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What Is The Cause And Treatment For Bilateral Ovarian Cyst?
Question: Hi Dr. XXXXXXX - This is actually a follow-up question from last week. You looked at my ultrasound images and gave me your impression of my ovarian cyst and some very helpful suggestions on what my doctors might do next. I just wanted to provide an update: The hormone tests my doctor ran came back completely normal, turns out I'm not in menopause after all, just not having my period. I was just wondering if this means anything (good or bad)? Apparently the CA-125 test came back in the normal range, but they did not tell me the number.
I'm still waiting to get in to see my OB/GYN (Oct. 27) but at my visit with my primary care doctor all they told me was that I had bilateral ovarian cysts. I was so glad I had the information from you, or I would have probably been very worried. I am still having a lot of pain from the cyst on the right, the one on the left is only 1.7cm and isn't giving me trouble. I didn't send you the image of that one last week.
I'm still waiting to get in to see my OB/GYN (Oct. 27) but at my visit with my primary care doctor all they told me was that I had bilateral ovarian cysts. I was so glad I had the information from you, or I would have probably been very worried. I am still having a lot of pain from the cyst on the right, the one on the left is only 1.7cm and isn't giving me trouble. I didn't send you the image of that one last week.
Brief Answer:
follow up...further approach explained
Detailed Answer:
hello,
thanks for the direct query.
Its good to hear that tests have revealed that you are not menopausal, i presume they must have done FSH and LH levels. In that case you are oligomenorrhoeic now . with CA125 values normal , these cysts are definitely not malignant and should be removed laparoscopically now that they are symptomatic in terms of pain over the right side.
before contemplating that , i suggest an ultrasound pelvis to find out the endometrial thickness of the uterine cavity as you have not got periods for 2 years together, which usually doesn't happen. if you are not menopausal then the ET should be thick ,> 8mm in thickness and then we need an endometrial biopsy and PAP Smear as well to complete the evaluation.
If you are not menopausal , then you should be given a withdrawal bleed with progestins to initiate a period after checking the endometrial thickness(ET). its a possibility that simplecyst would regress on their own if your menses resume and need for laparoscopy may be avoided.
The reason why i am insisting on ultrasound is because it is highly uncommon for a lady to have no periods for 2 years and not being in menopause, as that changes the approach towards the patient completely. i would request you to send me the ultrasound images of uterus and also the blood report ( FSH & LH VALUES) for perusal.
please discuss these options on your visit to your gynae.
As for the pain , i would like to suggest as we do here ..TAB DICLOFENAC SODIUM 150mg SR twice a day. that should help relieve your pain.
Do keep me informed about your progress .
thanks,
regards,
Dr.Sameer Kumar
follow up...further approach explained
Detailed Answer:
hello,
thanks for the direct query.
Its good to hear that tests have revealed that you are not menopausal, i presume they must have done FSH and LH levels. In that case you are oligomenorrhoeic now . with CA125 values normal , these cysts are definitely not malignant and should be removed laparoscopically now that they are symptomatic in terms of pain over the right side.
before contemplating that , i suggest an ultrasound pelvis to find out the endometrial thickness of the uterine cavity as you have not got periods for 2 years together, which usually doesn't happen. if you are not menopausal then the ET should be thick ,> 8mm in thickness and then we need an endometrial biopsy and PAP Smear as well to complete the evaluation.
If you are not menopausal , then you should be given a withdrawal bleed with progestins to initiate a period after checking the endometrial thickness(ET). its a possibility that simplecyst would regress on their own if your menses resume and need for laparoscopy may be avoided.
The reason why i am insisting on ultrasound is because it is highly uncommon for a lady to have no periods for 2 years and not being in menopause, as that changes the approach towards the patient completely. i would request you to send me the ultrasound images of uterus and also the blood report ( FSH & LH VALUES) for perusal.
please discuss these options on your visit to your gynae.
As for the pain , i would like to suggest as we do here ..TAB DICLOFENAC SODIUM 150mg SR twice a day. that should help relieve your pain.
Do keep me informed about your progress .
thanks,
regards,
Dr.Sameer Kumar
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks, Dr. XXXXXXX I have uploaded 24 images of the uterus and one of the left ovary. Sorry there are so many, but it's tough for the layman to tell which ones are meaningful. The small fibroids that you see are something I've had for many years.
I do not have the results from the hormone-level tests but I know LH and FSH were on there, and I believe estrogen and progestin (or progesterone?) as well. To clarify, I had no periods for two years, then I had five periods of regular duration (3-5 days), the first one beginning on Feb. and the last one beginning on July 14. The first cycle was 29 days, the next two were 32 days each. The last two were longer. I had a tiny bit of spotting around July 29 and thought I might be pregnant, as I'd had intercourse on July 20 and my son (now 7) was conceived on Day 8 of my cycle. I was excited at this potential miracle, but three home tests performed three days apart came up negative. I had no pain or troubling symptoms at the time, so I figured I was going back into menopause and that phase of my life was over. When I began having the bloating, lower back pain and pelvic pain I did another home test, which was negative, and had a blood pregnancy test performed two weeks ago and that was also negative.
Also, one more odd thing, the past 4-5 days my breasts have become very sensitive.
Thanks so much for looking at the images and giving me your feedback. I've subscribed to the monthly specialist service now as you have been so very helpful and as, here in the U.S., despite having good health insurance, the wait is many weeks even to see our own doctors, the information has helped a great deal.
