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varying opinions of how Doctors handle ovarian cysts for post menopausa...
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varying opinions of how Doctors handle ovarian cysts for post menopausal women?

Hi: what a great forum! I'm trying to make a decision about whether to have surgery or not for my right ovarian cyst. We also don't know if the endo lining is thick or not, we tried an office biopsy and I could not take the pain despite relaxation pills.

What are the symptoms of ovarian cyst problems, ditto for ovarian cancer or thickened lining in the endo? I understand from a friend that Doctors vary on how they would handle these things. I don't have a measurement for the lining but the ovarian cyst on my right side measures 3.2 x 2.5 x 2.9 cm. in May it was 3.2 x 2.2 x 2.7 cm. These were done by the same vaginal ultrasound machine and tech.

In January, done at a different medical group, it was 2.59 x .97 x .91 so it may have grown or a different tech or what have you?

I too have cancer in my family and don't know if I should have it removed or to see if it is cancerous. I am about a year into menopause now or maybe at menopause. I did have some light bleeding toward the end of my period years which at my age, 56, concerned the GYN.

I really would prefer not to have surgery if I don't have to! I am not only a caregiver at home but the healing time of 2-3 weeks would not work with my lifestyle. Too, every surgery I've had in the past, the surgical drug have knocked me out for up to 2 months and this despite them being careful. I don't respond well to drugs.

Thanks for helping, any advice or suggestions would be most helpful.
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Avatar_f_tn
Those are not large measurements regarding the cyst.  Generally they look for a measurement at or greater than 5 cm before considering removal or if you are starting to get symptoms that show the cyst is disrupting your quality of life.  

Women usually can't tell one way or the other if a cyst is benign or not (often doctors can't tell either without removing and testing it) although a vast majority are benign.  Post menopausal women tend to be put on higher alert with doctors when cysts appear although they can be a problem at any age.  Symptoms vary and some women have none at all.  A lot of cysts are discovered in routine exams while nothing is suspected of being there.

Can't comment on endo since I have no experience with it.  If, however, you ever need abdominal surgery, it could be a good time to get rid of both ovaries.  Once you are past menopause, their removal makes little difference in how you feel and you'll never need to worry about cysts again if you have a good surgeon that truly does remove the entire ovary.

I waiting a LONG time to see a doctor and by the time I did, my cyst was on the huge side and I didn't know how sick I was.  I was getting used to the symptoms, thinking it was how I was supposed to feel at my age (wrong!)  That led me to needing the larger surgery (laparotomy) and much longer recovery period.  If caught sooner, who knows, maybe I could have had the lesser surgery (laparoscopy) and shorter recovery period.  I'll never know for sure how long I had a cyst since I waited something like 3 years between routine exams.  And thankfully, it was benign.  

I don't think the need for surgery ever appears at a time that is convenient for anyone.  It sidelines you and nobody is really in a position to be out of commision for weeks or months (for me it was months).

My noticeable symptoms (and remember it's different for each woman):
Hair loss
Constipation
Backaches/leg aches
Occasional abdominal pain (mostly at night or after a larger meal)
Lack of energy
Weight gain/abdominal bloat (not caused by diet)

Once the cyst and ovaries were removed, all the symptoms disappeared.  My hair is making a comeback, but it takes months for hair to recover from something that causes loss. I still can't tell for sure how much will return, but I have a lot of new growth which is encouraging.

Not trying to scare you, just helping you get your head around the idea that if surgery is ever needed, sooner is better than later.  Smaller surgery is easier for recovery than larger surgery.  But if the doctors are OK with a "wait and see" approach, then there's no need to rush for surgery either.  A lot depends on how much trust and confidence you have in your doctor(s) and their opinions.  And in how you feel physically.  You know if something is "wrong".  I did.
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356929_tn?1246393356
Hi,

I can only speak from my experience.. I'm waaaay past menopause and even though cysts are a little more "worrisome" at our age, they are still fairly common and still 95% benign. Your cyst isn't  large (neither was mine) I elected to have the entire ovary & tube removed , even though they suggested waiting a month or so. (I don't "do" waiting very well) . My surgeon didn't feel removal of other ovary was indicated (she's rather big on not removing healthy organs). Her opinion was that having one small cyst did not necessarily increase the odds of having another.

