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Speaker 1: Welcome to the kick Your Expert led podcast, helping you

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Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming

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Speaker 1: a parent.

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Speaker 2: On the podcast and our online pregnancy program grow My Baby,

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Speaker 2: we share my experience of helping more than four thousand babies.

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Speaker 1: To be born and our experience of running a women's

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Speaker 1: health clinic and parenting for boys.

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Speaker 2: We're here to help everyone to feel empowered in pregnancy

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Speaker 2: and birth with real life, practical information.

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Speaker 1: Oh. Welcome everyone. I'm Bridget Maloney.

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Speaker 2: And I'm obstetrician doctor Patrick Maloney.

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Speaker 1: And today we are going to be talking about a

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Speaker 1: listener question that is common that people ask this question,

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Speaker 1: but it's also it speaks to when we go and

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Speaker 1: have a test done and we hear words said in

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Speaker 1: that test, or we read a report and we just

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Speaker 1: really start to worry.

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Speaker 2: Start to worry.

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Speaker 1: So I'm going to the listener question first and then

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Speaker 1: we'll go on for it. Hi, guys, just found out

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Speaker 1: I'm pregnant. I'm about six weeks with my very first

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Speaker 1: I was on the pill for fourteen years, then fell

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Speaker 1: pregnant in the first month after going off it. Exclamation mark.

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Speaker 1: Loving the podcast so far. I've just found out that

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Speaker 1: I have a cyst on my ovary that is four centimeters.

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Speaker 1: I've never had cysts before as far as I know.

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Speaker 1: From what I understand, this is very normal in early

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Speaker 1: pregnancy and will likely resolve itself. But I can't find

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Speaker 1: too much information about it, and the doctors haven't given

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Speaker 1: me much information. Could you please discuss this?

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Speaker 2: Fine?

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Speaker 1: Good?

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Speaker 2: All right?

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Speaker 1: So you know, let's start really simply. Someone is six

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Speaker 1: weeks pregnant and they've been told that they have a

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Speaker 1: fourth centimeter over insist. Should they be worried?

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Speaker 2: Yeah? Usually not. So we don't have any details, unfortunately,

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Speaker 2: on what the cysts looks like, but it's probably it's

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Speaker 2: probably just a corpus lutelsist, which is a perfectly normal

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Speaker 2: thing to find. The six week culture sound. So when

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Speaker 2: the egg comes out of the ovary, a bit on

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Speaker 2: the surface of the ovary that the egg pops out

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Speaker 2: of forms the structure on the edge of the ovary

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Speaker 2: called a corpus luteum, and its job is to pump

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Speaker 2: out a bunch of progesterone in the second half of

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Speaker 2: the cycle and help the pregnancy get up and underway.

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Speaker 2: And that's the source of progesterone in the early part

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Speaker 2: of the pregnancy until the placental structures kick in. So

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Speaker 2: that's a perfectly normal and necessary thing to be there.

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Speaker 2: And you can usually zoom in on one ovary or

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Speaker 2: the other on a six week scan and see which

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Speaker 2: one's ovulated, because there'll be a corpus luteum there and

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Speaker 2: the structure. It's quite normal for corpus lutem to bleed

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Speaker 2: when the egg comes out, and sometimes it forms a

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Speaker 2: little thing called a hemorrhagic cyst, which is a little

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Speaker 2: bit of blood clot sitting on the corpus luteum, and

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Speaker 2: that's a normal thing as well, one of the reasons

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Speaker 2: why ovulation is mildly painful in some people. And so

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Speaker 2: that could be all that is there, and a good

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Speaker 2: ultrasound report will say what it is. If they think

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Speaker 2: it's corpus, the team they should say so, because that's

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Speaker 2: perfectly normal. Other times the ovary might have something called

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Speaker 2: a simple syste on it, which is like a sack

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Speaker 2: full of water, and what that sometimes is is just

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Speaker 2: another follicre that was forming and then didn't ovulate. A

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Speaker 2: different one did, and that's what that one's left there.

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Speaker 2: Because once the ovulation's happened, there's some signaling within the

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Speaker 2: ovaries not to bother opulating any more eggs, otherwise we'd

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Speaker 2: have multiple pregnancies all the time. And so that could

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Speaker 2: just be an arrested follicle at four centimeters, which is

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Speaker 2: another thing that happens all the time, is normal and

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Speaker 2: just resolves by itself.

