Persistent Ovarian Cyst

[Ricasso]

My wife is 35 years and we have a son who is 2 years old. She became pregnant again last year but lost the baby around September. During the pregnancy, her doctor discovered two 4.9 cm cysts (one on each ovary). She had a D&E after her miscarrage (miscarriage) and a followup ultrasound about 8 weeks later. One cyst had regressed/ruptured but the other remained unchanged. The remaining cyst was clear, uniocular, thin walls, defined, etc. Her doctor scheduled a follow-up ultrasound in 3 months and prescribed OCP's in the meantime (she has been on OCP for her entire adult life except during pregnancy). At the three month ultrasound, the cyst was still there but was about 1 cm smaller (appx 4 cm). The doctor scheduled another ultrasound in 3 more months (which was today 06/12/02). The orginal cyst is still there but is about .5 cm larger than the last US (appx 4.5 cm...not as big as the orignal US). In addition to this cyst, the US operator noted a couple of very small cysts on the other ovary (only a millimeter or so...appearing as "bumps"). The large cyst is still clear, thin walled, uniocular, no septations, no intrusion into the cyst body, sharply defined borders, etc...all the classic signs of a functional (non-malignant) cyst.

Her mother had ovaian cancer but was in her 60's when diagnosed. We are following up with her doctor but I'm wondering if we should aggressivly push to do surgery. Based on the information, is it still likely that this is benign/functional? The persistance along the with formation of the small cysts on the other ovary have me concerned...but should I be? I feel like the doc will recommend another 3 month follow-up US.



Please help.

[Forum-M.D.-DT]

Thank you for visiting the Family Practice Forum.



Typically Ovarian Cysts are benign. In fact, ALL ovarian cysts are benign. Apparently your doctor has not tried to treat your ovarian cysts because you are trying to get pregnant. If you are NOT trying to get pregnant, the use of oral contraceptives will solve the problem. Ovarian cysts form when an egg is released from the ovary each month. In some women, fluid will be released with the egg, forming a cyst. Taking an oral contraceptive medication will "fool" the body into not releasing any more eggs, and therefore not releasing any more fluid which can cause the formation of cysts. The fluid that is present will eventually resorb (disappear).

Lets talk about Polycystic Ovarian Disease further ...

Polycystic Ovarian Disease (PCOD) is a disease of reproductive age women marked by irregular, infrequent menses (oligomenorrhea) and/or lack of menstruation (amenorrhea).  This condition may be also marked by 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. 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.

Should you aggressively push for surgery? My feeling is that if you came to my office with this history and were not trying to get pregnant, I would recommend using an oral contracptive (such as Orthotricyclen). If you are trying to get pregnant, I would say ... go ahead and try, surgery leaves scars, adhesions and I am not certain it is going to provide you with any long term benefit.

I hope this helps you!

[Ricasso]

Thank you so much for your reply.



To clarify one point, her doctor did prescribe oral contraceptives back in October/November and she had been taking them ever since. The idea was to try to get the cyst to resolve before letting her get pregnant again. Once the cyst resolves or her doctor give us the "OK", we do plan on trying for another child.



Thanks again...your information is very much appreciated.

[Tomasello_MD]

Good,

It sounds like your doctor is on the right track. Anti-inflammatory medications, along with the oral contraceptive will hopefully help the ovarian cyst resolve more rapidly. In addition to an oral contraceptive, I typically prescribe Motrin 800mg three times daily with food to help the cysts clear. Of course if you have an allergy to anti-inflammatory medications or have a history of peptic ulcer disease or gastroesophageal reflux disease, you should refrain from taking Motrin, otherwise, I think it would really help.



I wish you and you wife all the best and hope the lord blesses you with a healthy baby in your future pregnancy.

[Ricasso]

Thanks again for your help.



Since yesterday I have some follow-up information to add. Her previous Doctor has moved away but she is familiar with the new Doctor since they were both in the same practice. He received the ultra sound results and wanted to schedule a CA-125 to help ensure that there was no cancer involved (I realize that this test isn't as accurate for young women but the Doctor wants to use it for supporting information). Being the more anxiety prone than my wife, I immediately assumed that there was more than met the eye so I set up a phone conference with him to try to understand his concerns.



He said that the Radiologist report showed that the only remaining cyst has shrunk only slightly in the past 9 to 10 months (less than 1 cm overall but at least it hasn't grown). It does have the appearance of a functional cyst as mentioned above (uniocular, thin walled, etc). He also said that there was a "small amount of fluid" in the pelvic area. This statement is more or less consistent with previous ultra sound findings. The Doctor also wants to run an ultrasound in his office so he can actually see what the Radiologist has described in real time. Now I'm begining to get the feeling that he may want to do Laporoscopy to remove the cyst.



I suppose my question is this. Given the facts...such as this cyst has persisted for approximately 10 months even with the use of contraceptive pills, it has maintained a benign US appearence, there is still has a "small amount" of pelvic fluid etc., ... AND given her family history of ovarian cancer, how likely is this situation to be anything more serious than a persistent cyst? Also, what can the results of CA-125 tell us? How common is it to see functional cysts that persist like this.



