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Right sides paraovarian cysts. Irregular periods after stopping OCPs - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Women's Health
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions

Doctor :   hi
Doctor :  
how can i help you?
User :   Hi, so I have a question about irregular periods and pregnancy...
Doctor :  
ok
Doctor :  
please proceed with your query
User :   I'm 25yrs old and have been regular all my life. In Feb I discontinued birth control pills so that my husband and I could try for a baby. After that I had 2 periods then nothing until June then nothing again until Sept. I have been ultrasounded and they didn't find any evidence of Polysystic ovarian syndrome, but I do have 2 para ovarian cysts on the right ovary. I have been taking ovulation tests and have not been ovulating at all in the past few months either before the last period or after
Doctor :  
ok
Doctor :  
please give me some time to read through your history.
Doctor :  
ok
Doctor :  
what are the treatment you are receiving for your para-ovarian cysts?
Doctor :  
has your doctor started you on any ovulation promoting drugs?

User :   No meds for either
Doctor :   hi
User :   sorry, internet problems
Doctor :  
ok
Doctor :  
you can proceed with the discussion
User :   yes
Doctor :  
when was the recent scan done for you?
User :   So as of right now they aren't doing anything about the cysts but they are rechecking an ultrasound of them next week (6 weeks after first diagnosis) to make sure they are not getting bigger. I decided to start taking the ovulation tests in early Sept and have not had a chance to talk to them about the negative results, so no meds for no ovulation either
Doctor :  
what were the size of the paraovarian cysts mentioned in the scan?
Doctor :  
ok
User :   I'm not sure of the exact size but a few cemtimeters each
Doctor :  
ok
Doctor :  
then it will be fine to check the ovulation again. when was your last menstrual period?
User :   Sept 22
Doctor :  
ok
Doctor :  
and when is your next scan due?
User :   On the 21st of this month
Doctor :   ok

Doctor :  
so what i will suggest you is, to go back to your doctor foe re-examination, see if the cysts have grown big, also look for ovulation evidences in the scan.
Doctor :  
and if you are not ovulating, you can request your gynac to discuss with you the probability of starting you on ovulation inducing drugs for you to get pregnant.
Doctor :  
but if the scan shows that the cysts have grown rapidly, then it will be better to get them operated before you get pregnant
Doctor :  
as these will result in complications in your pregnancy
User :   ok
Doctor :  
due to problems like torsion or sudden rupture etc.
Doctor :  
have you followed what i have said?
User :   ok
User :   yes,
Doctor :  
many women do get pregnant with the cysts, but later they face problems due to torsion, where the cyst rotates and results in complications, requiring urgent laparotomy.
Doctor :  
and the cysts are known to undergo torsion almost 33% of the women with them
Doctor :  
is there anything else that i can help you with?
User :   ok, that doesn't sound fun, I don't want that to happen, I just don't understand why all of a sudden I am not cycling normally and if the cysts had anything to do with that problem
Doctor :   no

