Bilateral complex ovarian cysts

[Laney8463]

I am new to this forum but I would really like your opinion Dr Goodman. I hope this doesn't get too long. I am 44yo married female with no children. I began experiencing irregular periods, abdominal pain, constipation and back pain. I went to my OB and she took a polyp off my cervix, did a uterine biopsy and ordered my first (of many) vaginal US. It showed complex bilateral ovarian cysts, enlarged ovaries and fibroids. I have had 5 serial US since the first in Sept 07 and I feel that I am nowhere closer to finding out what is wrong with me than I was 6 months ago. The cysts have gotten bigger (not alot), I still have some pain on and off throughtout the month and my period is more irregular. My uterus is thicker than it should be 1.5cm and the last two US have stated that I should have an MRI as the US doesn't rule out ovarian masses. My OB goes from one extreme to the next but won't actually give me advice as to what I should do. I really dont want to have surgery, but if that is the best thing, then of course I will do it.  The cysts are possibly endometrioma, they are pleomorphic in nature, they have been referred to as lesions and one radiologist states that ovarian neoplasia is within the differential diagnosis. I had my latest US on Jan 30th, the impression stated the bilateral complex cysts were present with no interval improvement and recommend an MRI. My OB says she doesn't have much faith in MRI's. She then asked me if I wanted to wait 3 months to have another vaginal US. I am so confused as to how serious this could be or how benign this could be that I don't know what to do.
My Ca-125 was 25, which was reassuring but not convincing from what I have read about this test.
Should I get a second opinion? Should I get the MRI? Should I do both?
Your input would be greatly appreciated
Thank you for your time

[Laney8463]

Hi Dr Goodman,
I have an addendum to my post. I should mention that my mom had uterine cancer and my uncle (maternal) had colon cancer. Do you think it is reasonable to just wait 3 months for a repeat US and is it reasonable to get a second opinion from a gyn onc? I live in the Boston area and know there are many great docs in town including your group. thank you for your time and input. It is appreciated.

[Annekathryn Goodman, M.D.]

Dear Laney,

I suspect that you most likely have endometriosis with endometriomas.  The big question is whether you are trying to have children. If not, with all your symptoms plus the growing nature of the cysts, I do wonder whether it might just make sense to just have a full hysterectomy with removal of both tubes and ovarian.

Your family history is important. There is a syndrome called hereditary nonpolyposis colon cancer syndrome or HNPCC. There is a high risk of uterine, colon, and breast cancer with this syndrome. There is a genetic test for HNPCC. If it would help you decide whether to have major surgery, consultation with a genetic counselor may be useful.

Sometimes a second opinion can help clarify or bring together all the hard work you and your doctor have been doing to try and understand what is going on.
best wishes