The Doctor has assured me that, deep down, he doesn't think it's cancer but that he wants to cover all the bases. I believe him but I'm am prone to "worry a problem to death". Thanks again for your time and input.

[Ricasso]

In reference to my most recent post I to clarify the size of the cyst. From reading the post one could infer that the current diameter of the cyst is less than 1 cm...this is not the case.In the first paragraph I'm saying that there has been a decrease in the overall diameter of less than 1 cm in the last 10 months or so. The current size is around 4.0 to 4.5 cm. Originaly it was about 4.9 to 5.0 cm.



Sorry and thanks

[Tomasello_MD]

Well, it really sounds like a benign cyst to me.

I am sure if you have it laporascopically removed, it will prove to be nothing more than a benign cyst. However, I guess sometimes it is better to be "safe than sorry". However, in 10 years of clinical practice, I have yet to see something on ultrasound which looked like a "cyst" turn out to be anything other than a "cyst". In the situation you describe, with your anxiety, and a physician ready to "cut" ... I predict you will have the laparscopic removal of a benign cyst, with a 1-2 day hospital stay and a nice paycheck for the GYN.

I really don't mean to be sarcastic, but some Gyn surgeons are ready to do surgery when ANY opportunity arises. Maybe get a second opinion from another OB/Gyn. Bottom line ... if my wife had this ... I wouldn't recommend surgery.



All the best to you.

[Ricasso]

Thanks again for your input. You've been a great help!



Take care,

Ric

[SARAH82]

Hi, sorry to add my question here but Im a skint student and cant afford the fee at the moment.  I am 19 years old and for the last year Ive been finding it impossible to use tampons.  I have been using them for about four years but when I put one in, after only about an hour it is leaking heavily and I have to remove it.  However it is impossible to remove as there is only a small amount of blood down one side of it, always the left hand side.  I have now had to stop using them as they are not providing me with any protection and Im worried whats wrong with my insides.  Does anyone know if this is normal?  My period is not too heavy and lasts about 5 days.  I have been on Dianette contraceptive pills for four years as I used to get severe pains which led to me passing out and sickness and diarrea (diarrhea).  However lately Ive been getting the same pains but at other times of the month and one was so severe I ended up in hospital.  They kept me in for a week doing tests, all on my bowel as I was passing blood, but all came back negative and they decided that my bowel must have twisted and Ive to wait for it to happen again now so they can find out for sure.  I did mention about having the same pains during my menstrual cycle in the past but they didnt really think it was anything to do with that as I wasnt on my period.  I just hope someone can help me.  Sorry once again for posting my question here.  Thanks x

[jal40]

i had a 9.8 cm cyst removed two years ago and i now have a 6 cm cyst that will be removed in a few days. i was on the pill when when both of the cysts formed. i have read alot about them and had two dr's opinions. i understand that any cyst over 4.0 cm is in danger of causing the ovary to twist which in turn can cause problems.  A cyst that does not go away within a few months should be taken care of not left alone. A person with a cyst can have no symptoms then one day crawl out of bed and be in severe pain. According to the drs i have consulted with, my research and my own experiences, the attitude that the dr on this site has about surgically removing a cyst that has not gone away in a few months is not a good one.   i hope the person who asked the advice goes along with his gyn's advice and not some stranger on the net.

[EMP]

My sister-in-law has had a persistent ovarian cyst for the last year.  Her first symptoms were an abdominal ache and pain during intercourse.  After ignoring the pain for a long time, she went to the doctor and was immediately admitted to hospital.  She was finally diagnosed with an ovarian cyst that had caused bleeding in her abdomin (abdomen) and was operated on the following day.



Since then, things have not improved.  She got another cyst that has not disappeared.  The doctor gave her hormones and then birth control pills to try to get rid of it.  But it remains.  She has highly irregular periods.  Often she has multiple periods in one month, with heavy bloodflow.



She is also under a high amount of stress as she lives in Ramallah, a town that has been under occupation by Israeli troops since March.  She has been living in a context of intense conflict since the outbreak of the intifada in September 2000 and has been subject to recurrent 24-hour curfews since March 2002.  These restrictions and the effects on her children cause her a lot of anxiety, which perhaps also have an effect on her condition.



Her body has also been stressed throughout her life by pregnancy and abortion.  She was pregnant seven times but had three miscarriages and one induced abortion after the fetus died.  She also only has one fallopian tube.



Her doctor now wants to operate on her again.  But if the cysts returned after the last operation, what good would anotehr operation do?  Is there any chance that she has a cancerous condition?  What are her options for treatment?

[kileysmom]

i have endometriosis. i have had three surgeries to have ovarian cysts removed and the endometriosis cauterized, the last being about a year ago. i have very heavy period. some months i can not leave my house. others i have had to wear adult diapers. i no longer have health insurance. i make too much money to get medicaid but not enough to pay for another surgery. i tried to get private insurance but was turned down because it was preexisting condition. any ideas?