questions about ultrasound results

[sk1]

Hi I am 47 and have been having the feeling of needing to urinate more often and also am having more than normal clear vaginal discharge.  Enough so I am wearing thin pads.  My Dr tested for urinary tract infection and that came back negative.  I had a trans-vaginal ultrasound done and the Dr said the results that were found shouldnt be causing my symptoms but Im not so sure.  The report says my uterus is enlarged with multiple fibroids diffusely through the uterus.  The largest measures about 2.4 cm.  The endometrial stripe is normal at 5mm.  The ovaries are remarkable for a complex cyst on the right mesasuring 2.5 x 1.8cm with posterior fluid level.  This may reflect a hemorrhagic cyst.  The left ovary is normal.  I also remember the tecnician saying she saw a fibroid right on the tip of my uterus that could cause the urinary symptoms but the report didnt say anything about it.  Can you help explain this report more and whether my symptoms of discharge and urinary could be caused by these findings?  Will these fibroids and the cyst resolve themselves in time or if not what needs to be done about them?  Are they dangerous?  My last period was not a full period like I normally have and now this time Im late, my periods have been irregular for a couple of years now.  Perhaps if my next period is normal in length and volume, would these fibroids and cyst shrink?  I appreciate any information you can offer.

[Machelle Seibel, MD]

A. You have several problems to address.  Fibroids are benign muscle tumors of the uterus that are like “knots in wood”. If the number of fibroids are great enough or if their size is large enough, or their location is pressing on your bladder, they can cause you to urinate more often.  So it depends on how much all the fibroids you have increases the size of your uterus.  If the fibroids make your uterus as big as it would be if you were 12 weeks pregnant, the chances of it contributing to your urine problems is increased. The fibroids will not go away but will get smaller in the year or two after you stop having periods.
Your discharge might be normal.  But it is also possible that the discharge is due to atrophic vaginitis which is an inflammation due to lower estrogen levels.  That can irritate the urethra (opening where the urine comes out) and make you feel like you have to go.  Try buying a vaginal gel called Replens. It is available at most drugstores.  Use it daily for a week then twice a week after that.  If it is due to the vaginal discharge, it will likely improve in a few weeks.
The cyst needs to be followed up.  Repeat your ultrasound of your ovaries in 3 months to see if the cyst goes away.  If it does not, talk to your doctor about whether or not the cyst should be removed.
Machelle M. Seibel, MD