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Dr. Andrew Rynne

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Suggest treatment for ovarian cyst

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Dr. Madhuri N Bagde

OBGYN

Practicing since :2001

Answered : 1390 Questions

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Posted on Thu, 14 Aug 2014 in Menstruation and Miscarriage
Question: Hi Doctor,
My Mummy is 47 years old. Since last 2 months she has skipped her periods. Apart from this she has no other problem. After ultrasonography report, the gynecologist told that she has not reacahed menopause yet. There is a cyst in the right ovary and the uterus walls are thickened.
I am really very much worried. Can you please tell me what is this exactly and what is the treatment for this? Does she has to undergo any kind of severe surgery or only medicines will be fine?
And will she be fine and whether this can lead to cancer or any other life threatening or malingnant disease?
doctor
Answered by Dr. Madhuri N Bagde 17 minutes later
Brief Answer:
do not worry.

Detailed Answer:
Hello and welcome,

I understand the issue.

Let me explain to you all this in detail.

First is that it is not possible for us to comment upon menopause based on ultrasound findings. Blood tests for the female hormones like FSH, LH and estrogen are needed. If FSH and LH are velvated then menopause is likely. So just get these done.

About the ovarian cysts. Small cysts are not uncommon. If they are bigger than 5 cm then only they need evaluation. So kindly provide the complete ultrasound report. Cancer is very rare in such cysts. Cancerous cysts are usually big, septated and have a typical ultrasound appearence. There are some blood tests [ CA 125, HCG, LDH, AFP] that give us an idea if the cyst is simple or cancerous and they have to be corroborated with the patients age, findings on vaginal examination and also ultrasound and blood report.

About the uterus wall. I am not sure what you mean by this as the terms are not medical ones and so may have different interpretations. There is a conditions called adenomyosis where the uterus is thicker than normal. Such women usually have pain and bleeding. But your history is against it. Also after 2-3 deliveries, the uterus permanantely increases in size and it is not abnormal. If the doctor meant that the uterine lining [ endometrium] is thick then it may indicate a hormonal imbalance or very very rarely an underlying cancer.

The management of all this depends upon the cause and findings.

So as of now, please provide the complete report to me and do not worry. The history does not suggest a cancer. Let me know the reports and I will help you further.

Hope this satisfies your query.
Thanks for using HCM.     
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Madhuri N Bagde 20 minutes later
Hi Doctor,

Please find below what the Ultrasound report says exactly.

Uterus is normal in shape, size and echotextutre. Myometrium is isoechoic. No mass lessen noted. Endometrium echocomplex is echogenic and thick 14.5 mm.
Endometrial / miometrial junction is regular. No gastational track noted. Uterus measures about 90 mm * 46 mm * 54 mm (about 120 ml).

Ovaries - Left ovary is normal in shap, size and echotexture. Right ovary contains a simple cyst. (27 * 20 mm)

Adnexa - Nothing abnormal detected.

Pouch of dougles - No collection.

Impression - Thick echogenic endometrium (?) hyper width small functional cyst in right ovary

I think you will have a better idea now. Please tell me about the exact problem and its treatment and its risk.
doctor
Answered by Dr. Madhuri N Bagde 5 hours later
Brief Answer:
report is big help.

Detailed Answer:
Hello and welcome back,

The report is a big help.

It says that the size and shape of the uterus are pretty much normal. The only problem is the thick endometrium [ uterine lining that is shed during periods]. This is common in the perimenopausal age group. Common causes are hormonal imbalances leading to a condition called endometrial hyperplasia or overgrowth of the endometrium. This is very common. In rare cases cancer of the endometrium can cause this. The risk of cancer is small in XXXXXXX women.

The next step is to do a fractional curettage or a hysteroscopic biopsy of the uterine lining, collect tissue from there and examine under a micorscope. It is used to diagnose the cause of thick lining.

The further treatment depends upon the cause. If you are too scared a hysterectomy may be done for endometrial hyperplasia and the ovarian cyst can be removed simultaneously.

So do not worry. Get her endometrium sampled and examined under a microscope for correct diagnosis and further treatment will depend upon it. The ovarian cyst is not significant. It is very small and as of now does not need any treatment. Just follow up scans every 6 months for 2-3 times to see how it behaves are enough.

So do not worry. This is not a very rare finding but it needs further investigation.

Hope this helps. Feel free for any further queries.

Take care.
Dr Madhuri
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Madhuri N Bagde 15 hours later
Hi Doctor,

Could you please tell me that whether this problem (thick endometrium) needs immediate treatment? And would she be fine with medicines or she has to undergo any surgery? According to you what are the causes and diagonosis for this ? And is this disease very risky? I am so much worried.

Thanks. XXXXXXX
doctor
Answered by Dr. Madhuri N Bagde 10 hours later
Brief Answer:
please do not worry so much.

Detailed Answer:
Hello and welcome,

I have already clarified that the common cause for this is a condition called endometrial hyperplasia where the uterine lining grows excessively most likely due to hormonal imbalances. In a very small proportion of women the cause is endometrial cancer.

The management plan is usually a endometrial biopsy to look for the cause of the thick endometrium [ hyperplasia or cancer].

If it is only hyperplasia then there are many treatment modalities like progesterone, endometrial ablation [ cauterising the endometrium by heat or cold] and very rarely a hysterectomy or removal of uterus may be needed depending upon her findings of biopsy report.

If there is a cancer then treatment depends upon stage. This is less likely in her case as cancer is rare and also she is not having any symptoms of bleeding etc. But still I recommend an early endometrial biopsy first to know the cause and then treatment can be decided.

So please do not panic. Just talk this out with your doctor and get a biopsy done as soon as possible.

I am always here to help you.

Take care and dont worry. Cancer is very rare.

Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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