Post menopausal woman - What would you do?

[Ruthiejb]

Hello, I posted here a few months when a very small complex cyst was found on my left ovary.  I'm 58 years old and post menopausal.  I just had my 2nd follow up trans vaginal ultrasound, and the cyst is still there, a bit smaller, but now there is a second very small cyst.  My family doctor had his nurse call and tell me there is "no change" from the previous two ultrasounds, but the fact that there is another cyst, although very small, to me means there is a change.  Here are my ultrasound results:

Sept. 14 2009:  A small complex follicular cyst on my left ovary, measuring 16 x 10 x 8 mm.  I also had a CA-125 blood test that was normal (8.2).

Nov. 17, 2009:  No change, left ovarian cyst measured at 17 x 9 x 9 mm.

Feb. 22, 2010:  Two complex left ovarian follicular cysts are seen measurinng 12 x 9 x 9 mm and 5 x 7 x 5 mm compared to a singlar left ovarian complex cyst visualized previously.

I haven't heard from my gynecologist yet, but can you please tell me what I should ask her and what you would do if these were your test results?  I've read so much conflicting information about post menopausal cyst treatment, I'm somewhat confused.   I would like my ovaries removed but I'm not sure it's justified.

Thank you very much.

[grits223]

Is anyone here PM with a 3 cm simple cyst? (possibly more smaller ones)  Also, I am 51 yrs old, and a 15 yr Stage II breast cancer survivor.  My doctor just wants to 'wait and see', but I am emotionally ready for a total hysterectomy.  I don't want to spend the next several years "waiting and seeing"  

[bluebutterfly2222]

Glad your surgery went well. What an encouraging preliminary report!

Wishing you all the best in the future,
bluebutterfly

[weety911]

You are so sweet to check on me!  My surgery went well.  Preliminary reports say that my cyst was a cystadenomafibroma and is BENIGN!  Of course I have to wait for final path report to get the all clear, but I know the prelims usually are correct since they did a frozen check during surgery.  Thanks for all the well wishes!

[luba28]

Just wanted to wish you the very best for your surgery tomorrow.  It'll be a "piece of cake".  One minute you'll be wide awake and being prepped and the next you'll be opening your eyes in the recovery room and this will be over.

Hugs and kisses to you.  Let us know how you are after surgery - when you're up to sitting at your computer.

[weety911]

Thanks for the kind words and yes, I remember you.  I hope you are doing well.

[bluebutterfly2222]

Hi weety,

I first "met " you in the BC Forum back in August, and just came across your latest posts here  today. What a year you've had!! :-(

I want to wish you the best possible outcome in regard to your surgery on 4/20/10.

Warm regards,
bluebutterfly

[weety911]

Thanks Luba, for updating us!  I am so glad that everything was benign!  I am assuming that you were able to go through with the laparscopic surgery since there were no complications/irregularities.  I have my pre-op scheduled for today and the surgery next week.  I will update you after that, and hopefully I will be able to write the same word:  BENIGN!

[luba28]

I've had my Laporoscopic surgery 2 weeks ago and yesterday I had my Post Op with the Doctor.  The cyst was benign, thank heavens, and he removed the cyst, the one ovary and the tube.  I had pain post-surgery, but it was controlled by keeping up with the meds regularly.  I did that for almost 10 days - then I switched to Advil on an as-needed basis.  I was lucky minimal gas pains, although I did have the "preggie bloating" - but with regular bowel movements that went away fairly quickly.  I just came back to work yesterday and will be doing partial days for a bit.  I find I still tire very easily - and my doc said that I should be back to my normal activities in about 2 weeks - assuming I continue to take it easy and let my body heal at its own natural pace.  Surgery, even with small incisions, is still surgery and the body goes into some sort of shock, so it needs time to get back to normal.

Your surgery is coming up in a very short while.  I wish you the best of luck and pray for the very best outcome.  Just try and relax and imagine you'll be taking a mini-vacation where you can catch up on your reading, you TV shows and your sleep - and before you know it you'll be back on your feet and doing great and all the bad stuff will be behind you.

Have you had your Pre-op scheduled yet.  I found that very helpful and the hospital staff was very forthright in answering all my questions (I took in a list), and in preparing me for what to expect.  

Good luck and please keep us posted on your surgery and the outcome.  Hugs to you.

[weety911]

I'm so glad they decided to get you in pretty quickly and I totally understand how you're feeling about just wanting to get past this all.  I'm currently waiting on my surgery date, too, but it's not till April 20th.  I do have a follow-up ultrasound that's been scheduled in the interim (March 23) so at least I won't feel like I've done nothing but wait. Keep us posted.

[luba28]

The gyn/onc didn't say whether the cyst being the same size was good or bad, just that all other factors dictated that it shouldn't stay and surgery was necessary as soon as possible.

My pre-op is this next Weds, 3/24, and I'm starting to get a little nervous - but really just want to get past this.  

