Hailey Bieber is battling another health issue. She recently revealed in her Instagram Stories the new setback she’s facing. “I have a cyst on my ovary the size of an apple,” and shared a photo of herself with her shirt pulled up that showed her stomach. “I don’t have Endometriosis or PCOS [Polycystic ovary syndrome] but I have gotten an ovarian cyst a few times and it’s never fun.” The Rhode skincare founder, who just celebrated her birthday in Japan with husband Justin Bieber, also addressed pregnancy rumors that she’s been plagued with ever since tying the knot. She wrote, “not a baby,” confirming she’s not expecting. 

The 26-year-old explained how she was feeling, which is “nauseous and bloated and crampy and emotional.” While she didn’t give further details she did offer encouragement, “Anyways…I’m sure a lot of you can overly relate and understand. “We got this.” Sadly, this isn’t the first time Bieber has experienced a health scare. While on vacation in Palm Springs with her superstar husband in March of this year, the model started having stroke-like symptoms and was hospitalized after suffering a mini-stroke called Transient Ischemic Attack (or TIA).

“I had a small blood clot that traveled through a hole in my heart that I was born with that never closed, and went to my brain,” she said on Live with Kelly and Ryan. “I never knew I had the hole in my heart, so it’s actually a blessing in disguise because then I discovered that and I had a procedure done to close it. So now I have a device in my heart forever.” 

Eat This, Not That! Health spoke with doctors who have not treated Bieber, but shared what to know about ovarian cysts and signs you have one. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Dr. Andrey Petrikovets, Urogynocologist and Gynecological Surgeon with Dignity Health California Hospital explains, “Ovarian cysts are typically fluid filled benign masses that can happen in women of all ages. Ovarian cysts may cause bothersome symptoms in day-to-day life by causing pain, pressure, early feeling of fullness, bloating–even nausea and vomiting.”

​Steve Yu, MD FACOG Gynecological surgeon with Dignity Health Northridge 

tells us, “Ovarian cysts are fluid-filled sacs that develop inside of an ovary.  There are many different types of cysts.  They can be filled with all sorts of fluids. The fluids can be watery, bloody, pus-like, or a combination of all. Ovarian cysts are very common.  Most go away on their own and do not need any treatment.”

Edwin Ramirez, MD, FACOG Dignity Health St. John’s Regional Medical Center  says, “Ovarian cysts are sacs filled with physiologic fluid that harbors a female’s genetic material (eggs).  Most of these cysts are harmless and resolve on their own.  At birth, the ovary contains approximately 300,000 – 400,000 follicles (small ovarian cysts) and over time, these cysts get depleted resulting in menopause.  However, there are times where these ovarian cysts become dysfunctional and never leave the ovary, causing severe pelvic pain and irregular menstrual cycles.”

Dr. Petrikovets states, “People should know that ovarian cysts are common and usually there is not a cause for alarm. They should be monitored if persistent, usually with ultrasounds and, if they have concerning findings, and bothersome symptoms like pain, pressure, bloating, early satiety then they should be evaluated more closely for possible cancer.”

Dr. Ramirez says, “Ovarian cyst is a normal phenomenon that occurs in women during their reproductive age.  Every month, a mature egg is released from either the right or left ovary resulting in a process known as ovulation.  The ovary produces two major female hormones (estrogen and progesterone) and each hormone plays a major role in a female’s menstrual cycle.  For example, progesterone is an important hormone that helps support implantation of a fertilized egg, hence the name PRO-GESTATION.”

Nita Landry, MD, FACOG, a Board-Certified OB/GYN and author of Dr. Nita’s Crash Course for Women: Better Sex, Better Health, Better You tells us, “Hailey says she does not have endometriosis, a condition that can make conceiving a child more challenging, so that’s good news for those on Bieber baby watch. There are several types of cysts and many do not impact fertility.  However some are associated with an underlying condition that makes it harder to get pregnant. Without knowing the exact type of cyst and her full health history, I can’t speculate on her fertility odds.”

According to Dr. Yu, “All women in their reproductive years will form what is called physiologic cysts.  Every month when a woman ovulates, it is actually a cyst that ruptures releasing an egg.  If a woman gets pregnant, then her ovary will create another type of a physiologic cyst that does not need any treatment. Other cysts are caused by a benign tumor.  Rarely, cysts can be formed by a dangerous malignant growth.”

Dr. Petrikovets says, “A lot of times they’re normal and they are functional cysts as they are a function of the menstrual cycle. Oftentimes cysts resolve on their own, other times they persist. This happens usually for factors that people can’t control. Cysts can also happen to people who, for example, have gynecologic problems like endometriosis and PCOS. Ovarian cancer is also secondary to cancerous cyst formations of the ovary.”

Dr. Landry says, “Most ovarian cysts don’t cause symptoms. For example, an unruptured two-centimeter follicular cyst is not a likely cause of pain. However, some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Cysts that bleed or burst also may cause sudden, severe pain. A large cyst may cause your ovary to twist, a complication known as ovarian torsion. Ovarian torsion may cause pain on one side that comes and goes or can start suddenly. Ovarian torsion requires surgery immediately. Women with polycystic ovarian syndrome (PCOS), which is a common condition caused by an imbalance of reproductive hormones, may have many small cysts. These cysts do not cause pain or need to be removed, but these women may need treatment for other PCOS problems, such as irregular menstrual periods, acne, weight gain, excess hair growth or hair loss.”