I also had that horrible "endo biopsy" .. quite a procedure, but post menopausal bleeding is usually cause for concern.

The TVUS showed some fluid in the uterus (which is not common) so they decided to do a D&C during the procedure as well as hysteroscopy (viewing and bios of uterus) . All this of course while I was "out". Perhaps they can do that for you as well.

Regarding the anesthesia; the laparoscopy is usually done on an outpatient basis. The degree of anesthesia given is no doubt not the same as one would get for a longer procedure. I'd like to tell you that it is a shorter recovery than 2 weeks, but that's about the minimum . Even though I felt fine in a week, driving  and heavy housework is not recommended.. There are those that take even longer to feel back to normal .

The main thing is try not to worry.Chances are great that it is benign (they have no way of being 100% till surgery.) But, there probably is no reason to "rush" either. It may still dissolve but if it hasn't yet, it probably isn't going to. My own opinion --for me-- is that if it has to be done, go ahead and get it over and done with .. no sense in worrying and fretting about it... But , you have to be comfortable with your own decision.

Please keep in touch,
Sandy
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Avatar_f_tn
I am 62 and emigrated from Ireland to New Zealand 2 years ago to enjoy retirement close to family.  When I started having aches in my hips & legs I put it down to a more active lifestyle - lots of gardening & walking.  When it started to really annoy me I had it investigated - I was carrying around a 17cm ovarian cyst !!  Luckily we had medical insurance & it was removed immediately, 5 months ago, together with my ovaries. Thank goodness it was benign !  I feel & look so much better & have more energy.  I still get a bit of an ache in my lower back but i'm sure this will disappear in time.  I would advise anyone to have the surgery, if given the option - the symptoms just seem to creep up on you & you learn to live with them & they become part of life !!  Irish Joke - " Did you hear about the man whose wife didnt know he drank until she came home one day & found him sober !!"
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Avatar_f_tn
You made me laugh.  I am glad you are feeling so much better.  I still joke that 49 feels a lot better now than it did when I had the cyst.  It's so easy to blame the new pains on age and not investigate the real cause. I am glad it all turned out benign.  That has to be encouraging to the other older ladies that may be reading this who are just discovering their own cyst problems.
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Avatar_f_tn
Boy, am I glad to find this forum, if for no other reason than to vent concerns that I haven't been able to discuss with anyone else yet.  

I'm 60 years old, have been post menopausal for 10 years.  Imagine my surprise when I saw blood in the water during a shower.  Thought I cut my foot until I saw it running down my leg.  (Sorry to be so graphic, but it was quite a surprise.)

I went to my primary care doctor because my gynecologist passed away a few years ago and I hadn't found a replacement for him.  Sonogram showed fibroid tumors and a small cyst on the left ovary, 1 cm x 1.6 cm.  

I don't worry about the fibroids, since they're almost always benign.  I wouldn't worry about the cyst since it's so small, except that my mother had ovarian cancer and her mother had uterine cancer.  15 years ago, I had severe cervical dysplasia that was removed in a cone biopsy (leep section) by the now deceased gynecologist.

So, my primary care doctor made an appointment for me in two weeks with a gynecologist.  I have two weeks to stew about it, I guess, and have decided not to worry my family about it until after I see the  gynecologist.

I'm surprised, though, that with such a small cyst I have symptoms besides the bleeding (which is probably from the fibroids) - lower back ache, bloating, lower abdominal "twinges" (not quite cramps, but little pinches occasionally), and an increased urgency to urinate, annoyingly often.

I've been getting online info so I at least know what what the gyn's talking about and can be prepared to ask question about my options.  At this point, that's all I can do.  

