solid masses on both ovaries, fibroids elevated CA 125

[kash_71]

Hi,

i am 37 yo and have had v. painful periods all my life with lots of clots. my cycle used to be around 50-60days long but in the last 7 years has shortened to 28 days and in the last 18months has become a little more irregular ranging from 26-33 days. I take tranxemic acid during my periods since 2004 to control the bleeding, and paracetamol for the pain. my periods are 4-5 days long. i also had a bout of PID in 1997 and was hopistalised for one week.. it resolved with IV antibiotics but i was told that it probably has rendered me infertile.

since 1995 i've had what appears to be an enlarged left ovary which is solid in appearance. This in various US has been variously described by different gynos as a 'dermoid' or an 'ednometrioma' or a 'polycystic' ovary. it is oval in nature and well defined. since i have decided to adopt the 'watch and wait attitude' i have been getting an US every couple of years to monitor the progress and any changes. the size of the ovary has varied over the years but the solid lesion remains
1995 (42mm), 1996 (51 x 37 x 45mm), 1998 (no lesion), 2003 (no lesion), 2005 (47 x 35mm ovary - 30mm lesion), 2006 (33mm lesion),

on my 2005, 2006, and 2008 US reports some fibroids were also noticed. with the largest one measuring approx. 5.5cm.. the largest one has essantially remained unchanged

dec. 2008 US (day 21 of cycle)  left ovary dimensions are: 74 x 54 x 75mm with part solid part cystic appearance (solid part 48 x 34mm) (cystic part 42 x 28mm) .. the right ovary had a 'small well circumsribed area of increased reflectivity of 14 x 13mm'.
GP ordered a CA 125 which came back elevated at 58 (normal range up to 30) and a repeat CA 125 (10 days later) which was 78. my previous CA125 in 2005 was elevated at 47.

the latest US (feb 2009) showed the left ovary as having solid mass of 48 x 47mm
right ovary as solid area of 32 x 22mm. this US was done on day 1 of cycle.

what are your impressions and suggestions? thanks

[Annekathryn Goodman, M.D.]

Hi There
thank you for your complete information.  I would say that a mass that has been present for over ten years and has been pretty much the same size is a benign growth of some sort. CA 125 test is fairly nonspecific. The level can vary with the menstrual cycle. The most common reason for a benign elevation is fibroids.

An MRI can definitely add information. It can help define the fibroids better and look at the mass in your ovary with more resolution. It sounds like you are managing your care in a very reasonable manner.
best wishes

[kash_71]

prolly also worthile adding that i have no history of OVCA in family and although i am not concerend about fertility [or lack thereof] i am exceptionally reluctant about surgical procedures ... hence the long 'wait and see' approach i've adopted so far with the ovaries...and why i never allowed a laparoscopy post the PID to find out the extent of the damage caused by the abcesses.

however i am worried about the new mass on the right ovary and the rise in CA 125.

would an MRI or a CAT scan be able to shed extra light on the situation rather than an invasive prcedure involving scalpels?

thanks for all your help :)