Ovarian cysts refer to the development of cysts within ovarian tissue, and can range from being otherwise benign to cancerous. Up to 20% of all women have some degree of cyst formation in their ovaries at some point, although the vast majority are symptom-free. Ovarian cysts are often discovered by routine examination, or from the investigation of abdominal pain, discomfort, or pain upon intercourse. An ultrasound will indicate the presence of an ovarian cyst, but without performing a biopsy it is difficult to identify the kind of cyst. The most common form of ovarian cysts are physiological cysts, as well as those associated with polycystic ovarian disease (PCOD). Other less common types of ovarian cysts include the cystadenomas, fibromas, dermoid cysts, and Brenner cysts. Most cysts are symptoms free unless they rupture or twist upon their stalk (pedicle). Some cysts are malignant, and others, called functioning cysts, have the ability to produce hormones. 

Physiological cysts are simple cysts that do not produce hormones, and represent a deviation in the normal functioning of the ovary. Follicular cysts are formed due to a problem with the developing follicle in which the mature follicle either fails to release the ovum and continues to enlarge, or one of the developing follicles fails to disintegrate. The symptoms are minimal and require little in the way of treatment. Luteal cysts form during the luteal phase of the estrus cycle after the corpus luteum has formed. Typically the cysts are small and require no treatment, but sometimes the cysts will become quite large and be filled with blood. Luteal cysts may interfere with the normal cycle, delaying menstruation and can cause an alteration in blood loss during the period. Luteal cysts typically resolve after one cycle and require little in the way of treatment. 

If physiological cysts occur often however, the use of botanicals that regulate follicular growth and development such as Peony root (Paeonia lactiflora), True Unicorn root (Aletris farinosa), and False Unicorn root (Chamaelirium luteum) are indicated.

Polycystic ovarian disease

The term ‘polycystic’ refers to the formation of many cysts within the ovaries. Polycystic ovarian disease (PCOD) represents a dysfunction of the endocrinal activities of the ovaries, with erratic ovulation and menstrual dysfunction in association with a tendency to excessive androgen secretion. The signs and symptoms of PCOD are ovulatory failure, infertility, hirsutism, obesity, and abnormal menstruation. A smaller percentage of women with PCOD may also experience male pattern hair growth, a deepening of the voice, and a loss of feminine contour. Diagnostically, an ultrasound is used to detect ovarian cysts, and blood tests will reveal high levels of LH with relatively constant or low FSH. The differential diagnosis includes Cushing’s syndrome, adrenal hyperplasia, adrenal adenocarcinoma, hyperprolactinemia.

The causes of PCOD relate to the abnormal function of the ovaries, with the excessive production of androgens within the developing follicle. Obesity is recognized as an underlying factor, and about 40% of women with PCOD are obese. With obesity there is the increased conversion of ovarian androgens into estrone by the fatty tissues of the body by the enzyme aromatase, leading to chronically high estrogen levels. Obese women, and in particular those women with truncal or abdominal obesity, display a greater proclivity to insulin resistance, leading to elevated blood sugar levels, hyperinsulinemia, and a greater risk of cardiovascular disease and diabetes. Women with PCOD may also display abnormal adrenal function, with an excessive production of androgens that results in their conversion to estrone. High levels of estrone without the normal cyclic variation then stimulates excess LH production. This secretion of LH then adds fuel to the fire by triggering ovarian androgen production. Further, the levels of FSH, due to the high levels of circulating estrogens, remain suppressed. Low FSH reduces the ability of cells in the ovarian follicle to convert androgen into estrogen. Although elevated levels of LH are generally accepted as being caused by an androgen excess, some researchers have suggested that the cause may be abnormal hypothalamic function with the improper secretion of GnRH. This could lead to elevated LH levels, resulting in elevated androgens, which in turn, initiates LH secretion in a self-perpetuating cycle. Playing into this whole cycle of low ovarian estrogen, high peripheral estrogen, and excess androgen, is SHBG (sex hormone binding globulin). Normally, SHBG binds to both estrogens and androgens to reduce the bioactivity of these hormones. With obesity and elevated androgens however, the level of SHBG declines, and the masculinization effects of the excess androgens begins to be seen. 

The treatment of PCOD consists of reducing androgenic virilism, stimulating ovulation, correcting menstruation, and protecting the uterus and breast tissue from the cancerous changes caused by consistently high estrogen levels. If obesity is an issue then this must be addressed as well, as must the effects of insulin resistance such as hyperlipidemia and hyperglycemia. Often there is a thyroid insufficiency behind the weight gain and this must be addressed simultaneously.

Botanicals that can be used to normalize ovulation and reduce androgenization include the ‘female restoratives’ such as Peony root (Paeonia lactiflora), Dang gui (Angelica sinensis), Shatavari (Asparagus racemosa), False Unicorn root (Chamaelirium luteum), and Wild Yam (Dioscorea villosa), all of which have been used historically to enhance female fertility. Chasteberry (Vitex agnus castus) may also be used to stimulate ovulation, taken every day first thing in the morning, and may also help to reduce the androgenization. Another herb that may be useful with androgenization is Saw Palmetto (Serenoa serrulata), normally considered a ‘male’ herb that inhibits the production of more potent androgens. Botanicals that can be used to normalize LH secretion can be introduced in conjunction with therapies that inhibit androgenization, which of itself, will promote normal LH levels. Of the botanicals that help to regulate LH secretion are Hops (Humulus lupus) and Black Cohosh (Cimicifuga racemosa).

The most important method to protect the uterus and breast tissue from the consistently high levels of estrogens are the use of the phytoestrogens as competitive inhibitors. To protect the endometrium progesterogenic botanicals are emphasized, such as Chasteberry (Vitex agnus castus) and Peony root (Paeonia lactiflora) .

If obesity is an issue than an active weight loss regimen must be promoted, with an emphasis upon anaerobic exercise, the elimination in refined carbohydrates, and an emphasis upon dietary fiber. The guidelines for the treatment of obesity and insulin resistance should be followed as well.

Chasteberry (Vitex agnus castus) and Peony root (Paeonia lactiflora) .Passionflower .

For your Good Health.

Altmed Lifestyle Clinic.