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Avatar_f_tn
Im sorry you are going through this !  I have been dealing with my left ovarian cyst for three years myself. I dont really talk to my family about it , so i know what you mean. It scares the **** out of us so we dont want to scare them as well. Your NOT alone...we are all here for eachother...so talk to us!! and please keep us posted!!!
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Avatar_f_tn
Thanks for your response and encouraging words.   You're right that it scares me and that's why I haven't wanted to talk about it.  I'm getting over that hurdle ever since I admitted to the doctor that I'm scared when he asked, "How are you?"  It's only been a month for me and I've been anxious about it most of that time.  I can only imagine what it's like for you to deal with it for 3 years.

But now I'm both puzzled and scared.  I saw the gynecologist that my primary care doctor referred me to.  The gyn is not concerned about the fibroids (neither am I), but he's also not concerned about the cyst, and I am.  Even though it's small, everything I've learned about ovarian cysts says that they're normal in childbearing years but not after menopause.  Plus, my mother's had ovarian cancer and it's familial.

The gyn is more concerned about the endometrial lining because it's thicker than normal for a 60 year old post menopausal woman.  Also, the location of the hyperplasia (thickened endo) is very near to the cervix, where I had a section of pre cancerous dysplasia removed 15 years ago by another doctor.  So, he's scheduled a D & C biopsy for December 23.  Terrible timing for it, but he can't do it sooner because he'll be out of the country for the next few weeks.  

I live about a 3 hour drive away from the Roswell Cancer Institute in Buffalo, so he offered to give me a referral there if I didn't want to wait a month, although he said the time wouldn't make much difference.  If I went to Roswell, it would take two weeks to get in anyway.  Two more weeks shouldn't matter.  Also, because of the long drive, I'd probably have to stay overnight the night before or after (maybe both).  Having it done locally, I can go home the same day.  It'll be done under general anesthesia in the local hospital instead of the office procedure that janepm mentioned in her post.  In fact, the gyn said he'd prefer I have the D & C under general anesthesia because he's known patients who couldn't deal with the pain of the office procedure.  Kudos to him for his concern for patient comfort!  

I also liked his sense of humor.  Instead of posters/pictures on the wall, like other doctors' offices, he's got them on the ceiling above the exam table.

The expertise at Roswell might be good for a diagnosis.  On the other hand, this gynecologist is good and has several years experience.

Regardless of whether the endometrial hyperplasia (thickening) is pre cancerous or cancerous, the end result would probably be the same - a radical hysterectomy, which would also take care of my concerns about the ovarian cyst.  I hate the idea of surgery and the recovery time involved for a hysterectomy,  But, if necessary, I'll deal with it.  Other women manage to handle that and worse.

I finally let a few family members know.  Hard to hide the fact that I'll be in the hospital the day before Christmas Eve.  But, I asked them NOT to tell my mother where I am that day or what's going on.  Not yet, anyway.  She's 87, prone to high blood pressure, and also prone to raising it higher when she worries.  Generally, she's a tough one, has survived both ovarian cancer and colon cancer.  But she frets easily about others.  
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Avatar_f_tn
Happy Thanksgiving!  I'm glad you talked to your family. It is stessful tho, especially when they seem worried, it tends to make us feel they know something bad is going to happen and we are so worried that just the thought of that freaks us out! lol. My family know too..they dont talk alot about it to me unless i bring it up..they know how i stress! Im married and my husband is 1800 miles away working and has been for 7 months. I havent told him anything about going to the doctor recently (he knows i did 3 years ago) and he knows i still have this in me. he would only stress me out more if he did know i was going to have surgery in january. and would probably come home and we cant afford for him to do that! Did your doc say its all fluid? or both fluid and solid? Mine is fluid in the center and solid around it, no septations tho. its pretty big..8.6cm. tree years ago it was 4.3cm. I dont know what type it is...doc said she didnt want to rule out dermoid but she didnt see any fatty stuff in it..but the transvaginal shows white marks in the solid so thats why she wont rule that out. she has also said it could be a fibroma but i researched (of course..lol) and those are totally solid. so thats why im scared because i dont know if its non cancerous or not. I did have this thing in me when i was having periods three years ago..and now i havent had one for a year and a half..doc doesnt seem to think its due to the cyst/tumor. I tend to think it may. scary stuff isnt it!? Im praying for us!! Keep me posted please!!!!!  Take Care!!!
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978961_tn?1251345903
Wow ! my cyst is not very big but I do know its the reason for my pelvic pain, low right or abdominal pain.
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Avatar_f_tn
Has your doctor said anything about a procedure for checking whether the cyst is cancerous?  There is a procedure (can't remember what it's called), but my doctor said that he didn't want to do it since it's a more complicated surgical procedure than he thought was warranted for such a small cyst.  I don't  understand that reasoning because I don't see what relationship size has to do with whether or not a cyst is malignant.

