Ovarian cyst concerns
Dear Dr Mitchell,
I am 32 and trying to get pregnant. Can you help me please? I have a cyst on one of my ovaries.
Ovarian cysts are very common in women in the reproductive age group. Some ovarian cysts are considered simple cysts and do not result in any significant challenges while some cysts can be serious and could represent cancer of the ovary.
Simple cysts can sometimes grow to a significant size and cause pelvic pain or pressure. If the cyst becomes too heavy the ovary can sometimes twist on its pedicle and lose its blood supply (ovarian torsion). This usually presents with a sudden onset of severe one-sided pelvic and abdominal pain. This will usually need emergency surgery to be done to try and preserve the function of the ovary, but in situations where there is a significant delay, the ovary can lose its entire blood supply and has to be removed to prevent infection. In some women there can be bleeding into the cyst or the cyst can rupture and cause significant abdominal and pelvic pain.
In some cases the ultrasound can report that the cyst is complex or solid. In these cases, urgent attention is needed. A complex ovarian cyst or an ovarian cyst that is reported as haemorrhagic (bleeding into the cyst cavity) can be suggestive of endometriosis. This condition can interfere with your ability to become pregnant by destroying your normal ovarian tissues and also cause adhesions or scaring that damages the Fallopian tubes. This can present with severe pelvic pain before the menstrual flow starts and this pain usually continues throughout the menses and even after the menstrual flow has stooped.
This can sometimes be suspected based on the ultrasound findings of a complex cyst in the ovary. Once the cyst is of a significant size, usually greater than 5cm, then surgery should be done to try and preserve the function of the ovary and improve fertility. The use of drugs can also help to reduce any pain associated with the cyst and to suppress the endometriosis until surgery can be done.
A solid ovarian tumor is usually in keeping with cancer of the ovary and this should definitely be removed by doing surgery and doing tests to rule out cancer. In this case the entire ovary has to be removed and tested.
A test to check the level of tumor markers in the blood can also be done. This can help in determining whether the ovarian cyst is suspicious for cancer of the ovary. In endometriosis the tumour marker CA 125 is usually elevated and so a high CA 125 does not always confirm ovarian cancer.
It is extremely important for you to see your doctor and have a pelvic and abdominal ultrasound done to check on the size of the cyst and to determine if the ovarian tumor is complex or solid so that you can get the appropriate urgent intervention in the event that there is a high index of suspicion for ovarian cancer or endometriosis.
You should follow the instructions of the doctor and if surgery is recommended you should definitely plan to have this done urgently to preserve your fertility.
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.
