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History of hysterectomy. Pain on pelvic region, bloating and weight loss. Had ultrasound scan. What are the findings?

Mar 2013
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Practicing since : 1998
Answered : 5625 Questions
I had a hysterectomy in 2002. They left my ovaries. I had a large pedunculated fibroid and the carcinogenic type of HPV lesion, plus severe dysplasia on cervix.
All has been ok until recent pain on right side, pelvic region, bloating, weight loss of 25 lbs in last 9 months.
So I had a pelvic ultrasound last week. The report states findings as: R ovary measures 4.7 cm x 4.5 x 2.2 with a simple cyst measuring 3.3 x3.7 x 2.0 Small calcification w/posterior shadowing. L ovary is 2.5 x 2.4 x 1.3.
Also noted a nabothian cyst in residual cervix ((which they left in w/ hysterectomy.))
Question: Is it normal that my R ovary is almost two time as big as my L ovary? And that a cyst is on the R ovary is 3/4 of the size of the enlarged ovary? Is there any followup recommended? Colposcopy maybe?
Posted Fri, 15 Nov 2013 in Vaginal and Uterus Health
Answered by Dr. Aarti Abraham 36 minutes later
Brief Answer:

Detailed Answer:
Thanks for your query.
To answer your questions in the order in which you have posed them -
1. The right ovarian size is not normal, specially at 53, but it is enlarged because of the cyst contained within it.
2. The cyst also is not normal, however it is a simple cyst, that is the consolation.A simple cyst is generally when one of the normal follicles inside the ovary swells up. Also, it could be a simple collection of fluid causing a cyst. Simple cysts, specially of this size ( < 5 mm ) are generally observed, and nothing is done for them, as chances of malignancy are very very less. Within a couple of months, they clear up, specially after taking hormonal estrogen and progesterone containing pills for a couple of cycles. Also, complex cysts ( showing haemorrhages, masses, solid echoes inside ) are more likely to require surgical removal. Just a single spot of calcification could indicate age related changes in the ovary also. Right now , you can wait and watch, and also take a CA - 125 test ( blood test that estimates the risks of malignancy in ovarian cysts ). A repeat scan after 2 months is advised.
3. A Nabothian follicle is quite a normal finding, it is just a blocked normal cervical gland that presents as a Nabothian cyst.
4. With a carcinogenic type of HPV, and severe dysplasia, my first question is why the cervix was left behind, it SHOULD have been removed. Now, follow up is definitely a must. You should have a gynecological check up ( per vaginum and per speculum ), alongwith a colposcopy. That much is a must.
I hope this answer helped you.
Please feel free to ask for further clarifications.
wish you lots of luck and good health.
Take care.

Above answer was peer-reviewed by
Follow-up: History of hysterectomy. Pain on pelvic region, bloating and weight loss. Had ultrasound scan. What are the findings? 21 hours later
Hi Dr. Aarati-
Thanks for your answer, I found it very helpful. By the way, are you from Kerala? Aarati XXXXXXX is a very 'Kerala' name! ((I lived in Kerala for many year : )and miss it terriby.))

I am writing back again because I had added some other information to the same question you already answered, but it must have gotten cut off? It was regarding a concurrent situation that is presenting itself...

I had gone for my routine annual check-up in September, and my mammogram came back with some questionable areas. So I went for ultrasound, which led to a steroscopic biopsy of an area of suspicious calcifications in my left breast. The area in question turned out to be ok, that is to say, benign. But an incidental finding was that the tissue sample contained Lobular Carcinoma in Situ. The LCIS finding resulted in my seeing a breast surgeon as follow-up, not for breast surgery(!), but as a specialist. ((BTW, she had treated my mom, successfully, for breast cancer 10 years ago at the age of 65 yrs. She had a very aggressive form, and had to have a double mastectomy.))

So, long story short, I was sent for MRI to follow-up on the LCIS, and also a physical breast exam by the specialist showed that I had a retracted left nipple with some oily-type discharge around the areola of the same nipple. ((My nipples have generally been inverted type, until after breast feeding my baby 10 years ago, when they became more normal type, so the retraction of left nipple seemed more like a reversion to its original presentation in my mind)).

