Ovarian Cysts While Breastfeeding

Question

At my last check-up the physician assistant discovered that my left ovary is enlarged. I went for an ultrasound and there are cysts on that ovary. I have not talked to my healthcare provider yet about it, but from the reading I have done she may suggest the birth control pill or surgery if the cysts do not go away soon or if they are a certain size. I see that Dr. Hilgers recommends progesterone. However, I am not currently cycling due to breastfeeding. I tend to go for long stretches without cycling during breastfeeding. After my first son was born, I started menstruating again at 21 months postpartum and at 25 months postpartum with my second son. My youngest child is four months old currently. Can progesterone still be used considering my situation? Also, why did I develop cysts if I have only had one menstrual cycle in the past four years due to pregnancy and breastfeeding (I conceived my youngest child during my first cycle postpartum)? I do not have the symptoms of polycystic syndrome as far as I know. My pelvic exams have always been normal except for one two years ago. The physician found an enlarged ovary but the subsequent ultrasound did not show any abnormalities.

Answer

Last Updated: July 24, 2013
There is not enough information in your e-mail to make a good recommendation as to your need for surgery. One needs to know what are the exact sizes of the cysts? Over five cm. is more serious. Sometimes you can observe smaller cysts longer, sometimes indefinitely, without removing them. Are there any solid components to the cysts, or are they purely cystic? Knowing the exact characteristics of the cysts are important. If a cyst is purely cystic and unilocular (with only one lobe), this is lower risk. Have you had any abdominal surgery recently or in the past? Surgery can result in pockets of fluid in the pelvis that are not really ovarian cysts but can look like them. Hormonally dependent cysts such as a follicular cyst or a corpus luteum cyst, which are not harmful and go away on their own, often respond to a 200 mg. progesterone injection. This can safely be given while nursing. Progesterone cream will not affect cysts as much as a single injection of 200 mg. and might not have any effect. As far as a waiting period for a cyst to shrink or go away, four weeks is short. Six to eight weeks, or even a bit more, is more common unless it is a higher risk situation. The age of the woman is also important, since older women (over 40) may be more at risk. If you have concerns about the recommendation for surgery, by all means get a second opinion from another gynecologist and an ultrasound from a radiology facility independent of your original doctor.

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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