Is surgery necessary for this cyst?
DEAR DR MITCHELL,
My doctor says I have a huge ovarian cyst and may need an operation to remove it before it ruptures and causes pain. I do not want to do surgery, and want to know what the odds are that it will shrink with time. Is there anything I can take to shrink it.
Ovarian cysts that are large in size should be removed because the cysts can rupture, leak or undergo torsion. A ruptured cyst can cause severe abdominal pain and bleeding on the inside of the abdomen, sometimes resulting in shock from the excessive blood loss. Torsion of the ovary is a surgical emergency since the blood supply to the ovary can be completely cut off, resulting in a complete loss of function in the ovary. The ovary can then become gangrenous, resulting in severe infection. This usually presents with sudden onset of severe abdominal pain confined to the side of abdomen over the ovary. Surgery has to be done immediately in this case.
As a general rule, it is thought that any ovarian cyst greater than five centimetres should be removed. If the ovarian cyst is simple, which means that it does not have any solid components in it, then it is less likely to be cancer of the ovary and can shrink over time. If the ovarian cyst is solid or has solid and cystic parts in it, then the risk for cancer of the ovary is increased significantly and then surgery to remove the abnormal growth is extremely important.
If the ovarian cyst is less than five centimetres in diameter and simple, then the use of a low-dose contraceptive pill can be used to shrink the size of the cyst and reduce the need for surgery. An ultrasound scan can be done to monitor the size of the cyst to ensure that the treatment is working. If the cyst does not shrink and certainly if it increases in size and is associated with abdominal pain, then surgery is definitely needed.
It is important to be guided by your doctor and follow the recommendation that you are given to reduce complications such as rupture of the cyst or torsion of the ovary which can cause you to lose your ovary.
If the cyst continues to grow or is left for a long time, then it can compress and destroy any normal ovarian tissue that could possibly be preserved at the time of surgery. This can result in the doctor having to remove your entire ovary.
The removal of an ovarian cyst is usually a straightforward and uncomplicated surgery unless you have endometriosis with a lot of scar tissues.
Follow the guidelines of your doctor and have the surgery done as soon as it can be booked for you. In the meantime, if you develop sudden onset of severe abdominal pain you should go to the emergency room immediately so that an examination of the abdomen and an ultrasound can be done to rule out complications such as rupture or torsion of the ovaries.
Best regards.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