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Speaker 1: So in this case, it is possibly just the egg

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Speaker 1: that has erupted, yeah, or could it be the folly

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Speaker 1: call but another recondent? Yeah, yeah, And I'm curious about

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Speaker 1: multiple pregnancies. So what do you see? What does the

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Speaker 1: ovar look like that you do you see two call

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Speaker 1: composer teams or you.

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Speaker 2: Yeah, well potentially, so if you saw one on each side,

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Speaker 2: that might be evidence that the woman populated twice, which

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Speaker 2: would be the sort of two week fraternal twins, and

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Speaker 2: of course the other ones the ovulations just once and

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Speaker 2: then that fertilized egg splits apart.

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Speaker 1: So she talks about her cyst being four centimeters. What's

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Speaker 1: the normal range at this stage of pregnancy.

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Speaker 2: The harmless cysts are typically about that size or smaller,

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Speaker 2: and we get interested in cysts that are more than

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Speaker 2: about five centimeters six centimeters or painful or causing the

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Speaker 2: overy to twist or having an abnormal appearance on ultrasound.

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Speaker 2: So some cysts look very different and are very different diagnosis.

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Speaker 1: So what do those cists look like on ultrasound? Then, well,

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Speaker 1: there's a.

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Speaker 2: Whole bunch of different types, and occasionally these are seen

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Speaker 2: on first trimester scanning as well, and some of them

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Speaker 2: are more significant than the one than a simple little

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Speaker 2: one that looks like a corpus of a team or

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Speaker 2: a simple little one that looks like a simple follicular cyst.

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Speaker 2: And the other ones that we would commonly see would

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Speaker 2: be something called a dermoid, which is an ovarian cyst

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Speaker 2: full of stem cells that have been in that woman's

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Speaker 2: ovary for many, many years, and these are the freaky

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Speaker 2: ones that are capable of turning into any type of

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Speaker 2: tissue type. So typically the ovarian cyst will have structures

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Speaker 2: that really belong elsewhere in the body and they've formed

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Speaker 2: inside the ovary from stem cells, and those would you know,

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Speaker 2: Typically there might be bone, cartilage, hair, fat, lung tissue,

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Speaker 2: brain tissue, and those are sort of a strange looking thing,

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Speaker 2: not cancerous, but a strange looking thing. And sometimes some

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Speaker 2: of them will have a dermoid in the ovary or

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Speaker 2: even both ovaries and sometimes have a decent size, but

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Speaker 2: because they haven't really affected over in function, nobody knew

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Speaker 2: they were there and it wasn't until the woman had

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Speaker 2: a first trimester ultrasound that the dermoid was discovered.

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Speaker 1: And so that dermoid. I don't want to go down

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Speaker 1: that part because I think it's pretty rare, isn't it.

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Speaker 1: Dermoid's No, they're common.

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Speaker 2: Oh wow, yeah, they're common.

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Speaker 1: And so they are just sitting there and by chance

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Speaker 1: that might be a discovery on ultrasound when.

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Speaker 2: You hadn't had an ultrasound for any other reason. They

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Speaker 2: weren't causing you pain, they weren't doing anything, Your fertility

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Speaker 2: was normal.

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Speaker 1: Right, I'm going down that track now. So if during

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Speaker 1: a pregnancy a dermoid cyst is seen, is anything done

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Speaker 1: with it?

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Speaker 2: Then typically not. What you need in that situation is

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Speaker 2: a high quality ultrasound to make sure that it has

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Speaker 2: a typical appearance of a typical dermoid, and that can

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Speaker 2: be pretty easily done. We would only get interested in

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Speaker 2: that dermoid if it was very large and potentially obstructing

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Speaker 2: the baby way out, or if it was or if

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Speaker 2: it had potentially malignant features, or if it caused an

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Speaker 2: ovarian torsion. So if it made the overary lopsided and

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Speaker 2: cause the overy to twist around on its stalk and

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Speaker 2: cut off its own blood supply, let's.

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Speaker 1: Talk about ovariantusion because can assist cause ovarian torsion apart

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Speaker 1: from this dermoid situation.

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Speaker 2: Yeah, typically it's only a cyst that will cause it.

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Speaker 2: So the ovary, a normal ovary is incredibly unlikely to

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Speaker 2: get a torsion because the stalk of the ovary inserts

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Speaker 2: into the middle and there's no reason why the ovary

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Speaker 2: would spin around unless it was lop sided. And the

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Speaker 2: lopsidedness is because of a cyst.

