Hormonal cysts, also known as functional cysts, are fluid-filled sacs that develop on the ovaries and are related to the menstrual cycle. They are very common, and most women will get them at some point. The good news is that the majority of hormonal cysts are benign and go away on their own within a few months. However, there are cases where cysts may linger, grow, or require treatment.
What are hormonal cysts?
Hormonal cysts form as a normal part of the menstrual cycle. Each month, the ovaries produce follicles which contain an immature egg. The follicle grows and releases estrogen, causing the uterine lining to thicken. Mid-cycle, the follicle bursts and releases the egg, a process called ovulation.
After ovulation, the follicle turns into a corpus luteum which secretes progesterone to prepare the uterus for pregnancy. If pregnancy does not occur, the corpus luteum breaks down and is reabsorbed. In some cases, the follicle or corpus luteum fills with fluid and forms a cyst instead of breaking down.
The two most common types of hormonal cysts are:
Follicular cysts
These occur when the follicle fails to rupture and release the egg. The follicle continues to grow into a cyst filled with fluid. Follicular cysts are usually 2-3 cm in size.
Corpus luteum cysts
These develop when the corpus luteum closes off after releasing the egg. Fluid accumulates inside, forming a cyst. Corpus luteum cysts can grow larger, up to 6 cm across.
Hormonal cysts are different from polycystic ovarian syndrome (PCOS). With PCOS, many small cysts form due to a hormonal imbalance. PCOS cysts do not go away on their own.
Do hormonal cysts go away?
In most cases, yes. Hormonal cysts are considered functional cysts because they form as part of normal ovarian function. They are benign and temporary.
Follicular cysts usually disappear within one to three menstrual cycles. Corpus luteum cysts dissolve after three or four cycles. This is because the cysts are hormone-dependent. When hormone levels drop at the end of the cycle, the cysts shrink and break down.
Up to 18% of women can have a functional cyst present during their cycle. Of these, less than 8% of cysts persist beyond three cycles. In rare cases, a cyst may linger for longer or continue to grow. Large or persistent cysts may require evaluation and treatment.
How long does it take for a hormone cyst to go away?
Most functional cysts resolve in the following timeframe:
- Follicular cyst: 1 to 3 cycles
- Corpus luteum cyst: 3 to 4 cycles
So a follicular cyst could go away within one menstrual cycle, while a corpus luteum cyst may take up to 4 months to disappear.
The duration depends on factors like:
- Type of cyst
- Size of the cyst
- Hormone levels in the body
Larger cysts may take longer to resolve. Changes in hormone balance can also impact the lifespan of a cyst.
While most cysts go away in a few months, some may linger longer. It’s a good idea to follow up with your doctor if a cyst persists beyond three or four cycles.
What makes a hormonal cyst go away?
Hormonal cysts resolve when hormone production that sustains the cyst drops off.
The follicle or corpus luteum filling with fluid is initially stimulated by the rise and fall in estrogen and progesterone. Once the corpus luteum regresses at the end of the cycle, hormone stimulation ceases.
Without this hormonal drive, the walls of the cyst break down. The fluid inside is reabsorbed by the body. The cyst disappears and the ovary returns to its normal state.
Basically, the temporary nature of hormone fluctuations allows functional cysts to naturally dissolve within a few cycles.
Can a cyst go away and come back?
It’s possible for new cysts to form after one resolves. Since hormonal cysts occur as part of the normal menstrual cycle, they can recur month to month.
Each month, around 5-10 follicles start growing on the ovaries. One reaches maturity and releases an egg. If any of the other follicles turn into cysts, they may go away only to form again the next cycle.
Recurrence is more likely if you have conditions like:
- Hormonal imbalance
- PCOS (polycystic ovarian syndrome)
- Endometriosis
- Estrogen excess
The abnormal hormonal environment leads to a higher chance of cyst formation.
However, recurrence does not necessarily mean the cyst never went away. Many women develop one cyst per cycle that resolves before the next one forms. New cysts may be indistinguishable from ones that returned.
Keeping track of cysts from month to month can help determine if they are actually recurring rather than resolving and reforming. Let your doctor know if you suspect a pattern of recurrence.
When should I worry about a lingering cyst?
Most of the time, you don’t need to worry about a hormonal cyst lingering more than a few cycles. Up to 20% of women have a functional cyst present at the time of an ultrasound. Of these, less than 8% persist beyond three cycles.
However, it’s a good idea to have your doctor assess a cyst with any of the following characteristics:
- Lasts longer than three or four cycles
- Does not respond to treatment with hormonal birth control
- Grows larger than 3 cm (follicular cyst) or 6 cm (corpus luteum cyst)
- Causes pain or symptoms
- Appears abnormal or complex on imaging
A longer-lasting cyst has a higher chance of being something besides a functional cyst, like a dermoid cyst or cystadenoma. Complex or solid-appearing cysts should also be evaluated to rule out cancer.