Thanks again, XXXXXXX
I do not have the results from the hormone-level tests but I know LH and FSH were on there, and I believe estrogen and progestin (or progesterone?) as well. To clarify, I had no periods for two years, then I had five periods of regular duration (3-5 days), the first one beginning on Feb. and the last one beginning on July 14. The first cycle was 29 days, the next two were 32 days each. The last two were longer. I had a tiny bit of spotting around July 29 and thought I might be pregnant, as I'd had intercourse on July 20 and my son (now 7) was conceived on Day 8 of my cycle. I was excited at this potential miracle, but three home tests performed three days apart came up negative. I had no pain or troubling symptoms at the time, so I figured I was going back into menopause and that phase of my life was over. When I began having the bloating, lower back pain and pelvic pain I did another home test, which was negative, and had a blood pregnancy test performed two weeks ago and that was also negative.
Also, one more odd thing, the past 4-5 days my breasts have become very sensitive.
Thanks so much for looking at the images and giving me your feedback. I've subscribed to the monthly specialist service now as you have been so very helpful and as, here in the U.S., despite having good health insurance, the wait is many weeks even to see our own doctors, the information has helped a great deal.
Thanks again, XXXXXXX
Brief Answer:
follow up
Detailed Answer:
hello XXXXXXX
Thanks for the follow up.
This time you gave your complete menstrual history, thanks. You are not menopausal as you had your menses regularly after feb. Its just that this cycle has been delayed.
I have gone through your ultrasound reports and Endometrial thickness is 8.9 mm which is fine for the period of amenoorhoea. There is no pregnancy for sure. Hence even endometrial biopsy is not indicated now in your case.
Considering the onset of your symptoms like bloating, low back pain, and breast sensitivity , this could very well be premenstrual syndrome and indicative of impending menstrual bleeding.
I could see couple of fibroids but they are all intramural, and not impinging into the cavity so unrelated to the oligomenorrhoeic state.
As far as the cysts of ovaries are concerned they are well within the limits and can be followed up with serial ultrasound every mid-menses cycle for 3 months.
If the lower abdominal pain remains persistent and the size of cyst keeps growing, then would warrant laparoscopic removal, otherwise ovaries are healthy.
FSH, Lh and other blood reports when available, please let me have a look.
At present what i can say is wait for your periods to resume, likelihood is high that they would in few days and your pain shall also subside.( premenstrual).
REGARDS,
Dr.Sameer Kumar
follow up
Detailed Answer:
hello XXXXXXX
Thanks for the follow up.
This time you gave your complete menstrual history, thanks. You are not menopausal as you had your menses regularly after feb. Its just that this cycle has been delayed.
I have gone through your ultrasound reports and Endometrial thickness is 8.9 mm which is fine for the period of amenoorhoea. There is no pregnancy for sure. Hence even endometrial biopsy is not indicated now in your case.
Considering the onset of your symptoms like bloating, low back pain, and breast sensitivity , this could very well be premenstrual syndrome and indicative of impending menstrual bleeding.
I could see couple of fibroids but they are all intramural, and not impinging into the cavity so unrelated to the oligomenorrhoeic state.
As far as the cysts of ovaries are concerned they are well within the limits and can be followed up with serial ultrasound every mid-menses cycle for 3 months.
If the lower abdominal pain remains persistent and the size of cyst keeps growing, then would warrant laparoscopic removal, otherwise ovaries are healthy.
FSH, Lh and other blood reports when available, please let me have a look.
At present what i can say is wait for your periods to resume, likelihood is high that they would in few days and your pain shall also subside.( premenstrual).
REGARDS,
Dr.Sameer Kumar
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks, Dr. XXXXXXX - I will get those lab reports when I go back to the family physician next week and upload them.
I'm grateful to hear that all looks okay with my uterus. I guess it's a mystery why I had no period for two years before this past February. A very bad case of PMS is not something a woman wants to have for two months (trust me) but since it's better than some of the alternatives, I hope you're right! I'll wait and find out.
Monitoring the ovarian cysts mid-cycle every month might not be feasible in my case as my co-pay for the ultrasound is $150 each time and that option would be cost-prohibitive.
Thanks again, XXXXXXX
I'm grateful to hear that all looks okay with my uterus. I guess it's a mystery why I had no period for two years before this past February. A very bad case of PMS is not something a woman wants to have for two months (trust me) but since it's better than some of the alternatives, I hope you're right! I'll wait and find out.
Monitoring the ovarian cysts mid-cycle every month might not be feasible in my case as my co-pay for the ultrasound is $150 each time and that option would be cost-prohibitive.
Thanks again, XXXXXXX
Brief Answer:
consider Mefenamic acid
Detailed Answer:
Hello,
Thanks for the follow up.
If monitoring is not possible monthly then you may take it 3 monthly and maintain a menstrual calendar each month.
I understand the pain you are having. I would like to suggest if diclofenac sodium is not available , then you can take TAB MEFENAMIC ACID 500mg three times a day for 3 days to subside the pain. It really helps in PMS.
We shall wait for the blood reports. I hope thyroid profile is also inclusive in the battery of tests.
I feel with the symptoms , you should be getting your periods in few days.
Keep me informed.
regards,
Dr.Sameer Kumar
consider Mefenamic acid
Detailed Answer:
Hello,
Thanks for the follow up.
If monitoring is not possible monthly then you may take it 3 monthly and maintain a menstrual calendar each month.
I understand the pain you are having. I would like to suggest if diclofenac sodium is not available , then you can take TAB MEFENAMIC ACID 500mg three times a day for 3 days to subside the pain. It really helps in PMS.
We shall wait for the blood reports. I hope thyroid profile is also inclusive in the battery of tests.
I feel with the symptoms , you should be getting your periods in few days.
Keep me informed.
regards,
Dr.Sameer Kumar
Above answer was peer-reviewed by :
Dr. Shanthi.E
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