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Speaker 1: Oh my god, I've got in my mind. You know

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Speaker 1: a goldfish, a goldfish that ends up having like a

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Speaker 1: blown up belly because of some reason. Goldfish do this

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Speaker 1: and then the goldfish just goes.

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Speaker 2: Yeah, I guess that's what it's like. So those are

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Speaker 2: not you know that that's something that presents with pain.

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Speaker 2: And then you have an ultrasound you can see an

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Speaker 2: ovary with a cyst on it, there's no flow inside it,

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Speaker 2: and occasionally a tortid ovarian syst is a sort of

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Speaker 2: surgical emergency that could happen during pregnancy and one of

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Speaker 2: the rare reasons why we might need to operate in pregnancy.

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Speaker 1: And so, you know, there's so much new pain that

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Speaker 1: a woman experiences during the early phase of pregnancy. Can

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Speaker 1: you describe what the usual symptoms that people say to

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Speaker 1: you they're feeling when they've got an ovarian torsion?

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Speaker 2: A very intusion. Pain is very severe. It's associated with

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Speaker 2: nausea and vomiting. It's relentless and not easily missed. Occasionally

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Speaker 2: it comes and goes, which is thought to be a

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Speaker 2: process of torsion and detortionion as that twists and then

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Speaker 2: untwists and twists and then untwists. But it's mostly the

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Speaker 2: severity that brings it to people's attention.

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Speaker 1: Yeah, So, going back to a normal sort of common

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Speaker 1: syst in this early stage of pregnancy, if so she

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Speaker 1: was had an ultrasound at six weeks, if she went

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Speaker 1: on and had another ultrasound, what would they see Normally, Well, you'd.

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Speaker 2: Expect resolution of the simple ones and resolution of a

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Speaker 2: corpus luteum and the dermoids and so forth would still

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Speaker 2: be there. And then if the dermoid is nice and stable,

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Speaker 2: it's not growing, it's not torting, then it can just

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Speaker 2: be left there and that can be assessed, reassessed postpartum,

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Speaker 2: and excised laparoscopically at a later date if that's thought

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Speaker 2: to be the plan. Very rarely and ovari insist happens

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Speaker 2: in pregnancy, is discovered in pregnancy that has features on

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Speaker 2: ultrasound suggestive of an early malignancy, so like a stage

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Speaker 2: one over in cancer, and that's just something that can happen,

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Speaker 2: but is exceedingly unlikely because hardly anyone gets so very

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Speaker 2: in cancer in the pregnancy age group anyway. But again,

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Speaker 2: one of the rare reasons why we might not want

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Speaker 2: to operate in pregnancy would be if ovarian malgiancy was suspected,

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Speaker 2: So that would not only be an ovarian cyst that

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Speaker 2: looked very dodgy, but also blood tests that would be abnormal.

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Speaker 1: Again, going back to the normal cyst. If someone has

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Speaker 1: a cyst that you know they hear the sonographer or

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Speaker 1: someone saying well there's a bit of a cyst there,

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Speaker 1: or they get read the report themselves or whatever, does

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Speaker 1: their GP or obstetrician then say you need to be

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Speaker 1: rescanned at a certain stage, or we just expect it

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Speaker 1: to resolve.

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Speaker 2: Now, we would typically re scan because a large cyst,

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Speaker 2: like if it's one of those small first trimester ones

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Speaker 2: just expected to resolve, then they're entirely normal. But a

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Speaker 2: large cyst would definitely want to be rescanned because there

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Speaker 2: is a phenomenon where a very large cyst could theoretically

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Speaker 2: obstruct the obstruct labor. The oes sit lower. You know,

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Speaker 2: if we think of the sort of the sort of

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Speaker 2: secondary school diagram of the female reproductive system, it looks

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Speaker 2: like the ovaries are sort of sitting out. It does

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Speaker 2: so the uterus. But when the when the uterus grows

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Speaker 2: to a full term pregnancy, they're not sitting up near

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Speaker 2: the top. They're sitting they're sitting much much, much further

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Speaker 2: down towards the cervix, and the a big cyst at

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Speaker 2: that point could theoretically obstruct the baby on the way out.

