PCOS cysts "bursting": fact of fiction?

[io2012.livejournal.com]

So I now have a tentative diagnosis of PCOS. Long story short, I am HWP, but have never had regular menses. Since going off HBC, I had an increase in acne and body hair, a big increase in sex drive (huzzah for that at least) and have been bleeding almost continuously. When they took a transvaginal ultrasound, they found multiple small cysts on both of my ovaries, but my left ovary is far worse - it is basically enlarged (as deep as it is long) and filled with PCOS cysts. They also checked the position of my Paragard IUD, which is fine, and found that my endometrium looked happy as a clam. (it should be, with all the shedding its been doing!) 

Now it is my understanding that PCOS "cysts" are basically small, immature ovarian follicles. That being said, can they actually "burst"? If so, what does that mean? I'm asking because I've had very few cramps with my continous bleeding, but the ones I have had are INTENSE (7/10 pain), sharp/stabbing, and very localized over my left ovary. Sometimes the pain seems to go directly through my abdomen from front to back (ie: I have pinpoint pain on a line that starts 6" diagonally down from my belly button and ends at a spot on my low back). These episodes start without warning (no normal "aches and pains" from my uterus) and last anywhere from 1 - 4hrs. Ibuprofen doesn't have much effect, heat and lying still seem to help more than anything. 

I'm just curious because my previous experiences with menstrual cramps were that they took a day or two to "warm up" before my period would start (when I would get it) and that they were more diffuse/spread out. They also responded well to ibuprofen and some light exercise/sex. When I get these cramps now sex and exercise are the last things I think of.

Any thoughts? 

Comments

[paraxeni.livejournal.com]

PCOS cysts generally don't burst, they're the tiny pearl-like ones (generally follicular cysts I believe) that usually stay put on the surface of your ovary under a thick membrane..

Functional cysts do burst though, and the pain you're describing could be due to functional (corpus luteum) cysts. I've got both types and contrary to popular belief a bursting cyst isn't always excruciating, sometimes it's just aggravating and needs a lie-down with a hot water bottle. Only the big ones are horribly painful. The ovarian pain I get associated with my PCOS is nagging and twingey.

I'd mention it to your doc when you go next. They may suggest further treatment options that make the likelihood of any type of cyst less likely, although for functional cysts this usually just involves using a combined pill for a while.

[io2012.livejournal.com]

Thanks for the great info....What is a "functional cyst"?

[paraxeni.livejournal.com]

It's usually the result of an almost complete ovulation I believe. Biggish fluid-filled cyst on a stalk like a grape. If we're sticking to fruity metaphors the PCOS cysts are like the tiny individual little berries on a blackberry, and the functionals are like grapes. The fluid ones can get almost impressively big. My biggest was only 10cm but the pain from that? Yikes. Horrid. But like I said for the smaller ones it's a case of just waiting for it to be over, taking pills, being cuddled and swearing a lot!

[io2012.livejournal.com]

Oh - in that case I don't think I have those....the weekend before I went for my ultrasound I had one of my intense pain episodes, and 4 days later they didn't find any cysts that were large on the ultrasound. The report, however, was disappointingly short. Just a few sentences describing the dimensions of my ovaries and the presence of "multiple small cysts" (I counted while I was lying there, I had 14+ on my left ovary, and they were the small "string of pearls" type).

I guess it remains a mystery!

[paraxeni.livejournal.com]

Oh they can pop up so quickly, and disappear just as fast.

My 10cm didn't exist 8 days before it burst and put me in hospital with the pain. When they did an ultrasound they saw it's 6cm evil twin just hanging out among the chaos (lots of fluid) and said "Uh-oh, better be careful because if this one goes it will go the same way".

Two days later, nothing there on my pre-discharge scan.. Not a thing. I had an abdominal and transvaginal ultrasound, no sign of anything but my PCOS cysts. That's why I hate the big cysts SO MUCH! It's so annoying that they're all like "BOO! GOTCHA!" with no warning, and then gone again before anyone can prove what's happened!

The PCOS ones just stay put, chilling on my ovaries. The chocolate cysts on my ovaries from endometriosis leave visible scarring and damage. These though? Come and go as they please. Virtually everyone with ovaries will get at least one between puberty and menopause, but they're mostly discovered by accident while being scanned for other things, because they're not often symptomatic, except in a handful of unlucky types (like me, maybe you too) who have to put up with recurrent nonsense from them.

Here's to a pain-free, cyst-free 2011 for both of us! If that's not possible I'll take a reduction in pain or better meds as a compromise :D

Best of luck.