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Abdominal pain, lower back pain, clear and odorless discharge. Ultrasound showed ovarian cyst. What should I do next?

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Practicing since : 1997
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I am 41 year old female with no natural born children. After years of pain and multiple attempts to alleviate the problem (birth control pill and 2 laproscopic surgeries), I had my uterus removed at age 37 due to a diagnosis of adenomiosis or endometriosis of the uterus. The next 4 years were pain free and wonderful. In May 2012, I noticed significant abdominal and lower back pain during and after intercourse and a few other symptoms, including a clear gel like fluid discharge (no odor). My OBGYN doctor conducted pelvic exam and ordered an ultrasound. The ultrasound (transvaginal) indicated an ovarian cyst measuring approx. 3.8 cm. At that point, my doctor suggested a follow up ultrasound for 8 weeks later. The subsequent ultrasound (last week) was basically the same..indicating a cyst or approx. 4.2 cm. Last week I had a results..the doctor told me he thinks the "complex cystic structure" described in the ultrasound report is actually a fluid filled fallopian tube because the shape of the mass is elongated and has other characteristics of tallopian tube. Today we also discussed (again) other symptoms I've been experiencing during the last 4 months including "hormone" like episodes that last approx. 10 days..where I have hot flashes..heart palpitations..night sweats..severe breast tenderness (first 2 or 3 days)..headaches/dizziness..bouts of nausea..moodiness/irratibility..and lack of memory/concentration. This is not regular is intense..and not normal for me. I feel like these are likely perimenopause symptoms and are the result of hormone imbalance. My doctor talked about different options for the fallopian tube issue, including surgery, and also options like lupron and hormone replacement therapy for a hormone issue. His recommendation for today was additional bood testing (bloodwork included CA-125) for hormones. We didn't decide anything about the "cyst" or fallopian tube issue. I got home and researched a little..and I started to wonder if maybe I need to talk to someone else as I don't feel like we're getting anywhere after 3 months..and he only just today ordered bloodwork for the first time. Maybe a CT or MRI is warranted to further evaluation of the "cystic structure"??? Just looking for a recommendation on what I/we should be doing next?
Posted Mon, 3 Sep 2012 in Vaginal and Uterus Health
Answered by Dr. Kulsoom Qureshi 1 hour later
Thanks for consulting us.
This cystic structure is most likely to be arising from your ovaries or tubes ( as I guessed from your history that your ovaries were not removed ).
Now the question that need to be answered is about the nature of this cyst. We need to know if it is a benign cyst or a cancerous one? and how much is this bothering you? The blood work suggested by your doctor can give a hint about the nature of the cyst. As with cancerous cysts the Ca125 levels are usually very high.
As far as your menopausal status is concerned you may confirm this by doing a blood test called serum FSH. This will tell you about your need for menopause has reached.
CT or MRI scan can surely help, to tell us the details & origin of the cyst & will be of great help if a repeat surgery is being planned.
Let me tell you one thing, with the given history if your initial diagnosis was Endometriosis then a repeat surgery is likely to be a difficult one & may result in complications. So, get yourself fully investigated & also take a second opinion before making anything final.
In my opinion if your initial tests do not indicate a serious problem then trying medical treatment first could be a safer option for you. However your Consultant Gynecologist knows the most about you & is in a better position to give you an appropriate advise.
Hope I have addressed the relevant issues with you. Please write back if you want to discuss this further.
Hope you get well soon.
Best Regards.
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