Hyperreactio luteinalis

Can having large cysts on my ovaries while pregnant affect breastfeeding?

Large fluid-filled sacs (cysts) sometimes develop in the ovaries of pregnant women. This is a rare condition called hyperreactio luteinalis, or HL. HL can cause severe abdominal pain and the release of male-type hormones by the ovaries. It may affect the pregnancy, increasing the risks of a premature birth, a Caesarean delivery, slow growth of the baby in the uterus, and high blood pressure and related problems. It usually goes away after delivery as the ovaries shrink, but mothers with HL may notice that their milk comes in late or their milk supply is low. They start to produce milk as their ovaries return to normal. These babies need to have their milk intake monitored.

A) Describing hyperreactio luteinalis

Large fluid-filled sacs (cysts) sometimes develop in the ovaries of pregnant women. The cysts are called theca lutein cysts, and this rare condition is called hyperreactio luteinalis (HL).

The condition can be diagnosed by ultrasound tests that show the enlarged ovaries. It goes away by itself after delivery as the ovaries shrink to normal size. However, some women need surgery during pregnancy to remove one or both ovaries because of complications or concerns about the enlarged ovaries.

B) Effects of hyperreactio luteinalis

Pregnant women with HL may develop symptoms caused by:

  • The size of the ovaries:
    • Abdominal discomfort.
    • Shortness of breath.
  • A problem with an ovary:
    • Twisting of the ovary causing severe abdominal pain.
    • Bleeding into the ovary or the abdomen.
    • The cyst(s) breaking open.
  • Male-type hormones released by the ovaries:
    • A deepening voice.
    • Acne.
    • Increased body hair.
    • Nausea and vomiting.
    • Weight gain.

The cysts may also affect the pregnancy, increasing the risks of:

One-third of women with HL do not have any symptoms and one-third will develop masculine features (Malinowski 2015).

C) Effects on breastfeeding

HL can reduce a mother's milk supply by: 

  • Increasing:
    • The need for surgery, including Caesarian section delivery.
    • The risk of illness in the mother. 
    • The risk of the baby not being able to breastfeed well after delivery. 
  • Producing male hormones.

Mothers with HL may notice that their milk comes in late (Baxi 2014; Hoover 2002). As their ovaries return to normal, they will start producing milk. Their babies need to be watched carefully during this time to make sure they are taking in enough milk and to start, decrease, and stop milk supplements as appropriate.

References

Baxi LV, Grossman LC, Abellar R. Hyperreactio luteinalis in pregnancy and hyperandrogenism: a case report. J Reprod Med. 2014 Sep-Oct;59(9-10):509-11
 
Hoover KL, Barbalinardo LH, Platia MP. Delayed lactogenesis II secondary to gestational ovarian theca lutein cysts in two normal singleton pregnancies. J Hum Lact 2002;18:264–8
 
Malinowski AK, Sen J, Sermer M. Hyperreactio Luteinalis: Maternal and Fetal Effects. J Obstet Gynaecol Can. 2015 Aug;37(8):715-723