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Dr. Andrew Rynne

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What causes lower back pain and frequent urination when suffering from ovarian cyst?

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Dr. Madhuri N Bagde

OBGYN

Practicing since :2001

Answered : 1390 Questions

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Posted on Mon, 18 Aug 2014 in Women's Health
Question: Hi Dr, I am 53 years of age. I stopped menstruating about one year and a half and just found out that I have a large tumor, fibroids and a small cyst on my ovary. The Dr. said I should have an immediate hysterectomy but I am not bleeding at all. I only have mild lower back pain and urinate more times a day now. I don't mind, I'm very frightened. I was thinking that maybe my body is still adjusting to my hormonal changes? Please help!
doctor
Answered by Dr. Madhuri N Bagde 15 minutes later
Brief Answer:
Please do not worry.

Detailed Answer:
Hello XXXXXXX and welcome,

I understand your concern. Please do not be frightened as fibroids are not cancerous at all.

I would be very glad if you could provide me with the details of the sizes of fibroids and also the ovarian cyst [ complete report with size of uterus and everything else mentioned as well as your past and family history if anything significant will be helpful].

Now about fibroids :

Fibroids are non cancerous tumors of the uterus. They are common in the reproductive age group and become less common after menopause. Most of them tend to shrink after menopause and may not need any treatment after that. They need treatment depending upon their size, location and clinical features that they produce.

In your case, you do have a few symptoms like increased urinary frequency and low back pain. If they are big they irritate the bladder and also the intestine producing symptoms related to urine and bowel.

A rare occasion is the presence of a cancer called fibrosarcoma, usually seen in big tumors that grow rapidly. This is a very rare condition diagnosed by clinical examination and investigations like a biopsy or a CT scan in advanced stages.

As of now, with the above history it will help to know the size of fibroids, if they are big, they are less likely to shrink.

In addition you also have an ovarian cyst. Most of them are benign and those below 5 cm size seldom need any treatment.

The logic behind your doctors suggestion was simply that big fibroids and also ovarian cysts in a menopausal woman do make an indication for a hysterectomy. Also a microscopic examination helps rule out cancer if any though this is very very rare.

The urgency depends upon the size of the fibroids and cysts. So please provide that information so that I can help you further.

Please do not worry as fibroids [ even big ones ] are not uncommon and so are ovarian cysts. They can be treated.

So just provide the reports so that I may help you.

Take care.

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. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde 2 hours later
Thank you so very much for your detailed explanation Dr. XXXXXXX
I will be getting a second opinion today, as I did not receive any of that information on my previous visit, or maybe I was just to terrified to absorb crucial information, as the details of my surgery were so quickly presented, as being my only sound choice. I am hoping to receive all of those details today. I also requested some labs from my family Doctor, which should be available already.
which kind of testing will I need to rule out cancer? would it be a surgical proceeder? or will it be an instrument inserted inside of my uterus, through my vagina? I will check back with you again!
doctor
Answered by Dr. Madhuri N Bagde 3 hours later
Brief Answer:
Detailed explanation given

Detailed Answer:
Hello and welcome back XXXXXXX

I understand that you are waiting for further results. Please do not be scared. Fibroids are common.

Also about the tests:
We generally rule out two cancers before operating for fibroids.
1. cancer of the uterine endometrium: Diagnosed by a hysteroscopy: a kind of a laproscope inserted per vagina and a bit of tissue is removed from the uterine lining [ this is the forming menstrual tissue that is shed during menses]. It can be done by two other methods which are more preferable: by a simple out patient endometrial biopsy or by a biopsy under anesthesia called Dilatation and curettage. In my set up, as the likelhood of cancer is very less in such women we prefer a simple endometrial biopsy on day 2 of periods if menstruating or on any day if menopausal.
2. a fibrosarcoma: this is usually difficult to rule out easily. The best way is a clinical suspicion and findings on vaginal examination as well as on ultrasound, CT [ if done etc]. Most of the times it is diagnosed only after the histopathology report is available after surgery. So the best thing is to talk with your doctor about this and if he finds anything suspicious. This tumor is even rare than the uterine cancer and so chances are extremely low. We generally do not do anything to rule it out if there is no clinical suspicion as it is very rare.

I can completely understand how a patient feels when we counsel for surgery. Your apprehension is justified. If you feel that you may miss out any of the important information while with your doctor it is a good thing to take a list of any questions that you might be wanting an explanation on. This way you will not miss any important question. Also if you are comfortable have someone who is close to you to accompany you as it helps to share the stress. Also sometimes a third person is in a better state of mind to understand the matter as the patient is already in distress.

I am always here for your queries. Feel free to ask them.

Take care.

Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde 4 days later
Hello Dr. XXXXXXX
I went for a second opinion.
A new ultra sound was performed by a technician with experience in performing ultra sound tests.
I was told that I had two fibroids measuring about 1 1/2 inches in diameter each and I did have a cyst the size of a green pea attached to my ovary.
These are located between the walls and my uterus is over an inch larger than the average 8 plus inches, which is the normal size?
The Dr. said since I have stopped menstruating for over a year now, the fibroids may shrink or remain the same and so I should go back for another ultra sound in about three months. I am wondering if I should take any hormone medication to help with my condition? I forgot to ask. THanks!
doctor
Answered by Dr. Madhuri N Bagde 16 minutes later
Brief Answer:
detailed answer below

Detailed Answer:
Hello XXXXXXX and welcome back,

I am glad to have the size of the tumors and also their location.

The fibroids are intermediate size according to me. They are not very large [ sometimes they are huge 20cm ones]. Yours are just about 4.5cm. The ovarian cyst is way too small to be worriesome.
The likelihood of cancer in these tumors is very small.

You can just wait and follow them up on ultrasound. A two months interval is enough. I do not expect them to shrink in 2 months. But if they are not growing then it is enough for me. It takes years for them to shrink and some may not even shrink. So it varies from person to person.

You are having urinary issue that may be due to these fibroids.
So as of now, there are two options:
1. if you are too scared to wait and watch then get a surgery done.
2. just wait and watch, get follow up scan 2 months later and then every 6 months once or twice, if they are not growing they probably will not need any further treatment.

There is no need to take hormones for these now. You are already menopausal and so the hormone drives feeding them must already be low.

If you are overweight then loosing weight especially if there is fat over the belly region helps a lot in decreasing the hormones that [ especially estrogen that comes from belly fat] feed such fibroids after menopause. So if there is fat on the abdomen just try to exercise and loose it.

I do not think that there is any reason to worry now. A follow up ultrasound will help.

Hope this helps. Do not worry. They are not very big.

Feel free for any further queries.
Take care.
Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Madhuri N Bagde 1 hour later
I thank you very much Dr . XXXXXXX
doctor
Answered by Dr. Madhuri N Bagde 30 hours later
Brief Answer:
You are welcome !

Detailed Answer:
You are most welcome XXXXXXX

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