As if our bodies couldn't get any more confusing and stress-inducing, sometimes, seemingly out of nowhere, we're thrown a curve ball in the form of an ovarian cyst.

Ovarian cysts are annoying and sneaky little things — some women experience no symptoms at all, while others have warning signs in the form of back or pelvic pain. While the idea of an ovarian cyst may seem scary, especially if you're trying to conceive, figuring out whether you have one in the first place and whether or not it's affecting your fertility can make you feel even more frantic. That's why it's important to know what ovarian cysts are, how to tell if you have one, and how they can impact fertility. 

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What are ovarian cysts?

Ovarian cysts are like bubbles or "pockets" that sometimes form on or inside your ovaries. They're fluid-filled sacs that can range in size from small little peas to can't-miss behemoths. Ovarian cysts can also come in different varieties, including functional cysts, the most common party-crashers. 

Functional cysts are typically related to normal menstrual cycle processes and include follicular cysts and corpus luteum cysts. Follicular cysts form when a follicle (a fluid-filled sac in the ovary that contains an immature egg) fails to release an egg during ovulation. Instead, the follicle continues to grow, forming a cyst. Corpus luteum cysts are cysts that form after the release of an egg during ovulation when the follicle transforms into a structure called the corpus luteum. Sometimes, the corpus luteum does not dissolve as it should, and instead fills with fluid or blood, forming a cyst. Functional cysts are typically benign and tend to resolve on their own within a few menstrual cycles.

Other types of ovarian cysts include the small cysts found in women with polycystic ovary syndrome (PCOS), and endometriomas, which form when endometrial tissue implants and grows within the ovaries, causing cysts filled with old blood to develop. Endometriomas are most common in women with endometriosis

How do I know if I have an ovarian cyst?

Ovarian cysts often present without symptoms, making it difficult to know if you even have one unless it's seen on a transvaginal ultrasound. However, sometimes these cysts overstay their welcome and decide to wreak havoc on your ovaries, causing symptoms that demand your attention. 

When ovarian cysts do decide to make their presence known, here are a few things you may experience, according to Penn Medicine

  • Dull aching feeling or sharp pain in your pelvic area below your bellybutton, usually toward one side

  • A sense of fullness or pressure in your abdominal region

  • Bloating

  • Painful sex

  • Irregular periods, which may be heavier or lighter

Ovarian cysts and back pain

While ovarian cysts can come with cramps and abdominal pain, your lower back may also be affected. Lower back pain can happen when an ovarian cyst grows in size and pressures the surrounding structures in your body, including your uterus and the ligaments that support it. As a result, it can irritate the nearby nerves, causing that unwelcoming sensation in your lower back.  

woman with back pain due to ovarian cysts

How do you know if an ovarian cyst has ruptured?

One of the most frightening aspects of having an ovarian cyst is the possibility of it rupturing. While not all ovarian cysts rupture, understanding the signs that indicate a rupture has happened can help lead you to get the proper treatment. Here are the main symptoms to be on the lookout for:

  • Sudden and severe pain. One of the key signs of a ruptured ovarian cyst is intense pain in your lower abdomen or pelvis. It might feel sharp or stabbing and can come on suddenly. If you experience severe pain that seems unusual, seek medical attention immediately.

  • Abdominal tenderness. After a cyst ruptures, you may feel tenderness or soreness in your abdomen. It may feel like a lingering discomfort that persists even after the initial sharp pain subsides. Pay attention to any unusual sensations in your abdominal area.

  • Nausea and vomiting. Some people may experience nausea or vomiting after an ovarian cyst rupture. It's your body's reaction to sudden changes and can signal that something is wrong.

  • Dizziness or lightheadedness. In some cases, a ruptured cyst can lead to a drop in blood pressure, causing dizziness or lightheadedness. See a doctor immediately if you feel faint or lightheaded, along with other symptoms.

Like any potential emergency, if you're experiencing severe symptoms, don't wait. Instead, call 911 or go to the nearest emergency room or clinic.

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The impact of ovarian cysts on fertility 

While the presence of ovarian cyst(s) doesn't necessarily mean fertility struggles, you may have difficulty getting pregnant if you have pre-existing conditions like polycystic ovary syndrome (PCOS) or endometriosis

Studies have also shown that ovarian cysts can lead to hormonal imbalances and interfere with regular menstrual cycles and ovulation. Certain types of cysts, particularly functional cysts, can interfere with the regular release of eggs from the ovaries during ovulation and even affect egg quality. If an egg is not released during ovulation, it cannot be fertilized by sperm, which can make conception more difficult.

Not only that, large cysts or cysts located near the fallopian tubes can hinder the ability of the egg to travel from the ovary to the fallopian tube for fertilization, and ovarian cysts affecting the lining of the uterus (endometrium) can make it less receptive to the implantation of a fertilized egg, reducing the chances of successful implantation and pregnancy.

In some cases, ovarian cysts may require surgical removal, which is why it's important to consult with your healthcare provider if you suspect that you may have an ovarian cyst.  

Ovarian cysts can be completely harmless and without symptoms in some cases, or extremely painful and rupture in others. Depending on the location or severity of the cyst, it may or may not have an impact on your ability to get pregnant. As always, if you have been trying to conceive for over a year without success — 6 months if you're over 35 — consider consulting with a fertility specialist. They can look closely at your ovaries along with your corresponding hormone levels and come up with a treatment plan that is personalized to you. Best of luck! 

Jennifer “Jay” Palumbo is a freelance writer, infertility and women’s rights advocate, former stand-up comic, author of the blog, “The 2 Week Wait,” and proud IVF Mom. Her articles have been featured in Time magazine, Huffington Post, and ScaryMommy. She has been interviewed on news outlets such as CNN, NPR, and BBC, where she has demonstrated her ability to make even reproductive issues fun and educational. You can follow her "infertility humor" on Instagram at @jennjaypal.