In this episode, Dr. Lisa and Dr. Toni are talking about the different types of ovarian cysts that perimenopausal women can commonly experience, including PCOS. Did you know that if you have ovarian cysts, it doesn’t mean you have PCOS? Find out what symptoms you need to watch for, what lab testing to consider and natural approaches to effectively managing ovarian cysts. 

What types of ovarian cysts can you develop?

Functional cysts – related to menstrual cycle, usually harmless, rarely cause pain, resolve within 3 cycles

  1. Follicular cyst – when follicle fails to release egg at ovulation and continues to grow, forming a cyst
  2. Corpus luteum cyst – when follicle releases eggs, corpus luteum continues to grow and accumulates fluid inside, forming a cyst

Other cysts: – can become large and shift position of ovary, increasing chance of twisting, or ovarian torsion, which can be painful and cause decrease of blood flow to ovary

  1. Dermoid cysts – also called teratomas, can contain tissue like hair, skin or teeth, because they form embryonic cells, rarely cancerous
  2. Cystadenomas – develop on surface of ovary containing either water or mucus
  3. Endometriomas – develop as a result of uterine endometrial tissue growing outside of uterus and attaching to ovary, related to endometriosis

These kinds of ovarian cysts are different than polycystic ovarian syndrome.

What is Polycystic Ovarian Syndrome (PCOS)?

Endocrine condition that affects other systems as well: 

  • not only hormones and fertility, but also your skin, cardiovascular system, metabolism, immunity, mental-emotional health and more

Risk factors for developing ovarian cysts:



Hormonal issues

  • Irregular menstrual cycles
  • Hormone imbalance
    • Insulin resistance and increased androgens like circulating testosterone in PCOS
      • insulin stimulates secretion of testosterone by ovaries, inhibits sex hormone binding globulin from liver, leading to increased circulating testosterone, leading to acne, excess facial and body hair and male pattern baldness in women
    • Estrogen dominance (for more info, see Episode 21 and Episode 22)
  • Use of medications like Clomid or Tamoxifen
  • Hypothyroidism – see Episode 42 for more info

Early menstruation (11 yoa and younger)

Cigarette smoking

BMI above 30

Dysfunctional fat tissue, not inert

  • Fat cells become enlarged and have less circulation, causing some cells inside fat tissue to die, resulting in inflammation results 

How do you know if you have PCOS?

You can have at least 2 out of 3 of the following:

  • presence of micro polycystic ovaries or 12 or more small follicles on ultrasound 
  • signs of high androgens – acne, hirsutism (dark hair on chin, around nipple, upper lip, sternum, lower abdomen), 
  • irregular menses due to chronic ovulation disorder = fewer than 9 periods in a year or any stretch of 3 months without period

How do you know if you are not ovulating?

You can check for changes in your:

  • Basal body temperature 
  • Cervical position
  • Cervical fluid or vaginal discharge

Lab testing to consider:

Ultrasound – transvaginal

Urine hormone testing – DUTCH or CHI

Blood work:

  • LH, FSH (looking for elevated LH/FSH ratio)
  • bioavailable testosterone, estradiol, progesterone
  • DHEAS (measures androgen production from adrenals)
  • Thyroid panel (TSH, free T4 and T3) – see Episode 42 for more info
  • Blood sugar panel (Fasting glucose and insulin, hemoglobin A1c)

Signs and symptoms you might experience if you have ovarian cysts or PCOS:

  • Irregular menstrual cycles and fertility challenges
  • Pelvic pain – due to ovarian torsion or rupture, especially after intercourse or vigorous exercise
  • Abdominal pain or pressure
  • Nausea and vomiting, especially when experiencing pain, having bowel movement or urinating
  • Signs of hyperandrogenism like acne, hirsutism (excess dark hair on face, chest)

Conventional treatment approaches can include birth control pill and metformin

Naturopathic approaches to addressing ovarian cysts and PCOS:

Diet – see Episode 10 for more info on eating for hormone balance

  • Anti-inflammatory, low glycemic, fasting at least 12 hours overnight
  • Reduce sugar, simple carbs, alcohol
  • Balance protein, fibre and healthy fats with each meal
  • Increase liver supporting vegetables like cruciferous veggies (broccoli, Brussels sprouts, cauliflower, cabbage, kale)

Exercise to support blood sugar balance

Avoid endocrine disrupting chemicals, especially in plastics – see Episode 65 for more info

Manage stress – see Episode 24 for more info

  • High cortisol increases your blood sugar and cravings for sugar and carbs
  • It takes 40% longer to process a high carbohydrate meal if you are in a high stress state or if you haven’t had enough sleep
  • Getting out in nature or forest bathing see Episode 30
  • Meditation, sound therapy or sound baths see Episode 70

Castor oil packs topically on abdomen can reduce inflammation and cyst formation when used long term

Supplements to consider 

  • Omega-3 fatty acids from fish oil is anti inflammatory
    • When studied with vitamin E for 12 weeks in a therapeutic dose, showed an improvement in insulin resistance, total and free testosterone levels
  • Resveratrol: anti-inflammatory antioxidant in red wine and grapes
  • Vitamin D has anti-inflammatory, pro-hormone activity
    • Studies show 4000IU dose improved glucose metabolism and lipid profiles better than 1000IU/day (get your blood levels tested for optimal dose for you)
  • Probiotics for gut health and to lower inflammation- 12 weeks helped support weight loss, improved insulin resistance and blood lipid balance
  • Green tea have anti-inflammatory and antioxidant activity
    • L-theanine for reducing stress and supporting calm
    • Research shows after 12 weeks of supplementation, improved weight loss; decreased fasting insulin and free testosterone
  • Myo-inositol and methylfolate improved ovulation and conception better than metformin
    • Myo-inositol also improves insulin sensitivity, similar to metformin
  • Cinnamon – research study in women with PCOS showed improved menstrual regularity
  • Alpha lipoic acid, chromium picolinate improves insulin resistance
  • Vitex, black cohosh, white peony and maca can support hormone balance and menstrual regularity
    • Supports menstrual cycle regulation and amount of flow
  • Adaptogens like rhodiola, schisandra, ashwagandha, licorice, tribulus
    • may improve menstrual regularity, weight, insulin sensitivity, quality of life and mood
  • NAC, DIM, calcium d-glucarate, hops supports liver detoxification to properly process excess estrogen

Today’s Mama Must Haves: 

Dr. Lisa loves her homemade “bits and bites” snack: TumYumm puffed fox nuts (Himalayan sea salt flavour) with broken up plantain chips, raw pumpkin seeds for healthy 3pm snack

Dr. Toni is a big fan of film festivals and recommends checking out the Calgary Underground Film Festival online – streaming until May 2. She watched Together Together with Ed Helms (from the US version of The Office) about surrogacy.

Dr. Toni’s next HypnoBirthing info session for expecting parents looking to trust their instincts and their body during labour and birth is happening in May. Join her at

Dr. Lisa’s Wild Collective in Fall 2021: get on the waitlist:

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Stay safe and healthy everyone!