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Menopausal and had complex ovarian cyst. Having abdominal bloating, constant urination. Done with vaginal ultrasound. Suggest the cure?

May 2014
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Am menopausal 57 yr old, have had complex ovarian cyst since 2008..... menopause started in 2010...
ever since menopause, have had constant - always there lower abdominal bloating, constant peeing - doesnt' empty completely and sometimes need to go 2-3 times in 5-10 min period, have constant indigestion,
New symptom 6 weeks ago, lower back pain....(but am thinking lower back pain due to healthclub possibly) -
don't know......

had vaginal ultrasound in 2008, 2012, 2013
in 2012, left hypoechoic lesion measured 2.6 x 2.0 x 1.6cm
in 2013, left hypoechoic lesion measured 2.5 x 2.4 x 1.8cm
I am worried, Ob/gyn says watch and wait and that size #'s staying the same...but
the 2013 #'s look slightly larger to me - or is the increase in size insignificant??

Also, in 2012, had bleeding, endometrial biopsy showed nothing.

(in 2008, left breast bleeding with lump, discovered dcis, treated with lump. & rad.,
as such, constant bloating, and diagnosis of complex cyst cause me to be nervous)

Is more testing warranted - or - are these #'s normal for menopausal women having complex
cyst that won't go away and causing discomfort?
Posted Wed, 30 Oct 2013 in Women's Health
Answered by Dr. Vivek Chail 1 hour later
Brief Answer:
Symptoms most likely due to menopause.

Detailed Answer:
Thanks for writing in to us.

I have read through your query in detail.

As we see, the size of the complex left ovarian cyst measures almost the same as it was in 2012, the size is stable and there is no significance for few millimeters difference. Please do not worry for that.

Addressing your constant need to pass urine every 5-10 mins, during and after the process of menopause, levels of the female hormone estrogen drop significantly. In addition to controlling your monthly periods and body changes during pregnancy, estrogen helps keep the bladder and the urethra, the tube that carries urine out of the body, healthy.

Lack of estrogen may also cause the pelvic muscles responsible for bladder control to weaken, resulting in urinary incontinence. I suppose that is what is occurring with you. However if in doubt, please get your ultrasound scan of bladder and kidneys (before and after passing urine) done to evaluate any bladder outlet obstruction and kidney problems.

Some of the bladder control problems which may develop because of menopause include:

1. Stress incontinence. Pressure from coughing, sneezing, or lifting can push urine through the weakened muscle. This kind of leakage is called stress incontinence. It is one of the most common kinds of bladder control problems in older women.
2. Urge incontinence. Urge incontinence is another very common bladder control problem. With this condition, the bladder muscles squeeze at the wrong time -- or all the time -- and cause leaks.
3. Painful urination
4. Nocturia. Need to get out of bed to urinate several times a night

Referring to your abdominal bloating, while bloating can occur as a result of such factors as diet or stress, the most likely cause for menopausal women is a fluctuation in hormones, particularly estrogen. Estrogen is important for a couple of reasons. First of all, it has an effect on the retention of water that occurs naturally as part of a woman´s menstrual cycle. Women tend to retain more in the days leading up to menstruation as a result of the rising estrogen levels. When estrogen levels become erratic during perimenopause, so does the incidence of water retention, leading to bloating.

Hope your query is answered.
Do write back in case of doubts.

Dr. Vivek.
Above answer was peer-reviewed by
Follow-up: Menopausal and had complex ovarian cyst. Having abdominal bloating, constant urination. Done with vaginal ultrasound. Suggest the cure? 11 hours later
my indigestion, constant bloating, peeing, and aching in sides and now back ache.....again ...all constant......a reminder everyday that something is going on.....

also, any medical webisite that talks about ovarian cancer, usually has a checklist
of symptoms and I always have like 1/2 the symptoms. They always say it is a
silent killer... the websites all talk about indigestion, bloating, need to pee,
back pain.. as well as other symptoms that I do not have.

plus I have the complex cyst. my symptom are a reminder everyday..
because they are constant and I am always aware of them....and they
are uncomfortable..... I just want to feel normal again.
and yet..... they are explained away. I guess I don't understand how
they can be explained away without biopsy or more testing??

Sounds like you are explaining away all of the above as normal female menopausal issues/symptoms caused by lack of estrogen.

I believe the issues are being caused by the cyst and more than just he lack of estrogen.

I understand that it may be as you state...but it may also be what I'm
fearing...cancer or just plain old symptoms of the cyst.

How can I be sure.?? Do we watch and wait and suffer while waiting and watching??
or what about a biopsy & removal of the cyst?? is that unwarranted ??

Are there more tests that could tell more?? I have only had the vaginal ultrasound?? Would MRI or other testing be more helpful??

Again, I'm reminded everyday something is
going on down there in my lower abdomen. I believe that is my body's way
of telling me something is wrong.

If these were normal menopausal symptoms then all women would have this
and they don't.

I thank you for your medical opinion.

Answered by Dr. Vivek Chail 2 hours later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Thanks for writing in with an update.

I have read through your query in detail.

As there is a complex hypoechoic lesion in the region of left adnexa measuring around 2.5 x 2.4 x 1.8 cm, it is not large enough to cause much discomfort, however, I would accept that pain is subjective and it might be causing a lot of discomfort and pain in you.

Surgery (laproscopy or laprotomy) is the treatment of choice with lesion of size mentioned by you only if there is significant pain and discomfort. The nature of the lesion is most likely benign as there has been no change in size and appearance in the last two years.

Confirmatory diagnosis is made only following Laproscopy/ laprotomy surgery, after which pathological analysis of the lesion is made. Because pathologic diagnosis of ovarian cancer is difficult without laparotomy, tumor markers such as CA-125, in addition to diagnostic imaging, are useful in preoperative evaluation for suspected ovarian tumors.

I suggest you talk to your doctor and get CA-125 level test done to rule out any possibility of suspected ovarian cancer for peace of mind.

Tumor markers are soluble glycoproteins that are found in the blood, urine, or tissues of patients with certain types of cancer. They are typically produced by tumor cells, but in some cases they may be produced by the body in response to malignancy or to certain benign conditions. Tumor markers are not elevated in all cancer patients, particularly patients with early-stage cancer. The various tumor markers differ in their usefulness for screening, diagnosis, prognosis, assessing therapeutic response, and detecting recurrence.

It is known that CA-125 is an important and reliable tumor marker for cancer in ovary. Though final diagnosis of cancer or not is after surgery and by pathology report, CA-125 level test will help in giving a clue towards cancer and if the levels are high, you need to discuss that with your doctor in detail.

You may get a CT or MRI scan pelvis done for better localization and descriptive imaging analysis of the cyst.

Please remember that ovarian cancer is a very quick progressing disease and cardinal symptoms include weight loss, fatigue, lymph node swellings, ascites (fluid in the abdomen) among many other features. Given your clinical scenario, cancer is less likely.

Hope your query is answered.
Do write back in case of doubts.

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