Persistent Complex Ovarian Cyst - Menopausal

[ptl2009]

I got my period in July this after exactly one year.  I asked my dr about it Aug and she suggested we do an US.  The US showed a 3cm cyst.  She told me "cysts are as common as cows in a barnyard".  Then she said we should do one more.  I had the second one and the cyst was just slightly smaller. Now she has ordered a CT scan and CA-125 blood test.  The second US said the cyst was complex.  I'm scared and at this point just want it out.  I am wondering why the CT scan?  Of course with the flu thing going on, I can't get anyone to talk to me!

[MarieMichele]

"Now I'm wondering if he's doing this because they have equipment to pay for - ugh!"  

I hear you on that one!  I sometimes wonder if more stuff gets ordered because they know insurance will pay and it will increase how much they can get paid themselves.

I'm glad you got so much better news today.  Sometimes you have to be assertive!

[ptl2009]

Hi! I called my dr to talk her IN PERSON. She said I should not worry that the cyst actually was smaller - from 3.3 to 2.4 cm.  She said the report did not indicte anything suspicious and that the radiologist suggested the CT scan.  Now I'm wondering if he's doing this because they have equipment to pay for - ugh!  Well, I'll go get it tomorrow and the dr said she expects them to recommend a 3 month followup with US if the cyst is still there or smaller, but she doesn't think I'll need surgery.

[MarieMichele]

I had a feeling your doctor was in a different specialty than gyn since I rarely hear of gyn's ordering CT scans.  Most have ultrasound machines right in their offices and focus more on those tests.  They also use CA-125 blood tests which are helpful but not completely reliable in trying to diagnose ovarian cancer. The test works better for post-menopausal women and to monitor the progress of chemo patients.

There's been some grumbling in health articles about the frequency of CT scans being ordered, the radiation of them, etc., so if you are reluctant about having this test done, it is possible a gyn, or even your current doctor, will help get you the answers you seek based on ultrasounds and pelvic exams alone.  

I don't know if stress can cause menstruation to stop for a year or not or if some medical condition beyond that is to blame, and I'm NOT trying to make you change doctors or treatments especially if you like your doctor.  I think there are other tests that can be done to determine menopause status.  It's remarkable that you had no menopause symptoms but some women can be lucky and have a graceful transition, too.  In retrospect, my menopause transition was not nearly as bad as what others have experienced.

It's not uncommon for more testing to be done when trying to understand a complex cyst but you are also in charge of what should and shouldn't be done.  If you want it out, you can just say that and skip a few testing stages by getting scheduled for surgery instead.  Surgical removal and testing of the cyst is THE BEST way to tell if it was cancer or benign.  

If benign, there's no rush for surgery, and possibly no need for it either...but you'll have to have that cyst constantly monitored for changes which can be a real intrusion on your time and nerves.  If cancer, speedy removal is your best chance for a complete cure.  This could mean loss of one or both ovaries, too, depending on how much you want done and what the cyst has done to the one ovary.

Unfortunately, all the tests are not much more than educated guesses and they prolong the waiting and wondering while no real treatment has begun yet.

[ptl2009]

Thanks for the info.  I think the question is about the menopause.  I have had never had any menopausal symptoms - no hot flashes, etc.  During the year I was not having my period, I was under EXTREME stress at work - working 80-90 hours per week without a break.  I wasn't surprised when I got my period because I just got a new less stressful assignment and had just returned from a two week vacation.  My dr is a women's health specialist, but not a gyn.  

[MarieMichele]

The CT scan gives a bigger clearer picture of the entire pelvic area compared to an ultrasound but really an ultrasound often is enough of a tool to find cysts.  It just seems the doctor wants as much information prior to surgery as possible and maybe wants to check surrounding areas besides the reproductive system.  She may learn more about the structure of the cyst as well.

Is this a gynecologist ordering the CT scan or another type of doctor?  You should be dealing with a gynecologist right now and for surgery it should be a gynecologist/oncologist for the most skillful specialist.

I started with a gyn and had surgery with a gyn/onc and neither one asked for a CT scan to diagnose my problems...however they did get it wrong about WHERE my cyst was located.  They thought it was on the right ovary and it really was on the left and this was not discovered until I was in surgery.  

3 cm is not that big when it comes to needing surgery but being complex, it warrants more investigation.because complex can be one of the types of cysts that can hide cancer (not saying that's the case, but that's the reason for all the investigation).  After a year it's amazing your period returned at all and that makes it confusing whether you are post-menopausal or not.  Post-menopausal women are almost always fast tracked for quick removal of cysts.