Recurrent Large Ovarian Cysts

I am 34 years old and have no children.  In the past 3 years I have undergone 4 Laparoscopic surgeries to remove large (from 5cm to > 10cm) cysts from both my left and right ovaries.  After the first surgery I was put on a birth control pill but the cysts came back within 2 months and were large enough to require surgery again after only 6 months.  The third surgery was a repeat of the first two having the cysts return in less than 6 months.  Following the third surgery I was given an injection of Lupron.  I was told that if we could prevent ovulation then the cysts would not form. The cysts formed again after a few months and I had the fourth surgery to remove them, again on both ovaries.  After 9 months of Lupron injections my latest ultrasound indicates that I have multiple cysts (<3cm) on my left ovary and some smaller ones on my right ovary.  My doctor has no other course of action to prescribe other than removal of both my ovaries. To date none of the cysts have had any abnormal cells indicative of cancer. The pain is bearable in the beginning but escalates as the cysts increase in size.  I still have no diagonsis for this condition.  I am looking for a potential cause for this condition and what can be done other than removal of both my ovaries.  

[Elaine Brown, MD]

Hi!
It would be helpful to know the pathology of the cysts.  If they are corpus luteum cysts, they are caused by ovulation and suppressing ovulation should reduce or eliminate their formation.  If they are something different such as serous cystadenomas or teratomas or endometriomas, then hormonal manipulation won't help.
Cysts that are caused by ovulation ( corpus lutea) almost always go away spontaneously, and usually don't require surgery--you just have to cope with the discomfort until they go away.  The other types of cysts that I mentioned will not go away on their own, and do require surgery.
Lupron shots should suppress the cysts, and usually, there is no need to operate unless the cysts are bigger than 8 cm.  Other things that suppress cysts are oral contraceptives and depo provera.  If you were my patient, I would not recommend removal of you ovaries, unless, either we suspected cancer, or the pain was intolerable. I would probably encourage you to continue with the lupron plus some hormone replacement therapy for your bone density, and do periodic follow up ultrasounds.  I wouldn't operate unless the cysts were greater than 8 cm, OR looked suspicious and did not resolve, OR were causing unbearable pain.
I hope this is helpful!
Good luck!
Dr B