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Speaker 1: Yes, because you only have to dilate tense animeters to

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Speaker 1: push a baby out, and if you've got a cyst

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Speaker 1: that's tense centimeters fifteen centimeters like that would be significant, wouldn't.

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Speaker 2: The potentially Yeah, So in that situation, which which comes

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Speaker 2: up from time to time. A decision needs to be

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Speaker 2: made about whether we would go one of three ways.

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Speaker 2: You can have surgery during pregnancy to take a cyst

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Speaker 2: out that has significant pro and cons and ideally is

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Speaker 2: best avoided. You could have a plan sas they're in

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Speaker 2: section if you thought the cyst was going to obstruct

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Speaker 2: the baby's way out, but that is a shame if

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Speaker 2: somebody doesn't want this as air in section. And lastly,

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Speaker 2: you could do a trial later and just see how

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Speaker 2: the baby goes get getting past a large syst.

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Speaker 1: I think it's hilarious that you talk about that secondary

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Speaker 1: school picture of the females anatomy, and it does the

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Speaker 1: uterus looks like it's got little sort of branches. And

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Speaker 1: but the other day when you were describing a uterus

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Speaker 1: only being the size of an apricot, a normal uterus

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Speaker 1: for pregnancy, like that isn't the picture that I have

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Speaker 1: in my brain.

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Speaker 2: No, it's not. It's quite different. Yeah, a number of

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Speaker 2: things are different. Yeah, yeah. I think the most misleading

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Speaker 2: thing about the diagrams is that is that they show

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Speaker 2: a sort of a diagrammatical representation where the tubes are

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Speaker 2: stretched out and are right out to the side, and

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Speaker 2: that leads We've been often to think that if they've

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Speaker 2: got pelvict pain that's very lateral right in their hip bones,

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Speaker 2: that that's so vary in pain. But in fact, the

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Speaker 2: ovaries are very very close to the middle of your body,

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Speaker 2: and you'd have to have quite a big syst on

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Speaker 2: an ovary for it to reach out towards pelvic side.

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Speaker 2: War like that.

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Speaker 1: It is funny though, so people do complain of pain

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Speaker 1: during ovulation, which is very side.

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Speaker 2: I can often tell the difference one side or the other. Yeah,

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Speaker 2: but that doesn't mean that the ovary is located right

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Speaker 2: there on the of your body.

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Speaker 1: Yeah, it's We had a student up the other day

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Speaker 1: and even she was in surgery with you and went,

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Speaker 1: oh my god, I can't believe how small the uterus is.

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Speaker 1: So yeah, it's fascinating, Like we get an understanding of

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Speaker 1: our body when we listen to podcasts like this. I hope.

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Speaker 2: I hope so well.

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Speaker 1: I certainly have over the years. Now. I know that

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Speaker 1: this podcast isn't about cis out side of the pregnancy,

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Speaker 1: but can you very briefly mention some reasons why people

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Speaker 1: might have cysts outside of pregnancy.

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Speaker 2: That's a whole bunch of podcasts in itself. So I

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Speaker 2: variensists in a really common thing that we see, ranging

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Speaker 2: from simple ones little bumps on the ovary right up

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Speaker 2: to right up to cancerous ones. Huge topic and an

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Speaker 2: important part of gynecological practice, but today we've been sort

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Speaker 2: of concentrating on the ones that might affect a pregnancy.

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Speaker 2: The other thing that I've seen from time to time

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Speaker 2: in pregnancy are other types of pelve exists in women,

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Speaker 2: not ovarian systs, but there's two that we commonly see.

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Speaker 2: One something called a bathlon cyst, which is an obstructed

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Speaker 2: gland near the vaginal opening. And the Bathlon's gland sits

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Speaker 2: just inside the vaginal opening, and one of its jobs

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Speaker 2: is to make vaginal mucus and lubrication for intercourse. And

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Speaker 2: it's got a narrow duct that gets blocked. And you

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Speaker 2: can get a bathlin cyst in pregnancy and present with

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Speaker 2: a big, swollen, swollen, very very sore cyst right at

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Speaker 2: the vaginal opening. And I've had a few of those

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Speaker 2: that needed operations even in pregnancy, and they manage much

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Speaker 2: the same way as you would have a woman wasn't pregnant.

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Speaker 2: If it's big and sword needs to be drained.

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Speaker 1: Under general anacity.