Yours sounds fairly large and growing, so I wonder if your doctor is considering removal.  It must be causing some pain.  Even with a small one, I've felt some lower back pain and occasional abdominal cramping, sometimes some fatigue, but I don't know now if those symptoms are related to the cyst, the fibroids, or the endometrial hyperplasia.  My doctor's focusing on the hyperplasia and pretty much ignoring the  cyst, so he hasn't said anything about whether it's solid or filled with fluid.  It didn't occur to me to ask.  

My family isn't talking about it now except if I bring it up.  But I don't mention it anymore, now that I've told a few of them about it.  Not much to say about it until I know more after the D & C.   My mother's in Florida and I'm in NY, so it's fairly easy for me to keep it from her.  I wasn't planning to visit her this year on the holidays, so she won't even be aware that I'm having the D & C the day before Christmas Eve, since I'll be home the same day and can talk to her by phone on Christmas.  It would not only stress me out more to have her upset, but I'd feel guilty if her blood pressure went up from worrying.  Fortunately, everyone else agrees with me.

You mentioned having the cyst three years ago when you were having periods, and that you're wondering if the cyst is why they stopped.  So I'm wondering how old you are.  When I was still having periods in my mid 40's, I had irregular bleeding, but shrugged it off as a sign that I was getting near menopause.  It wasn't until I had a positive Pap test that I realized there was something else going on.  Turned out to be severe stage cervical dysplasia (pre cancerous), which was easily removed through an in-office procedure under local anesthesia.  My periods continued regularly after that for a few years until I reached menopause.   Gynecologically, everything was fine after that - until now, when I started bleeding ten years after my last period and had no doubt that it wasn't normal.

The point of relating my history with the cervical dysplasia is that it caused irregularity, but once taken care of, my periods were regular again and didn't stop until menopause a few years later.  I'd think your case depends on your age.  If you're not near menopause, then I'd suspect the cyst cause them to stop.  If you are near the age of menopause, then that could be the reason for the periods stopping.  

As I told one relative, I'm feeling like an old car.   I was running smoothly until I got near 50.  Then I started needing tune ups and "replacements."  First the cervical dysplasia, then menopause, then hypothyroidism along with the menopause (and thyroid hormone replacement), followed by high blood pressure (side effect of hypothyroidism), and now this - cyst, fibroids, and endo hyperplasia all at once.  A lot of malfunctioning for someone who was always blessed with good health until I started aging.  Like a car falling apart with age.  But, better than a car that needs its parts fixed or replaced to keep functioning, I guess I can just toss out the bad ones if necessary and keep on running smoothly - more or less.  
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Avatar_f_tn
Thanks to everyone who expressed interest and concern in my problem.  I've waited (seems like forever) until I had an outcome to report.

The D & C showed a large polyp which the doctor removed.  Both polyp and uterine lining showed NO malignancy.  The polyp was apparently the source of the vaginal bleeding.

Regarding the ovarian cyst, the doctor has decided to monitor it with follow up sonograms and CA 125 tests.  I know that CA 125 isn't a reliable indicator of whether or not ovarian cancer is present, but done in a series and compared, the tests can show if there's a trend toward elevation.

Thanks again for supportive comments and concerns.
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