Dr. Yu explains, “Most ovarian cysts do not cause any symptoms.  However, there are several situations when they can.  For example, if a cyst ruptures, it can definitely cause pain.  In other situations when a cyst becomes big enough (typically the size of an apple) it can twist and cut off its blood supply.  This is referred to as an ovarian torsion.  This typically causes excruciating pain. Bieber said she felt, “feel nauseous and bloated and crampy and emotional.” Are those typical signs?  Those are not typical symptoms.  However, if the cyst gets big enough, like the size of a volleyball, a woman can look pregnant and definitely feel bloated.”

Dr. Ramirez adds, “Smaller ovarian cysts do not cause any symptoms however when they become enlarged, a patient may experience abdominal swelling, nausea, vomiting, localized pelvic pain, and painful intercourse (sex).  Some ovarian cysts may cause intra-abdominal bleeding (hemorrhagic corpus luteum) resulting in delayed menstrual cycles and acute anemia.”6254a4d1642c605c54bf1cab17d50f1e

Dr. Yu says, “This really depends on the type of the cyst.  Physiologic cysts form every month and resolve when a woman ovulates.  However, there are instances when a woman does not ovulate.  Then this cyst will continuously grow until she ovulates. Cysts caused by a benign tumor typically do not grow back after it is surgically removed. Malignant cysts unfortunately recur frequently even after it’s removed.”

Dr. Petrikovets explains, “Cysts can come back for many different reasons depending on what is causing the cyst.  They can come back in people who don’t ovulate; they can also persist  due to endometriosis, dermoids, and other benign or cancer diagnoses. One way to mitigate a cyst recurrence that is due to the menstrual cycle would be suppression of menses with birth control pills if appropriate.”

According to Dr. Ramirez, “Recurrent ovarian cyst is more common in the younger population since they ovulate more frequently.  Most of these recurring ovarian cysts develop a thicker membrane, blocking the release of an ovarian follicle (egg) leading to excess in hormone production.” 

Dr. Yu shares, “Treatment options include observation and do ultrasounds every 2-3 months to see if it will resolve on its own.  Persistent cysts that do not resolve typically need to be removed surgically.  If the cysts appear cancerous on ultrasound or MRI, then typically a surgeon will remove the entire ovary.  Is there a way to prevent cysts from coming back? Unfortunately typically not.  Many gynecologists will give their patients birth control pills with the intention that it will prevent physiologic cysts from reforming.  However, with the low estrogen level in the modern pill, it really doesn’t work.  There is a particular case when losing weight can help prevent cyst formation.  If a woman has a condition called polycystic ovarian syndrome, they do not ovulate frequently.  For reasons unbeknownst to doctors, weight loss helps them ovulate. What can cysts lead to if not treated?  Again, most cyst just go away on their own.  The cysts that persist can lead to ovarian torsion and if they keep growing, it can eventually stretch the ovary enough to damage it.”

Dr. Petrikovets says, “If a cyst is persistent and doesn’t go away then one way to get rid of a cyst will be surgical intervention, which is usually done via laparoscopy. Laparoscopy is a minimally invasive surgical procedure where gas is used to fill the belly and long thin instruments are inserted into keyhole incisions that are typically 1 cm or less.” 

Dr. Ramirez tells us, “First, we must understand the behavior of ovarian cysts.  They can be categorized as being either functional (physiologic) or non-functional (non-physiologic) The ultimate goal is to inhibit ovulation and there are a variety of ways on how this can be achieved, either with oral contraceptives or surgically.  If left untreated, these ovarian cysts can result in a bleeding ovary requiring blood products or more concerning, an ovarian torsion (twisted ovary) that can lead to the demise of an ovary.”

Dr. Yu states, “Apple size cysts are quite common.  I have seen cysts grow to the size of a basketball and make the woman look full-term pregnant.  In summary, cysts can range in size from a pea to something even bigger than a basketball.”

Dr. Ramirez explains, “Most ovarian cysts grow to a size of 2 cm (size of a grape) prior to ovulation and eventually resolve after ovulation.  If the ovarian cysts do not resolve, these can be monitored with a repeat pelvic ultrasound after 6 weeks from diagnosis.  If the ovarian cyst does not resolve or if they develop into the size of a large grapefruit (7-8 cm), then surgical intervention is highly recommended.” 

According to Dr. Petrikovets, “Cysts can be many different sizes. They can be 1 cm cysts and they can also be so big that they occupy the entire abdomen. When that happens it looks like somebody is nine months pregnant. However, they are usually on the smaller size and usually they’re easily treated. Cysts should be followed up by a doctor with an ultrasound and if the symptoms are severe as described above then minimally invasive surgery is a good option. If surgery is necessary they should be done by a gynecologist that is trained in performing minimally invasive gynecologic surgery as this is the appropriate modality for most patients. In Hailey’s case,the size of an apple is usually treated with three to four keyhole incisions that heal well and are barely noticeable. Typically, old fashioned big incisions are not necessary.”