Doctor :  
the cyst will not cause lack of ovulation
Doctor :  
please ask your doctor to prescribe you hormonal tests
Doctor :  
like FSH, LH, Prolactin, TSH, T3, T4
Doctor :  
and also do a fresh scan
User :   I did get a thyroid panel done and it was normal
Doctor :  
ok
Doctor :  
what about the other hormones?
User :   Will the FSH, LH, and Prolactin test results change the treatment options fo rme?
Doctor :  
if prolactin is raised or LH and FSH is reduced, then also you will not ovulate.
User :   Is the treatment the same?
Doctor :  
so then if that is the case, we will need to lower the prolactin levels to normal, and give you ovulation promoting drugs.
Doctor :  
but all these is after we confirm that the cysts are not growing
Doctor :  
most of the cases, the cysts remain static without growth. so we need to see.
User :   ok that makes sense
Doctor :  
let me give you an overview of the paraovarian cysts, so that you can understand better the treatment options.
Doctor :  
A paraovarian cyst is a closed, fluid-filled sac which grows beside or near the ovary and fallopian tube, but is never attached to them.
User :   lk
User :   ok
Doctor :   It is usually located on the broad connection (ligament) between the uterus and the ovary, and is often found on only one side (unilateral) of the uterus.
User :   ok
Doctor :  
It is thought to develop from embryological vestiges, the external covering of the Fallopian tubes (the tubal epithelium), or the smooth serous membrane that lines the cavity of the abdomen (peritoneum).
Doctor :   they usually are very small (ranging in size from 2 to 20 cm). these cysts have little clinical significance, occurring asymptomatically as incidental findings during other pelvic examinations and surgeries.
Doctor :  
Most often, they are diagnosed as benign ovarian cysts or as fluid-filled distentions of the fallopian tube (hydrosalpinx).
User :   ok
Doctor :   paraovarian cysts can sometimes grow larger, especially during pregnancies
Doctor :   And depending on their size and location, the largr paraovarian cysts can put pressure on the bladder or bowel, and cause pelvic pain or pain during sexual intercourse (dyspareunia). Also they may result in complicating pregnancy due to torsion.
User :   ok
User :   so if they do not grow then they can be left in?
Doctor :  
usually patient will have these complaints: pelvic pain, usually on one side (unilateral), irregular periods, abnormal uterine bleeding, and pain during sexual intercourse (dyspareunia
Doctor :   yes they can be left alone if they are not growing and are asymptomatic.
User :   ok
Doctor :  
Paraovarian cysts can be made out when the physician presses with the hands on the lower abdomen, or when he or she inserts one or two fingers into the vagina while pressing with the other hand on the abdomen.
User :   ok.. can they be missed this way?
Doctor :   but an ultrasound scan and a visual exam using a thin, lighted microscope inserted into the abdomen, or a laparoscopy are used to confirm the diagnosis, size, and location of a paraovarian cyst.
Doctor :   Most paraovarian cysts that remain small and asymptomatic do not require treatment; and sometimes they disappear on their own.
User :   I did have a yearly exam with a pelvic exam last Dec and no cysts were noted at that time
Doctor :   Surgical removal of the cyst (laparoscopic cystectomy) is usually indicated for young girls who have not reached puberty, or those already with an ovarian mass, and for postmenopausal women.
Doctor :   yes you can miss them if they are very very small
Doctor :  
they can be seen with laproscopy.
User :   ok
Doctor :   if ther are too very small
Doctor :  
A laparoscopic cystectomy enables the surgeon to insert a tiny scope into the abdomen to determine whether more extensive surgery is needed.
Doctor :   some times it is possible to remove the cyst with this surgery itself
User :   ok
Doctor :  
However, if the cyst is larger than 4 inches (10 cm), then it is complex, increasing in size, persisting after several months, becomes solid, dense, and irregularly shaped, or gets infected, bleeding or ruptured, more invasive surgery (cystectomy) may be required to remove the entire cysts.
User :   oh, ok
Doctor :  
In instances where the patient is not pregnant, a complete recovery can be expected with surgical removal of the cyst and no recurrence.
User :   how often will this have to be rechecked if they aren't changing in size at this next visit?
Doctor :  
usually every month is better if you are planning for pregnancy with the cyst
Doctor :  
But n instances where the individual is already pregnant, a complete recovery can be expected with surgery to remove the cyst when it is performed between 14 to 20 weeks of gestation
User :   ok
Doctor :   there are few complications associated with this
User :   ok
Doctor :  
this includes infection, bleeding, and rupture of the cyst. The rupture or bursting of a cyst is a medical emergency.
Doctor :   requiring urgent laparotomy and cleaning
Doctor :   In pregnant women, the cyst causes the enlarging uterus to be pushed up, out, and to the opposite side of the pelvic region.
Doctor :   this results in repositioning and may cause abnormal intrauterine fetal positioning and the period of gestation to be overestimated.
Doctor :   During labor, abnormal uterine and fetal positions can make delivery difficult and prolonged
User :   oh
Doctor :   In the absence of timely intervention, damage to important pelvic structures may lead to complications like intrauterine fetal death and life-threatening complications for the mother, such as rupture of the uterus. Additionally, the cyst may also rupture due to compression by the uterus and the fetus.

User :   oh
Doctor :   and the other less common complications include internal cystic bleeding (intracystic hemorrhage), and the formation of pus and its discharge (suppuration) from the cyst.
User :   ok
Doctor :   so it warrants more frequent examinations if the individual is pregnant. If surgery is necessary, heavy lifting may need to be restricted temporarily.
User :   ok
Doctor :   hence it will be better if you can relax for sometime and not hurry for the pregnancy.
Doctor :  
get this paraovarian cyst treated
Doctor :  
and then see that you are ovulating properly
Doctor :  
get the hormonal tests done
Doctor :  
have you followed what i said?
User :   Yes, the cysts should not be over looked and followup is important, and that they wouldn't be causing me to not ovulate, but it's more like a hormone problem, right?
Doctor :  
in case of doubts/queries please ask
Doctor :  
yes your lack of ovulation may be due to different causes. we can look into it once we are relaxed from the cysts perspective.
Doctor :  
and once the hormone tests results come, we will know what is the reason for you not ovulating
Doctor :  
and possibility of starting the ovulation inducing drugs can be looked upon.
User :   ok
Doctor :  
so meet your doctor this time and get a proper overview of what is the steps she is taking on the treatment procedure.
Doctor :   for the paraovarian cysts.
User :   ok
Doctor :  
is there anything else i can help you with?
User :   I don't think so, you have been very informative thank you very much for taking time to answer all my questions
Doctor :  
thank you
Doctor :  
Please fill the feedback form say done when done.
User :   done
Doctor :   Thanks for consulting Healthcare Magic. Bye for now. Please chat with our doctors 24/7 for medical queries. Please refer your friends to our service.
User :   thanks, bye
Doctor :   bye for now.
Doctor :  
wish you speedy recovery
Doctor :   and good health
User :   thanks and to you
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