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Speaker 2: Yeah, under general Yes. There's another thing that's commonly diagnosed

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Speaker 2: as a cyst, and it isn't really, and that's something

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Speaker 2: called a Nabothian follicle, which is a cyst in the cervix.

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Speaker 2: And these aren't really they're not quite accurately called a cyst.

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Speaker 2: What happens is the cervix has got little glands inside

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Speaker 2: it and there's a normal process where the where the

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Speaker 2: surface of the cervix, there's a layer on the cervix

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Speaker 2: that shifts back and forth. It's the layer that we're

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Speaker 2: interested in capturing when we do a smear test, and

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Speaker 2: that layer occasionally obstructs those little glands and causes a

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Speaker 2: cystic type structure within the cervix, which we can see

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Speaker 2: on ultrasound or you can even see when you look

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Speaker 2: at the cervix with a speculum. And those are typically

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Speaker 2: about a centimeter a cross and sometimes get reported on

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Speaker 2: an ultrasound, But they're an entirely normal fighting right.

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Speaker 1: And what about the uterus? Can it get cysts?

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Speaker 2: Not? Really? There are unusual appearances to the uterus in

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Speaker 2: that we see in ultrasound. We pick up you know

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Speaker 2: on fybroids all the time. Sometimes adenomiosis is reported as

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Speaker 2: showing cystic changes, but that's not quite accurate. It's not

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Speaker 2: a true cyst.

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Speaker 1: Okay, good now, I'm bringing back an old favorite that

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Speaker 1: we let go a long time ago. Stop at what

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Speaker 1: myth or fact?

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Speaker 2: Fact myth or a fact?

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Speaker 1: You know, I don't think anyone likes that, but anyway,

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Speaker 1: good Number One question, coming off the pill causes ovarian

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Speaker 1: cysts myth?

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Speaker 2: Really, Well, you'll get a follicular syst, but that's the

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Speaker 2: overy working normally, So I'm saying myth.

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Speaker 1: Myth, And if people think that it is, it's probably

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Speaker 1: because it was helping with something like PCOS or Yeah.

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Speaker 2: Well, occasionally we'll use the pill in women who get

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Speaker 2: a you know, recurrent large cysts because it suppresses ovulation.

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Speaker 2: That's how it works as a contraceptive, and most of

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Speaker 2: those cysts are ovulatory in origin, so it's a good treatment.

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Speaker 2: But and if you come off the pill, you might

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Speaker 2: get that problem back again. But that's not to say

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Speaker 2: that one necessarily caused the r You just had that

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Speaker 2: problem along along, and you're taking away an effective treatment.

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Speaker 1: Number Two, A cyst can cause miscarriage in early pregnancy.

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Speaker 2: I don't think that's true either. Ruptured cysts can happen

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Speaker 2: in pregnancy, and they can be painful, but I certainly

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Speaker 2: don't think it's an important cause of first trimester loss.

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Speaker 2: It's a pretty unusual thing to happen in the first place.

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Speaker 2: And sorry, what is the having a ruptured cyst? I

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Speaker 2: am yeah, and I don't believe it's an important cause

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Speaker 2: the first trimester pregnancy loss. You get pain, and occasionally

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Speaker 2: that person might go and have an ultrasound and find

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Speaker 2: out they miscarry. But where the one caused the other?

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Speaker 2: I don't know.

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Speaker 1: A three A cyst can impact early implantation, Are we stumped?

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Speaker 2: I don't think so. Yeah, I doubt, I doubt. I

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Speaker 2: doubt that's a phenomenon. I mean, early implantation requires that

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Speaker 2: the overres ovulated the eggs gone down the tube, it's

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Speaker 2: met up with some sperms coming up the other way,

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Speaker 2: and got fertilized, made its way down into the uterus.

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Speaker 2: So I'm not sure that no very insists could necessarily

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Speaker 2: interrupt that process.

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Speaker 1: A cyst causes left sided ovulation pain.

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Speaker 2: Just populating on the left side, it causes left sided

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Speaker 2: ovulation pain. It's neither here nor there when it comes

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Speaker 2: to cysts.

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Speaker 1: And I think people can refer back to your answer

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Speaker 1: about you know what pain feels like if it's a

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Speaker 1: torsion or if it's something Yeah, and the referred pain

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Speaker 1: to the left side. So I think you've already answered that. Okay, good,

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Speaker 1: forgotten what number I'm up to. But here we go.

