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Avatar universal

Size of Ovarian Cysts and Pain

Hello Dr. Goodman,
I have asked you questions in the past and you have been very helpful. I have had an elevated ca 125 since Nov. 07. It ranges from 41-58. The latest one was done two weeks ago and was 48. I have had numerous transvaginal ultrasounds over the past months and all but the most recent revealed a normal pelvis without cysts. I also had a lap in April 08 and the results of that was normal except a small patch of endo. I started having intense right sided pelvic, hip, and back pain about two months ago. The transvaginal ultrasound revealed bilateral simple appearing cysts. The left measures 5.0 cm and the right measures 4.3 cm. There was a small amount of free fluid. My gyn started me on the nuva ring, in hopes of preventing more cysts, dissolving the two that are there, and helping with the pain. The pain is really intense and can last for hours. It wakes me up at night and I have to use a heating pad as well as aleve for the pain continuosuly. A few days after started the nuva ring the pain went away and I thought that the cysts were dissolving, but for the past two days the pain is back and just as intense as before.  Along with the pain I have intermittent spells of nausea. This can last for hours and usually happens for a few days in a row and then will disappear for  week and then return. I went to the gastro doctor for the nausea and he is doing a endoscopy tomorrow. Could you please lend your opinion to the following questions.

1. Are the cysts that I have considered large?
2. Could cysts this size cause such pain?
3. Should I be concerned with these cysts in reference to my ca 125 level?
4. Can these cysts be causing the nausea?
5. Should I ask for these cysts to be removed surgically?
6. Does the continued pain indicate that the cysts are growing larger?

Your opinion is greatly appreciated and thank you in advance for taking the time to respond.
9 Responses
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Avatar universal
A related discussion, Chances of Benign Cyst or Cancer? was started.
Helpful - 0
242604 tn?1328121225
MEDICAL PROFESSIONAL
Hi Jaxie
yes , you can fly

Hey Corky
-yes endometriosis has a very characteristic look. We usually get biopsies
-cysts of ovulation will be gone after a cycle or two
-sometimes medication can make you nauseated. Consider removing  the nuva ring for a few days and see if that makes a difference
best wishes
Helpful - 0
Avatar universal
I wanted to add that I did have a transvaginal ultrasound done on April 10, 2008 which indicated that there was a 2.0cm cyst on the left ovary (consistent with a corpus luteum cyst) and a simple 1.7 cm cyst on the right ovary. Following this ultrasound I had the laparoscopy in which my gyn stated in the operative report that both fallopian tubes and ovaries were within normal range. I am assuming this meant that the cysts were no longer there. Would I be right in assuming this? Then came the transvaginal ultrasound on July 25 stating that there is simple appearing (physiologic) ovarian cysts, one on each ovary, which measures 5cm on the left and 4.3 on the right. My concern is that these may be the same cysts and they have grown substantially and if there not the same cysts is it out of the ordinary for cysts to continue to appear on both ovaries?
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Avatar universal
Also, when the endo was cauterized it was not sent to pathology. Can endo be diagnosed without being sent to pathology?
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Avatar universal
The small patch of endometriosis was cauterized during the laparoscopy when it was discovered.  The size was 1.5cm At that time that was the only endo that was seen and I did not have any other abnormalities. The cysts that are seen now are reported as being simple cysts. The doctor has stated that they are not endometriomas. He feels that they are cysts of ovulation and should not be causing such pain. He also feels the nausea has nothing to do with the cysts. He put me on the nuva ring and says he expects them to be gone at next ultrasound. Does the continued pain indicate that they are growing larger or that they are dissolving. Do you think the nausea can be related to the cysts. Thank you for your advice.
Corky
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Avatar universal
Thank you so much for your response- I appreciate your opinion. I have not heard from my doctor here, so that is good news for me.
Thankyou so much for your service to this forum, Bless you.
Helpful - 0
242604 tn?1328121225
MEDICAL PROFESSIONAL
Hi There
yes J you can fly

Corky, it sounds to me that you have symptomatic endometriosis. That causes a mild elevation in your CA 125. It also causes pelvic pain and over time you can develop cysts of endometriosis called endometriomas.

Your doctor is trying to suppress the growth of endometriosis with medication. Other meds that are commonly used include the birth control pill and lupron shots.

Ultimately for women who have completed their families and are struggling with severe side effect of endometriosis, an option is to consider surgical removal of the source of endometriosis - the uterus and possibly the ovaries.

That is pretty drastic. We always try medication first. Another option is a follow up laparoscopy with the plan to excise the patch of endometriosis and remove the endometriomas.

Your cysts are not that large but with endometriosis, size of cyst or spots of endometriosis does not correlate with pain. Some women have terrible pain and tiny spots , other women have huge cysts and no pain.

One of the many mysteries of the disease.
best wishes
Helpful - 0
Avatar universal
I have talked to Corky about this, and wondered if you could give me your opinion- I have a 5cm complex cyst and elevated CA-125, should I fly? I want to travel home for treatment.
Thanks in advance for any help (sorry for high-jacking your post Corky)
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Avatar universal
Sorry, forgot to include my age (38).
Helpful - 0

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