[weety911]

luba,  It was my understanding that even in premenopausal women, most complex cysts do NOT resolve on their own.  You said you had a repeat done, but your cyst was still the same size?  Is that a good prognostic factor (I would assume no change is good)?  Have you had your pre-op appt yet?  

[Ruthiejb]

Hi luba28,
Thank you for your resonse.  I've also read that persistent cysts should be removed in PM women regardless of size but I guess every doctor thinks differently.  Good luck with your sugery....I believe you're totally doing the right thing that will bring you peace of mind.  I just had another CA125 blood test because my last one was 6 months ago (which my doctor didn't suggest...I asked her).  If it has gone up, I'll be calling my doctor and telling her that I really don't want to wait any longer.  Thanks again.

[luba28]

I'm surprised that the Gyn/Onc didn't want to remove the cyst immediately since you are postmenapausal.  Possibly the smaller size of your cyst makes it less urgent, regardless of your PM situation?  Its my understanding that the cysts do not resolve themselves in PM women, so what would be the point in waiting.

The Gyn/Onc I met with advised that due to my PM situation and the size of my cyst, it should be removed asap, along with the ovary and tube - via Laparoscopy.  My surgery is scheduled for March 26th.  He did not advise removing my other ovary - since it is clean right now - but did advise me that if they find some irregularities when they go in then he will shift to a Laporotomy and remove everything to avoid possible cancer in the future. From what I understand that is normal procedure.

Good luck with your situation and I hope it works out well for you.  Please keep us informed on your next step...

[Ruthiejb]

Hi weety911, I think you should start a new post with your question as it will get a lot more attention and more responses.  I'm glad your doctor is not waiting.  Have you had a CA125 blood test?  I do hope everything turns out okay for you.

[weety911]

ruthiejb, I just found your thread and I'm in a similar situation, except my menopausal status is chemo-induced rather than natural.  I just finished chemo in Dec for breast cancer.  My complex cyst is about 3 cm and has what they called a "mural nodule" and I don't like the sounds of that one bit!  I did see a gyn-onc and because of my history he is not going to do the "watch and wait 3 months"  (although that is the usual protocol according to him) but he is setting me up for a surgery date for sometime probably mid-April as I need the ovaries removed or shut down medically anyways because of the estrogen and breast cancer connection.

What is really confusing me is what this mural nodule might be.  If the cyst came back malignant, would it be the whole cyst, or just this little piece of it that is solid?  Maybe someone will come along and be able to answer and explain it all a little better.  I keep reading that smaller cysts are not as apt to be cancerous.  Is that because the solid part in a small cyst would be so much more tiny?  I guess I don't really understand how ovarian cancer presents itself.

Also, what other possiblities could this complex cyst with mural nodule be?

[Sandymac]

Good luck, try not to worry and keep in touch...

Sandy

[Ruthiejb]

Thank you both for sharing your experiences.  But it looks like I won't be experiencing that for now....my gynecologist wants me to have another US in 3 months, which will be my 4th since September.  kgregor, I'm sorry your recovery has been so difficult.  If I eventually do have the procedure, I'll keep an open mind and hope that my experience is more like sandymac's.  So, I won't know anything until the end of May.  Thank you again for taking the time to reply and for your advice.

[Sandymac]

Hi,

Just a little reminder.... everyone is vastly different in the way in which they recover. I was told it was going to be a piece of cake (removal of ovary and tube.)And.. it was..  I was one of the lucky ones (and Ruthie... you may also be as fortunate as I was. ) I truly had no pain to speak of. I took one pain med and I had the worst headache I've ever had! I then only took tylenol x strength for a few days.

I'm not going to say I felt 100% right away.. But truly it was more soreness than actual pain. I had my 1 week post op and went to the grocery store the same day. I was told not to lift anything, drive , or do heavy housework for two weeks. Unlike the previous poster, I was given lots of recovery  information before the procedure and was even required to watch a little video .Now.. THAT was misleading since the little actress in the video had the procedure on a Friday and went back to work on Monday ! Sure......

I just wanted to mention that not all folks have a hard time of it.. I would have driven much earlier had I been permitted. I didn't have the bloating nor pain associated with the gas either. ..I really was lucky !!!  So there is another side to it.

As far as the decision to remove the ovaries or not--- I believe it was Marie Michele who stated that checking on these cysts and worrying about them constantly is no fun at all . Couldn't agree more !!! I don't do the waiting game very well !!!

Good luck and keep us posted
Sandy (and I'm waaaay past menopause)

[kgregor]

Just be aware that having both ovaries removed (as I just did for what turned out to be a benign cyst, at age 51) is major surgery. It will take a month out of your life to recover.  I did it because I am a breast cancer survivor (9 years) and I hope it was worth it, in the end!

