post menopausal bleeding and ovarian cysts

[milliron]

First, thank you for your answer.   52 years old, no peroids since 06/06, diagnosed by blood tests as menopausal in 10/06, and repeat tests in 06/07 showed defenite menopause.Long history of ovarian cysts and   had a 12 cm. cyst and right ovary removed in 06. all pathology OK.

Now I have been having ovarian cysts being followed since 10/06 with repeat ultrasounds every 3 months.  Doctor said there was one, then a couple of them and they were small so he continued watching. Since Octorber  06 I have had all the symptoms that I know are related to the cysts, but now  have had bleeding.  a couple of times just spotting for a couple of days, and last months 10 days of  a lighter period type bleeding.   3 weeks after this bleeding doctor  did an endometrial biopsy and said my lining was very thin.  But the cyst was about the size of a golf ball.  He suggested still watching, and repeat the ultrasound in 2 or 3 months.

Does this sound OK, or should I get another opinion.  I am tired of the symptoms.  But don't I still need that other ovary?  I do not care to take any HRT. I  am small and lean.  doesn't that ovary still help with a little estrogen production?  or am a I better off with out it.

[Machelle Seibel, MD]

At age 52 the amount of estrogen an ovary produces is typically small. But the ovaries do also continue to make androgens which can help with libido and some of the androgens are converted into estrogen. If your cysts are small and coming and going, it is likely that these cysts are "functional" cysts meaning they are less typical cysts from a normal ovary rather than tumors (either benign or malignant) that must come out. However, If you are being troubled by constant observation with ultrasounds and symptoms, and the worry creates stress for you, it is a reasonable consideration to discuss removing the remaining ovary with your doctor. It could likely be done by laparoscopy and your recovery would be much shorter than if done by a bigger operation. You would have to see how many symptoms you have and decide if you in fact want to or do not want to take estrogen at that time. Hopefully, your estrogen level being low, you might not experience many symptoms and not need treatment for hot flashes. You still might want to have a bone density done and a colonoscopy to evaluate risk for osteoporosis and colon cancer. Getting a second opinion would make sense if your current doctor does not want to discuss these options with you.
Machelle M. Seibel, MD