as a golf ball or lemon before discovery. Treatment may require surgery during which the entire ovary may be lost. An alternative treatment for ovarian cysts is natural progesterone. Biofeedback mechanisms dictate that sufficient gonadal hormones inhibit hypothalamic and pituitary centers, such that FSH and LH production are also inhibited. That is, in the usual circumstances, the successful response to FSH and LH hormones is the rise in progesterone from the corpus luteum. If sufficient and natural progesterone is supplemented prior to ovulation, LH levels are inhibited and regular ovulation does not occur. This is the effect of contraception pills, for example. Similarly, the high estriol and progesterone levels throughout pregnancy successfully inhibit ovarian activity for nine months. Therefore, adding natural progesterone from day 10 to day 26 of the cycle suppresses LH and its luteinizing effects. Thus, the ovarian cyst will not be stimulated and, in the passage of one or two such monthly cycles, will very likely regress and atrophy without further treatment.
A naturopathic approach to treating someone with ovarian cysts would start with a complete hormone panel to discover any hormone imbalances as well as a fasting blood sugar and insulin test followed by a two hour post prandial blood sugar and insulin test to rule out underlying insulin resistance as a cause to the ovarian cysts. Most often the imbalance in the hormones is estrogen dominance which can also be accompanied by low progesterone. Therefore treatment would start with an estrogen detoxification program. Estrogen is detoxified through the same p450 enzymatic pathway as caffeine and alcohol so one way to maximize the detoxification of estrogen is to eliminate caffeine and alcohol from the diet. Clinical nutrition may also be added to assist. If insulin resistance is determined on lab findings a low glycemic, high protein meal plan may be recommended to help address the underlying insulin resistance. Bio-identical progesterone may be prescribed or botanical natural progesterone if progesterone is low. Castor oil packs may be prescribed to help manage symptoms as the underlying cause is addressed.