Hi and thanks for the query, I think it this case the cysts are becoming symptomatic and might require some aggressive therapy. Cysts generally greater than 6cm in size are at greater risk of torsion, hemorrage or infection. The menstrual irregularities you experience could be ascribed to these cysts. Characterization of these cysts as either organic or functional could be important in making an appropriate diagnosis to propose a suitable therapeutic approach. Doing a CA125 for ovarian cancer exclusion could be appropriate. In case surgery is finally opted for, I think it s a good idea because endoscopic surgery today is less invasive and effective especially under such circumstances. I suggest you book an appointment with your gynecologist for a proper review and discussion of the various therapeutic options. Wishing you good health. Kind regards. Bain LE, MD.