I had both ovaries and fallopian tubes removed laproscopically nearly three weeks ago, and I now realize I was not at ALL prepared by my doctor's office for what I would be going through.  I live in the U.S.; this was a day surgery, and I was discharged being told I could return to work and walk my dog THE NEXT DAY.  I can barely do that now, 3 weeks later.  If you are reading this pre-surgery, please take it upon yourself to research the procedure, and prepare yourself for a slow recovery over a month, with plenty of help and support. I didn't!

Here's what I wish someone had told me - prepare yourself and rearrange your life for being in bed, on total bed rest with just a little puttering around the house, for at least two weeks. I thought I'd be back at work on my laptop the next day!  (That's what the only handout I received indicated.)  I am a solo mother to two school-age children, and I had no backup help arranged for them and for simple chores like grocery shopping - big mistake.  Thank god my mother stepped in and filled the gaps! But it would have been far better to go into it expecting this, instead of feeling faint and bursting into tears and having to call her again each day.

You should arrange to take a two weeks off work, and then go back part-time for two weeks, but stay off your feet.  Rally your family and friends NOW to create a support network, and help you financially through this period, if you need it.  I am now 3 weeks out from the laproscopic removal of both ovaries. My doc did not mention a word about recovery,  I downplayed it in my mind as "minor" surgery, and then had to keep canceling commitments, day by day, and getting frustrated.  I would try to just do e-mail at the computer for an hour or two, and my body would start shaking from exhaustion. I felt like a wimp, until I read this forum.  Why don't doctors prepare us?  (And I have an all-women gyn practice!)

I went back for my two-week check-up certain there was something terribly wrong with me, because I was still in pain.  They checked and found nothing.  I think the pain just lasts longer than they admit!  Also, gas causes a lot of the pain, I now will try Gas-X daily.  (Unclear why this is, but they inflate you with co2 during the surgery, which is part of the problem - you will feel very bloated, like you're  months pregnant, for a good while.)  I also wish someone had told me to take a gentle laxative every day post surgery.  It took me five days to have a bowel movement, and that was not fun when it finally happened.  I now read this is common.

It would have been better, psychologically, to just clear the slate for a month from the start. You can always add things back!  Don't expect to accomplish anything at all for at least two weeks - even reading anything serious. Get a lot of escapist fiction, magazines, movies and TV miniseries around you, and just relax and enjoy them ...

[Ruthiejb]

Thank you both for your replies and I agree with both of you.  I forgot to mention that after the second US I did consult with a gyne/onc (who was recommended by my gynecologist when I told her that I wanted my ovaries removed...she agreed too), but his attitude was that as long as it's not growing it's not cancer.  I heard such wonderful things about this doctor but felt like he dismissed me.  I know the cysts are small, but as MarieMichele mentioned, constantly checking on them is not fun (and expensive, as my insurance has a high deductible).  I will call my gynecologist on Monday and tell her what I would like to have done (remove the ovaries).  If she agrees (again), I'll ask her to call the gyne/onc and tell me that she recommends removal.  Luba28, good luck with your situation...I hope your gyne/onc is more receptive to your wishes than the one I consulted.  Thanks again.

[MarieMichele]

They are not very big but constantly checking on them and worrying about them is no fun at all.  There's no reliable way to rule out cancer without surgery, even though most cysts are benign.  But it's the small percentage that are NOT benign that keep us in worry mode.

You really have little to lose if you have the ovaries removed and get on with your life without the constant vigilance and worry.  I never felt better than I do now with no ovaries.

[luba28]

+Hello
I'm in a somewhat similar situation.  I'm 65 and Post-menopausal and was diagnosed with a 5+cm cyst a month ago after an ultrasound.  My gynecologist didn't think it was anything to worry about and suggested a 6 mo followup.  Having read a lot about cysts in post-menopausal women I didn't agree that waiting that long was an option since cysts generally don't occur in pm women,  So he had me do an ultrasound in 6 weeks.  It had not changed and he still thought it was OK to wait and see.  He offered to remove the cyst if it would "make me feel more comfortable" and I wouldn't worry about consequences.  I wasn't comfortable with his lax attitude about what could potentially be a problem.  From everything I've read here on the posts, as well as on the internet, postmenopausal women are at greater risk with cysts, and they really shouldn't be getting them, so when they do it is cause for some concern.  I chatted with some women on this forum and followed their advice and insisted on a referral to a gynecologic/oncologist for his opinion.  They specialize in this area and I would feel more comfortable having a professional discuss my situations and my options with me.  I'm scheduled to meet with him tnext week.

I had already made a decision that I needed to have the cysts, and possibly one or both ovaries surgically removed.  I would rather take those steps than worry for the next number of years whether a cyst will grow back, will it be cancerous - etc.  

So, for whatever its worth, that's my situation.  I would strongly recommend that you also get a second opinion - whether it be from a gynecologist or a gyn/oncologist - just for your own peace of mind.

Let us know what you decide and my prayers and thoughts are with you.