So, I am waiting to see the MRI results at a follow-up appointment with the breast surgeon next week, 23rd Oct. She already advised me that I would probably be put on tamoxiphen, and also she had wanted to see current bloodwork on my hormone levels trying to determine whether I was peri-menopausal or post-menopausal.

Question: Is there anything you notice in above that I should ask about or follow-up on in a more thorough way irrespective of what has already been done?

All of this above, combined with the pelvic pain, and pelvic ultrasound findings you already addressed, has really gotten my attention. I guess I have to wait and see what the breast surgeon finds in the MRI/blood work, but in the meantime I will get a gynecological exam/colposcopy as you recommend.

PS I only found out last week when the ultrasound results were given to me, so 11 years later, that they had left in my cervix!? I too, was stunned. I was told, not by the surgeon, as he is since retired, that often the cervix is left in for its function in female orgasm. I found that a TOTALLY bizarre way of decision-making, and had I been consulted would have strongly objected to leaving in my cervix, as it was the site of the HPV/severe dysplasic lesion. But I don't think there is anything to be done now until I see a gynocologist, do you? My recent PAP smear came back ok.
Answered by Dr. Aarti Abraham 3 hours later
Brief Answer:

Detailed Answer:
Hello again.
Glad to hear from you.
Kerala is God's own country, I have just briefly visited Kerala, but am still in love with it, so I can understand how you must be yearning for the XXXXXXX greenery and grace that is sheer Kerala !
To answer your question , I am not from Kerala, but fortunate in being married to a Keralite ( hence the Abraham as surname ! )
My husband originally hails from Tiruvalla , and having lived and travelled around the world, still is a Keralite at heart, and misses the place so very much !
Thank you for your warmth though.
Yes, the information regarding the breast concern was missing from the previous query.
I would like to say that the procedure and work up for the breast lesion is up to the mark.
A biopsy was in order, and for LCIS, follow up imaging is also done. Also, tamoxiphen is routinely given in hormone responsive LCIS, that too, after assessing the hormonal status in peri menopausal women, so that sounds on track too.
In short, I have nothing to add to the management of the breast lesion, which is optimum till now.
The cervix , with severe dysplasia and HPV, being left behind, without patient counselling is an error that I cannot comprehend.
That said, you should have a colposcopy, that you had a normal recent Pap is reassuring however.
The cyst also should be followed up, along the lines I suggested ( observation with serial ultrasound and a CA -125 level at present ), because any kind of ovarian mass post menopause should be vigilantly looked into and monitored.
It is all the more important, given your family history of carcinoma breast.
Do take care, and feel free to discuss anything with me whenever you so wish.
You can always use the following direct link -

WWW.WWWW.WW It has been nice interacting with you, your warmth and generosity of personality combined with an intelligent and perceptive mind comes across.
Wish you loads of luck and good health always.
Above answer was peer-reviewed by
Follow-up: History of hysterectomy. Pain on pelvic region, bloating and weight loss. Had ultrasound scan. What are the findings? 19 hours later
Good Morning Dr. Aarti-

Again, thank you for your detailed reply. I found it helpful, and it added confirmation of the track I am on in pursuing the necessary follow-up. It gave me peace of mind to know that. I have an 11 year old daughter, so very important that my health stays ok. Also, it was kind of you to include a way to be in touch with you directly. I will keep you in the loop as my exams proceed.

Tiruvella! Wow, I've been there many, many times. What was a quaint town when I first visited in 1984, is now a bustling city full of all things that make the emerging Indian cities vibrant. I took my daughter Mirabai there as recently as 2011 and she found it impressive.

All the best to you and your family in the coming holiday season : )
Answered by Dr. Aarti Abraham 21 minutes later
Brief Answer:

Detailed Answer:
Thank you again for the feedback.
Its an honour and a privilege interacting with a random stranger, who still seems so warm and somehow important in the karmic circle of life !
I am sure you would be in perfect health, as you are so aware and informed about everything that concerns you.
Would love to be posted about the further developments too.
I too have been to Tiruvalla as a dutiful daughter - in - law, and Kerala has left me enthralled - it gave me peace of mind which I have found only in certain places that have a special spot in my heart - the pristine Himalayas being one such example.
All my love and good wishes to you and your loved ones too !
Take care.
Above answer was peer-reviewed by
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