Ovarian Cysts & PMOS Care
Ovarian cysts and PMOS (polyendocrine metabolic ovarian syndrome, formerly known as PCOS) are common and are often confused with each other. Dr Laarnie Pe Benito consults at Women’s Care in Castle Hill and can help you understand what is going on and what to do next.
Ovarian cysts
An ovarian cyst is a fluid-filled sac on or within an ovary. Most cysts are benign (not cancer), and many are functional cysts that form as part of the normal menstrual cycle and settle by themselves within a few cycles. Other types include:
- Endometriomas, cysts caused by endometriosis (see endometriosis and pelvic pain)
- Dermoid cysts (mature cystic teratomas), which are benign and can contain different tissue types
- Cystadenomas, which develop from the surface of the ovary and can grow large
Many cysts cause no symptoms and are found incidentally on a scan. When they do cause symptoms, these can include pelvic pain or pressure, bloating, pain with sex, or changes to periods.
Seek urgent care for sudden severe pelvic pain, particularly with vomiting, fever or fainting. A cyst can twist the ovary (torsion) or rupture, and both need prompt assessment at an emergency department.
How ovarian cysts are assessed and managed
A pelvic ultrasound is the main test, and it shows the size and appearance of a cyst. Sometimes an MRI or blood tests are added. Blood markers such as CA-125 can be raised by benign conditions as well, so they are interpreted alongside the scan and your age and symptoms.
Management depends on the type, size and appearance of the cyst, your symptoms and whether you have been through menopause. Options include:
- watching and waiting, with a repeat ultrasound to see whether the cyst settles
- pain relief and, in some cases, hormonal treatment
- laparoscopic cystectomy, which removes the cyst and aims to preserve the ovary, when a cyst is persistent, large, causing symptoms or has features that need further assessment
- oophorectomy (removal of the ovary), which is sometimes needed, for example when the ovary cannot be preserved or when there are concerns on assessment
Surgery is usually performed using keyhole techniques where suitable. See minimally invasive gynaecological surgery.
PMOS (formerly PCOS)
PMOS, which stands for polyendocrine metabolic ovarian syndrome, is the new name for the common hormonal condition long known as polycystic ovary syndrome (PCOS). The new name reflects that it affects hormones and metabolism as well as the ovaries. Despite the former name, it does not mean you have large ovarian cysts. The “cysts” are small follicles seen on ultrasound.
The 2023 International Evidence-based Guideline for polycystic ovary syndrome (PCOS), the previous name for PMOS, describes diagnosis in adults when two of the following three features are present, after other causes have been excluded:
- irregular menstrual cycles or infrequent ovulation
- clinical signs (such as acne or excess hair growth) or blood test evidence of raised androgens (“male-type” hormones)
- polycystic ovary appearance on ultrasound, or a raised level of anti-Müllerian hormone (AMH) in adults
PMOS can also be associated with weight changes, insulin resistance and a higher risk of type 2 diabetes, low mood and anxiety, sleep apnoea, and thickening of the uterine lining when periods are very infrequent. It is also a common reason for difficulty ovulating.
Managing PMOS
Care is tailored to your main concerns and may be shared between your GP, a gynaecologist and other health professionals. It may include:
- healthy eating and regular physical activity, with support for mental health and sleep
- hormonal treatment, such as the combined oral contraceptive pill, to regulate bleeding and reduce acne and excess hair growth, or a progestogen to protect the uterine lining
- medicines to reduce androgen effects, or metformin in selected situations
- treatment for heavy or irregular bleeding (see heavy menstrual bleeding)
- ovulation induction, usually arranged with a fertility specialist, for women who wish to become pregnant
If you have had no periods, or very few, for a long time, it is worth discussing protection of the uterine lining with your doctor.
How Dr Pe Benito can help
Ovarian cysts and PMOS are both part of Dr Pe Benito’s clinical focus. At Women’s Care in Castle Hill she can review your scan results, assess your symptoms, arrange further tests and discuss whether monitoring, medicines or surgery is the right approach, including laparoscopic ovarian cystectomy or oophorectomy where needed.
She consults women from Castle Hill, Baulkham Hills, Kellyville, Rouse Hill, Bella Vista, Cherrybrook, Glenhaven, Dural and Glenwood, and across the Hills District.
Common Questions
Do all ovarian cysts need to be removed?
No. Most cysts are benign and many settle by themselves. Removal is usually considered when a cyst persists, is large, causes symptoms or has features that need further assessment.
Can I have PMOS without cysts on my ovaries?
Yes. PMOS is diagnosed from a combination of features, and ovarian appearance on ultrasound is only one of them. Ultrasound is not needed for diagnosis if the other two features are present.
Can PMOS be cured?
PMOS is a long-term condition, but its symptoms and associated health risks can be managed. Management is individualised.
Consultation Enquiries
Dr Pe Benito is a female gynaecologist consulting at Castle Hill Women’s Care. A GP referral is recommended for Medicare rebates on specialist consultations. Please contact the rooms to arrange an appointment.