Ovarian Cysts

[Mouse22]

I am writing this to get my worry filled husband off my back.
I am a 34 year old female, good health with one child.  No cancer in my family, both parents still alive.  The only medical problem I have ever had was during birth I had bleeding complications that forced them to remove my uterus because of a bleeding disorder called DIC.  This was August 1998.
A couple of months ago I noticed a slight fluttering and slight pain in my lower left abdomen.  I ignored it until I felt a slight lump with tenderness when I pressed on it on my left side.  The area is midway between by belly button and side and is just below my underwear wasteline.  I didn't think anything of it because it didn't really hurt, just tender when I pressed on it. But I made an appointment with my GYN anyway.
He didn't know what it was as it was in a pecular area, slightly higher than the ovaries, but since I was there ordered an ultrasound.  The technition couldn't find my left ovary doing an internal ultrasound, but found it doing an external ultrasound. She made the comment that the left ovary was higher than usual and very close to the skin. It was probably due to the emergency hysterectomy I had during birth.  She also said I had a rather large cyst (5cm) on that ovary.  She said it rather casually.
I waited and saw the doctor and he seemed surprised it was a cyst, but handed me some reading material and scheduled a follow U/S in six weeks.  He didn't seem overly concerned and said we would watch it.  The diagonosis on the invoice said "hemorrhagic ovarian cysts."
A week after that, I was tryig to feel the area and didn't feel anything no tenderness, so I thought it just went away like he said it would. Last night I felt it again and it was tender.
My husband is overly protective (because of my child birth expereince) and freaked a little last night when I told him.
Questions I have:
1.   Is it possible for a cyst to go and come back within two weeks, or do you think I just didn't feel it.
2.   Based on it being a hemorrhagic cyst, is that more serious?  I haven't found much info about that kind of cyst.
3.   Can an Ultra Sound tell if the cycs is solid or fluid filled?  I am assuming fluid filled are better than solid.
4.   What kinds of questions do I need to ask when I go back.
5.   Are these type of Cysts a precurser to ovarian cancer?
Thanks for responding to this request.

[Forum-M.D.-DT]

Thanks for visiting the Family Practice Forum.
Let me talk a bit about Polycystic Ovarian Disease and then get to your specific questions.
Polycystic Ovarian Disease (PCOD) is a disease of reproductive age women due to the presence of fluid collections around the ovaries.

Symptoms :
It is marked by irregular, infrequent menses (oligomenorrhea) and/or lack of menstruation (amenorrhea). This condition may also be associated with infertility, dysfunctional uterine bleeding, abdominal pain, obesity, hirsuitism (excessive hairiness), enlarged ovaries, acne or deepening of the voice. Laboratory diagnosis will reveal elevated LH (leutenizing hormone) and somewhat low FSH (follicle stimulating hormone) as well as increased testosterone, increased estrone, progesterone and dihydroepiandrosterone (DHEA). Other blood tests including serum glucose (to rule out diabetes) or a "dexamethasone suppression test" (to rule out Cushing's disease) should be considered by the physician examining the patient with presumed PCOD. Ovaries may be enlarged with a smooth glistening capsule and pelvic ultrasound will reveal enlarged ovaries with one or more associated cysts.

Treatment
Several treatments are availiable. If large cysts are present and are causing abdominal pain, laparascopic removal of these cyst(s) may be indicated. Provera (progesterone) may be prescribed to stimulate cyclic withdrawl bleeding or low dose oral contraceptive may be prescribed to help return menses to a "regular" pattern. Other treatments include the use of follicle stimulating hormone or human gonadotropins. For pain, anti-inflammatory medications such as Motrin will give symptomatic relief.

1. Yes it is possible for a cyst to disappear and come back in 2 weeks. When your ovary releases and egg each month, fluid is being released along with it. Therefore, this fluid can cause pain, as it is "resorbed" by the body, the pain should improve.

2. If the cyst is "hemorrhagic", this means that there is some blood associated with it. It does NOT mean you are bleeding internally. It just means that there is blood in the cyst which does change the appearance of the cyst on ultrasound.

3. Yes, an ultrasound can distinguish between solid masses and "cysts". By definition, a "CYST" is fluid filled.

4. Well, you need to ask whether or not your doctor would consider the use of oral contraceptive medications. Oral contraceptives "fool" the body into NOT releasing an egg each month (and thus not releasing the fluid along with it that may form a cyst).  You need for your doctor to answer this question: "What options do I have to make sure this problem is resolved once and for all".

5. Ovarian cysts are NOT a precursor to ovarian cancer

Frankly, if you came to my office with this history and had no contraindications for going on birth control pills. You would leave my office with a prescription for "Orthotricyclen" and this ... in all liklihood would resolve the problem.

I hope this helps!

[Mouse22]

Thank You Dr. Tomasello,
I will show your answer to my husband when he gets home.  One comment and two follow up questions for me.  My GYN talked about birth control pills, but said he hadn't seen anything in the literature that told him they were effective against ovarian cysts, so he opted to watch it.
Two follow up questions:
1.  In an earlier question about ovarian cysts, you seemed intent on no surgery.  You even made the comment that you wouldn't have your wife go through it.  If it is stilll there, when do you believe surgery is nexessary.
2.  I am very active.  I play tennis three times a week, raise a three year old.  Is there any problems continuing with these types of activities.  About the onlt thing I have not done was my daily situps.  What would you recommend, if anything, me cutting back?
Thanks again, you have been a great help.

[confused7457]

Like Mouse22, I was recently diagnosed as having a hemorrhagic ovarian cyst and have had some pain/tenderness, so I started reading about the problem a little in various medical encyclopedias. My understanding is that this is not necessarily associated with polycystic ovarian disease but can occur simply as a corpus luteum cyst(?) Also, I've read in a couple of places that while hemorrhagic cysts don't always bleed, they can and do commonly bleed, sometimes leading to symptoms of shock. Is this incorrect?

[brainygal]

I'm 25 years old and I've been on birth control pills since age 15.  Last year I had 2 dermoid cysts on my left ovary and 1 on my right ovary removed.  At my annual exam this year I was again noted to have a cyst on my left ovary.  The doctors think this is just a fluid filled cyst.  My question is, if I'm on the pill, why do I continue to get cysts on my ovaries?

[Schanda]

I have just recently found a small mass inside my abodmen.  It is right below my belly button to the left.  It is a little tender, but that is all.  I am a little concerned though, does anyone know if this could be an ovarian cyst.  It seems as if this is too high... I just don't know what else it could be.