Can a small simple ovarian cyst cause pain

[eileen165]

I am a 57 years old and post menopausal.  About 3 years ago after ultrasound for abdominal pain, I was referred to the Gyn clinic as I had a right ovarian cyst of 3 cm.  The doctor there said there was no way my symptoms, to me classic cyst symptoms, could be caused by this small, simple cyst.  CA125 done and advised there would be no follow up.  The pain continued and I continued trying to find answers.  I had kidney and abdominal scans which found nothing.  The pain got so bad a few months ago I arranged to have a virtual colonoscopy, thinking that, since the pain has nothing to do with the cyst, I will find out what it is.  The scan found a tortuous colon and the cyst which has grown by 0.75 cm.  I also have had an episode of vaginal spotting, which I guess is related to the cyst.  My doctor has referred me with urgency to Gyn.  This referral has been downgraded to routine.  I'll be seen in 12 weeks.  My question is - can a simple cyst of 3.75 cm cause pain or am I imagining all of this?  Had this been removed years ago, I wouldn't have needed fruitless visits to the doctor and numerous unnecessary scans.

[eileen165]

Dear mtaig and Bhupinder

Thank you both very much for your kind responses.  I'm at the stage I think some of us are meant to live with chronic, debilitating pain.  My tummy pains started late 2009.  The latest episode started at Easter time this year.  At that time it felt like, don't let anyone come near me.  That settled, but there is still residual discomfort.  It would make you think that a cyst or something had ruptured, but it was still intact when I had the virtual colonoscopy done.  I have had similar episodes previously.  The CA125 came back normal.

Following a recent visit to the doctor and a brief vaginal exam, I have had a discharge and now have some external discomfort, so thought there was the possibility of an infection - and perhaps I have had an infection for some years without it being detected.  I am widowed but had a brief relationship a few years ago.  Any attempts at intimacy resulted in horrific pain and discharge.  The dr at Gyn said it was just menopausal stuff.  As relationship ended, so did the associated problems, but the latest discharge made me think possible infection.  I've just been to the doctor, who doesn't think so as infection would produce an ongoing discharge.  My pain is right across my tummy and not one sided, so perhaps not the cyst.  The doctor thinks tummy pain is IBS.  Doesn't everyone?  The virtual scan showed I had a tortuous colon, but that is in the right flank area, so nothing to do with abdomen.  I am waiting for an appointment for a Transabdominal ultrasound ultrasound and a proposed biopsy.  When the gyn appointment comes around I will ask them to check for infection.  I felt bad about the possibility of infection, as if had done something wrong - it's just menopause, it seems.  Who invented it??   Thank you both very much indeed.  Pain is so wearing.

Eileen

[Bhupinder Kaur, MD]

Hello,
Ovarian cysts in post-menopausal women are common but any cysts in a postmenopausal woman should be taken seriously and ovarian cancer should be ruled out. You have got a repeat ultrasound and CT scan done. A CA125 blood test should also be performed. Simple cysts (those which only contain liquid) are generally benign and may be followed through serial ultrasounds for a period of time. It is less likely for a small ovarian cyst to cause pain. It can cause pain if it becomes large, Bleeds, breaks open, interferes with the blood supply to the ovary, is bumped during sexual intercourseor is twisted or causes twisting (torsion) of the Fallopian tube.
Cysts should be considered for removal if they are associated with pain or an elevated CA125. Since you are having pain, it is best to consult a gynecologist and discuss the option of removal of the cyst and sending it for further histopath examination.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[mtaig12]

My answer is YES! Ultrasounds/scan are not foolproof, there can be more there that's not being seen.

I had an ovarian cyst that refused to be seen on ultrasound, though it was felt by my doc before and after the ultrasound. It later ruptured, and so could no longer be felt (and still couldn't be seen), and my doc considered her job done. Two years later, I was still having worsening abdominal pain, and saw a different doc who said my ovary was immobilized which isn't normal, and he thought endometriosis. I had a laparoscopy, and I had an three inch wide adhesion from my ovary to my abdominal wall, pulling everything over to that side. The adhesion was caused by the ruptured ovarian follicle, which was still leaking into my abdominal cavity as it had for years.

Moral of the story: Without actually looking inside the abdomen, no doc can say what is or isn't going on in there. If you have continued pain, that should be enough to warrant an exploratory laparoscopy. Find a new doc that understands that chronic pain isn't normal.

(Interesting aside: Ten years later, I started having very similar symptoms again, but again nothing abnormal seen on ultrasound. Doc and I came up with a plan to have a laparoscopy for tubal ligation, and he'd take a look around. At the surgery, I had had another cyst which was leaking into my abdominal cavity. He cauterized it, and the symptoms went away. Which brings me to the current day (another 10 years later, now at age 44), where I have similar symptoms and am waiting for my surgical consult for my current cyst.)