Let your gynecologist know if you have a persistent ovarian cyst. They can use ultrasound and blood tests to determine if additional follow-up is required. This may prevent complications down the road.
Complications of persistent ovarian cysts
While most are harmless, ovarian cysts that persist can sometimes lead to problems like:
- Growth in size – Cysts that continue to grow may rupture, bleed, or twist the ovary.
- Ovarian torsion – A large cyst can cause the ovary to twist on its supporting structures, cutting off blood flow.
- Hemorrhage – Bleeding into the cyst makes it unstable and prone to rupture.
- Infection – Bacteria can enter a cyst or abscess may form inside.
- Malignancy – A very small number of cysts can turn cancerous if they are not resolved.
- Infertility – Hormonal issues or damage from cysts can affect ovulation and fertility.
Catching a lingering cyst early allows it to be monitored and treated before these complications develop.
Tests for persistent ovarian cysts
If a cyst lingers longer than expected, your doctor may recommend:
- Pelvic exam – Feeling the ovaries for size, shape, and tenderness.
- Transvaginal ultrasound – Imaging the ovaries and cyst with a probe inserted in the vagina.
- Blood tests – Checking hormone levels, like estrogen, progesterone, and androgens.
- Pregnancy test – A positive test would rule out a corpus luteum cyst.
- Laparoscopy – Performing surgery with a tiny camera inserted in the abdomen.
These tests provide more information about the appearance, type, and origin of the cyst. They enable your doctor to determine next steps.
Medical treatment for lingering cysts
Several medical options are available if a functional cyst persists:
- Watchful waiting – Since many resolve on their own, your doctor may recheck the cyst in 1 to 3 months.
- Hormonal birth control – Oral contraceptives can help stabilize hormones and speed cyst resorption.
- Gonadotropin agonists – Drugs like leuprolide suppress ovulation and shrink functional cysts.
- Pain medication – Over-the-counter pain relievers help ease aches from large or ruptured cysts.
Your doctor will determine the right course of treatment based on your symptoms, cyst characteristics, and desire for fertility preservation.
When is surgery needed for ovarian cysts?
Most functional ovarian cysts resolve without intervention. However, surgery may be recommended if the cyst:
- Does not go away after several menstrual cycles
- Grows larger than 5-6 centimeters
- Looks abnormal or complex on ultrasound
- Causes severe pain due to twisting, rupture, or bleeding
- Is suspected to be cancerous
The main surgical options include:
- Laparoscopic cystectomy – Removal of the cyst with minimally invasive surgery.
- Ovarian drilling – Small holes poked in the ovary to induce ovulation for PCOS.
- Oophorectomy – Removal of the ovary with the cyst.
- Hysterectomy with bilateral salpingo-oophorectomy – Removal of the uterus, ovaries, and fallopian tubes.
This is typically a last resort for severe cases where bleeding, rupture, or cancer is a major concern.
Can you prevent functional ovarian cysts?
Since hormonal cysts form as a result of normal ovulation, they can’t always be prevented. However, some measures may help reduce your risk:
- Take hormonal birth control – Stopping ovulation can prevent cyst formation.
- Manage conditions like PCOS and endometriosis – Treating hormonal disorders may minimize cysts.
- Maintain a healthy weight – Obesity leads to more hormonal fluctuations.
- Limit fertility medication – Ovulation stimulants increase cyst formation.
- Get regular pelvic exams – Monitoring helps detect cysts early.
Making healthy lifestyle choices is also important to keep your hormones balanced and prevent cyst recurrence.
When to see a doctor
You should make an appointment with your gynecologist if you notice any of the following:
- Severe pelvic pain that does not resolve with over-the-counter medication
- Pain alongside nausea, vomiting, and dizziness
- Abnormal vaginal bleeding
- Fullness or swelling in the abdomen
- A cyst that persists more than two or three menstrual cycles
- Rapid cyst growth or a cyst larger than 5 centimeters
- Difficulty eating or urinating
Signs like these could indicate a complex cyst, ovarian torsion, rupture, or other complication requiring prompt evaluation.
Conclusion
Most functional ovarian cysts resolve on their own within 1 to 3 monthly cycles as hormone levels fluctuate. However, cysts can sometimes linger longer, come back month to month, or pose complications. See your gynecologist if you notice a persistent cyst, abnormal enlargement, or any worrisome symptoms. Proper monitoring and treatment can help prevent serious complications from cysts that do not spontaneously go away.
