Septated cyst and symptoms

[obsidian12]

Hi everyone,

I'm in my early 30s, and I was treated in June for complications associated with what appeared to be a pregnancy loss. Since then, I had weird white tissue (not mucus) that would come out in between periods that resembled fishbones, and that has since resolved following a D&C. Prior to the D&C, I had an ultrasound to ensure that there were no viable pregnancies, as I had a positive pregnancy test a week and a half before the procedure, which then turned negative following a really horrible bleed and after expelling more weird tissue-looking things.

After the D&C, I've been having these horrifically painful periods that vary in length (2-9 days; my normal is 7), and the bleeding is bright red and the clots range from half the size of my fist to the size of my fist. These clots are abnormal for my cycles (my normal ones are barely larger than a dime, and my cycle is typically heavy anyway, but nothing close to this). Anyway, my health care professionals have been really confused by why my cycles haven't been going back to normal, and they figured my hormones were imbalanced, but no one's tested anything other than estradiol, which appeared normal.

I just found out that my family doctor didn't inform me (and we never informed my specialist) that I have a septated cyst that appeared on that ultrasound in June on my left ovary. In March, both adnexa were completely clear. A repeat ultrasound two weeks ago showed that the cyst was still there, but it appeared to be a simple cyst (both cysts were approximately the same size, but one showed septation and the other didn't, apparently).

I've been largely symptomatic and suffering for the past 5 months, including weight gain, water retention, constipation, abdominal bloating, breast tenderness, really heavy/painful/ periods with large dark purple clots and bright red bleeding.

Three questions:

1. Do septated cysts convert to simple cysts or spontaneously resolve within 5 months?

2. Can either of these cysts cause these symptoms?

3. Is there anything I should be asking my family doctor? She seems to think a wait-and-see approach is best, but I have a very strong family history of all kinds of cancers, and so this makes me rather nervous.

I'm seeing my specialist in January (the earliest available appointment), and I'd appreciate any insight to see if there's anything that can be done to be more proactive.

My family doctor wants me on birth control pills to see if that controls the bleeding, but if I have a pathological/symptomatic cyst there (even if benign), I'm not sure that would be effective...

Thanks for your help!

[Lanniemarie]

I would recommend a follow up ultrasound. I had all of your symptoms including extreme pelvic/ back pain and fatigue. I opted to have my cyst surgically removed because the cyst was large and showed a mass within it. Unfortunately mine kept growing since 2012.  In 2012 it looked normal and was found when doing an ultrasound for an unrelated issue. So it went unmonitored.  After removal they found it had caused tortion of my ovary. I had to have the left ovary and Fallopian tube removed yesterday. I would definitely have them monitor it to make sure it doesn't get larger or form any intercyctic masses within in it. If the pain persists longer or gets worse and it's getting bigger surgery may be required. I also had some pre-screening cancer tests done including a CA-125, which was negative. They will do a biopsy on the cysts and I will get results in 2 weeks. Also my doc said that if cysts don't go away on their own in a few weeks and become symptomatic that's when surgery may be required. Best of Luck!

[obsidian12]

Oh my goodness. Thank you very much for sharing your experience, and I'm so sorry you've gone through that agony for so long - and that you've also had to undergo losing your ovary and tube in the process. I can't even begin to imagine how all that must feel. I'm keeping my fingers crossed that everything is benign and that you'll make a speedy recovery. If you'd like, please provide an update as to how you're doing. I really hope all turns out okay. I will definitely take your advice and make sure the doctor orders a follow-up ultrasound to see what's happening with this cyst (if anything) after starting on the pill. Best of luck to you too! *Hug*

[old_before_my_time]

I'm sorry you're going through this!

I wonder if the "white tissue...that resembled fishbones" could be a uterine (decidual) cast. You can find images via a web search. Very few women shed the cast of their lining but it can happen and generally is not a cause for concern. It seems I read that it can cause painful cramping.

D&C's can sometimes cause problems such as Asherman's Syndrome but that is more a concern with multiple D&C's and I think it typically involves less bleeding not more.

Ovarian cysts can affect hormones so can cause menstrual cycle changes but yours seem extreme for ovarian cysts. Ovarian cysts are common and usually resolve on their own. Do you know the size of the one(s) you have?

As far as family history of cancers, does that include any Gyn cancers especially ovarian cancer? I don't think there's any correlation between Gyn cancers and other types except in the case of Lynch Syndrome which is associated with colon, endometrial and ovarian cancer.

I would think a trial of birth control pills would be worth a try.

I hope this is all soon behind you.

[obsidian12]

Thank you so much for taking the time to respond and for providing such a great answer.

I've looked at decidual casts, retained products of conception, and miscarriages, and what came out of me closely resembles the latter two more than the first (although I know a definitive can only happen with a biopsy - the D&C came 6 months after the presumed m/c, and 2 weeks after a chemical pregnancy). So at this point, I guess it's hard to say. I've not seen anything weird come out since, other than those enormous purple clots. I've not seen white tissue in the clots or between periods since about May.

I decided to do the birth control pill trial on the weekend, and the clots have gone back to their normal size (smaller than a dime) within 2 days, and the bleeds and pain are hardly noticeable. A bunch of other symptoms went away too (my acne's cleared up, water retention is far less, and my energy is back). It's interesting because I've been told decidual casts happen following progesterone surges (and I have no idea what would have caused that), but my family doc says my bleeds are more indicative of estrogen dominance. No one's tested my hormones, other than prolactin (which was elevated shortly after the presumed m/c). So anyway, I'm not sure what my hormones have been doing, or how I could have both a progesterone surge and an estrogen surge at the same time/very close together without something going on - or unless I had two processes happening at once...  

Regarding the cancer history, I had one grandmother with lung cancer, one grandmother with cervical cancer and then CLL, one grandfather with colon cancer and then lung cancer, and another grandfather with three different types of colon cancers. None of the grandparents with >2 cancers had faced recurrences or metastases and each cancer occurrence happened decades apart in each person; these were all net new cancer occurrences.

I really hope nothing sinister is happening and that my hormones got temporarily derailed. I'm also hopeful the pill will reset something (I don't like being on them for too long). Thanks for taking the time to read this. :)

[old_before_my_time]

So glad to hear the BC pills have improved all your symptoms! It is odd how hormones can go awry sometimes but at the same time quite common.