Hello Mimi,
Ovarian cysts in and of themselves probably do not cause the hormonal imbalance that you are describing, although quite rarely there is a type of cyst that actually produces a specific hormone, be it progesterone or estrogen or testosterone or whatever. However, when you are ovulating and therefore making cysts (we grow cysts on our ovaries every month and one of these breaks open about fifteen days after the start of our period in order to release a egg into our uterus .. the other less dominant cysts regress back into our ovaries) you are experiencing a specific hormonal condition and between ovulation and your period is when you would be feeling the premenstrual syndrome which typically includes the symptoms that you are describing. In perimenopause this things are magnified.
I am 42 years of age and two years ago I decided to go off the birth control pill due to irregular bleeding (after twenty years of being on it and feeling OK). At that point, I began to ovulate again and although the irregular bleeding stopped and I began to have regular periods again, they found a very large ovarian cyst on my left ovary which is now so large that it has to be removed with surgery. I am very curious to know what type of cyst this is (serous, dermoid, mucinous, follicular ...) because I go through absolutely "furious" episodes. I don't know what comes over me and my husband is at my mercy during these times. I hope that this will go away when they remove the cyst but I suspect not. I genuinely think that when we are ovulating, we are going through some sort of hormonal process that has an emotional impact on us.
At perimenopause I think that this process is magnified because we begin to experience much larger imbalances in our hormones so where before we were slightly imbalanced the difference is much greater now. As our ovaries begin to shrink and become irregular in their hormone production, we begin to become affected. I think that the cysts come about as a result of this rather than the other way around. The only difference between a regular ovarian follicle and an ovarian cyst is the size. Anything less than 2 cms is a follicle, anything larger is a cyst. Therefore having say too much estrogen or not enough will either stimulate the ovaries to produce larger cysts (therefore more fluid in the abdomen when the cyst bursts open to release the egg and more bloating since your body has to absorb this) or have no cysts at all(therefore no ovulation and no period for that month). These ups and downs will inevitably cause emotional side effects. I personally feel so furious sometimes that I am wondering if I shouldn't begin to chop wood or something in order to take out my anger on something other than my husband (although on second thought perhaps putting an axe in my hand at that time is not such a good idea
).
I am not sure that having the hormones checked will provide an answer unless you have them checked several times over a few menstrual cycles. Hormones fluctuate and they can be normal at one point, and abnormal at another. Medicine is extremely imprecise when it comes to this although I imagine an endocrinologist would probably be better at looking at these things than say a gynecologist.
I am also not convinced that synthetic hormones are the answer. I was on birth control pills for twenty years and am convinced that this is what caused my ovarian cyst. Yes pills are supposed to reduce your risk for ovarian cysts but this is because they are anti ovulants so naturally they would reduce and even eliminate functional ovarian follicles (well duh !). My cyst is obviously not functional and I am not convinced that keeping a woman from ovulating for a long period of time is such a good idea. I regret not having thought of this before (I had expressed my concerns about long term side effects to my doctor about ten years ago who said that there is nothing to worry about and that I could remain on oral contraceptives until menopause .. I am now dying to forcefully feed these things to him on a daily basis and see how he likes the side effects). Please also know that the FDA has advised that the patch in particular results in a greater amount of estrogen being absorbed by the body because the hormones are absorbed directly into the blood stream through the skin rather than going through the intestines. These damned risks are never discussed or publicized on those TV commercials for hormonal contraceptives (they are only obsessed with showing pretty polka dotted bags and pretty girls in high heels .. this, in my opinion, is ethically criminal and it infuriates me).
Know your options before making a decision. You may want to pick up a copy of Dr. Christiane Northrup's book called The Wisdom of Menopause. This book is immensely informative and when I read the beginning of the book, which describes how the doctor herself felt when she began to experience the first inklings of perimenopause, I almost broke down and cried because I knew that I was not going crazy (like my husband thought). She describes this time of life as a change which brings about self realization and forces us to get to know ourselves. She explains medically the physical aspects of what women go through and also the mental aspects. She also offers solutions and advises us to seek out what is best for us because each woman is different. Isn't that a thought .. hormone replacement treats all women the same (same dosage for everyone).
Sorry this is so long but I am going through some of the same things that you are so don't despair. Hopefully our husbands will survive this time of our lives and so will we. Hang in there and all the best to you.
Estria