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Speaker 1: Here's another one. A cyst can burst and be painful.

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Speaker 2: Yes, so that's definitely a thing, and sometimes we make

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Speaker 2: that diagnosis retrospectively. I a woman comes in with a

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Speaker 2: lot of pain, you do an ultrasound and there's a

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Speaker 2: lot of free fluid within the pelvis, and you assume

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Speaker 2: that that fluid came out of a cyst. Now you

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Speaker 2: can no longer see the cyst because it's like a

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Speaker 2: popped balloon. The cyst is gone. But if you see

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Speaker 2: a lot of free fluid in a woman it's got

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Speaker 2: a lot of pain, then a cys structure is sometimes

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Speaker 2: that the proposed mechanism for that pain and the diagnosis.

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Speaker 2: Typically that just goes away by itself, but it can

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Speaker 2: be very.

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Speaker 1: Painful, and that's like the cyst problem resolving itself.

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Speaker 2: Yes, exactly. Yeah, And they can be pain for several

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Speaker 2: days to be quite severe.

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Speaker 1: All right? Can I just ask about that though, so

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Speaker 1: the person can manage that at home with pain relief

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Speaker 1: or do they need to see their doctor?

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Speaker 2: Typically they would see their doctor because the pain would

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Speaker 2: be very severe. They would have an ultrasound to rule

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Speaker 2: out other things like an over intution, like a pregnancy

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Speaker 2: complication like an ectopic pregnancy. And then if all that

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Speaker 2: was determined was that there was a cys structure, then

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Speaker 2: the treatment is pain relief and rest until it resolves.

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Speaker 1: Good. Last one. Yeah, and I'm sneaking it in because

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Speaker 1: it's not about pregnancy.

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Speaker 2: Sneak away.

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Speaker 1: A cyst means you are not ovulating properly.

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Speaker 2: That's not really true either. Those two events may be

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Speaker 2: related to each other, like, for example, you can have

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Speaker 2: assist on the over and still be ovulating. Just fine.

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Speaker 2: So we if we were investigating someone who wasn't ovulating,

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Speaker 2: the presence of an overiansist might be of some interest,

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Speaker 2: but it doesn't necessarily follow that someone with assist would

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Speaker 2: not be ovulating. Good.

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Speaker 1: All right. Well that's the end of my myth or

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Speaker 1: fact which turned into true or false.

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Speaker 2: Foo or yeah?

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Speaker 1: Good? All right? Anything else to add about.

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Speaker 2: Six sists in pregnancy. It's worth covering. It's it's something

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Speaker 2: that happens from time to time. It's not at all

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Speaker 2: comment but definitely a part of you know, of pregnancy

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Speaker 2: life and obstetric theory that people would do well to

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Speaker 2: be aware of.

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Speaker 1: And I think I wanted to bring it up because

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Speaker 1: you know, we do. There is so much that we're

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Speaker 1: learning in pregnancy, especially early pregnancy, and it's coming hard

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Speaker 1: and fast, this big learning curve. And then you go

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Speaker 1: into a doctor's clinic and they sort of talk about

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Speaker 1: terms like cysts that you think, well, that sounds bad.

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Speaker 1: It must be bad. So I hope we've demystified that

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Speaker 1: part of your first pregnancy visit.

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Speaker 2: So the vast majority of structures referred to as a

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Speaker 2: cyst on a first trimester ocra sound a normal.

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Speaker 1: Great, straight from the horse's mouth. Good. All right, Well

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Speaker 1: that's it for us. If you like our podcast, how

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Speaker 1: you can help us spread our information to other people

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Speaker 1: that I'm sure other people would be loving to hear

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Speaker 1: the same sort of information that you are is simply

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Speaker 1: five stars. That helps too. Good. All right, everyone, have

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Speaker 1: a great week and until next week, see you later.

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Speaker 2: Thanks for listening five now.

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Speaker 1: Hey, even though doctor Pat is well a doctor and

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Speaker 1: we get lots of other doctors and other experts on

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Speaker 1: our podcast, I just need to remind you that this

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Speaker 1: podcast is for informational purposes only. We share lots of

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Speaker 1: medical insights and experience, but everything we talk about is

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Speaker 1: general in nature and may not apply to your specific situation.

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Speaker 1: Please always consult with your own healthcare provider for your

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Speaker 1: individual medical advice. When you grow your baby,