Ovarian Cysts In Breastfeeding Mom

Question

At five weeks postpartum my midwife discovered a huge cyst on my left ovary (14cm). A radiologist drained it -32 oz of straw colored fluid. It returned weeks later to almost the same size. It was removed laparascopically and found to be a simple follicular cyst.
Last month (5 1/2 months postpartum) I went for another exam feeling some symptoms, pain on left side, fullness, etc. and the midwife thought she felt something and sent me for an ultrasound. She said that if a cyst was there she would recommend having the ovary removed. The ultrasound showed no cyst but 2cm by 3cm of free fluid in my pelvis indicating that a cyst had possibly ruptured. But, nevertheless, giving me a clean bill of health. However, she thought it appeared that I was ovulating. I am still breastfeeding my daughter and have not had a period yet. I thought follicular cysts occur during ovulation. Can I be ovulating without a period? Could follicular cysts occur without ovulating?

I would like to use the NFP approach but how do you go about it while breastfeeding? I haven’t nursed her during the night for months and she is now having solid food. I’ve done some research but I haven’t heard of my situation.

Aimee

Answer

Last Updated: October 21, 2013
There are several types of ovarian cysts that can rupture, including follicular cysts or corpus luteum cysts. They do not always indicate ovulation. If you are ovulating normally, you should have a period approximately two weeks after ovulation. However, with follicular activity (without true ovulation) or impaired ovulation you might have a period sooner or not at all. During breast feeding, there is an interval when your body is “gearing up” for ovulation and normal cycles, and has hormonal activity affecting the ovarian follicles, but not true ovulation yet. You are in the “weaning” part of breast feeding, where hormonal activity can be rapidly changing. Some methods of NFP can be helpful in sorting out your cycle and fertility, and help determine when you are returning to normal ovulation. Dr. Thomas Hilgers of the Pope Paul VI Institute, the creator of the FertilityCare method of NFP, has done a number of studies that help correlate normal and abnormal mucus and cycle patterns with fertility, even though you may not be ovulating regularly yet. I would not base the decision to remove your left ovary on the information you have given here, of having had two ruptured cysts from the same ovary (maybe). Decisions to remove an ovary are usually made at the time of surgery, and are based on the type of cyst and whether or not there is normal ovarian tissue present.

Two suggestions for women with a tendency to forming cysts:
1. Avoid NSAID’s (Advil and Aleve) – they may prevent normal ovulatory rupture of the follicle.
2. Omega-3 fatty acids facilitate normal ovulation. Flaxoil or flax oil capsules 1-3 grams/day can help.

Mary L. Davenport, M.D.

Answered By:

Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over MyCatholicDoctor.com She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.

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