Avatar universal

Has anyone had a complex cyst resolve or had one removed that was benign?

I'm 41, premenopausal, 2kids, both breast fed.  I've been diagnosed with a complex ovarian cyst on my left ovary.  I went to the dr because of an unusual pressure on my left side.  The ultrasound said there was a complex cyst with internal echoes, likely functional, 2.9cm. A pregnancy test was negative. No blood test.  The gynecologist said he sees cancer all day & I don't have cance but he cant know without removing it.  He felt confident enough to say there was 0% I had cancer.  He strongly believes in "do no harm" and put me on birth control and I am scheduled to return in Jan for another ultrasound and discussion. The pressure is getting worse and I feel it in my groin now.  I see a lot of cases on this forum but not how they resolved.  I have 2 kids that need me.  I don't need this ovary so reading that there is any chance that this may be cancer makes me want to request that someone take this out and biopsy it, however surgery carries risk too.  So should I continue on this path, request a second opinion or is there something else I should do?  Thanks in advance!!
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Avatar universal
I have had cysts on overies for several  years. Slight growth they said.  I'm a senior citizen. Overies are almost invisble.  Inside ultrasound said it's not cancerous.  How do they know?  BTW I had my uterus removed for fibroids and it saved my life.  I was bleeding so that I had to have transfusions.    
Helpful - 0
Sorry.  I have groin pain.  Has anyone had groin pain due to overies? Thanks much.
973741 tn?1342342773
I had a cyst resolve on its own as well.  But my symptoms resolved after.  Sounds like the further evaluation is key for you.  What were the findings?
Helpful - 0
Well, the Dr cancelled my first scheduled surgery due to a conflict on his end.  We have been on s shelter in place order for about 3 weeks due to corona virus and they are not doing exploratory surgery right now.  So, I'm kind of on hold I guess.  The pressure is very minor and all of the other pain I was having is gone as long as I remember to take my birth control.  I need to clarify with my dr. But the cyst was gone and the ultrasound didn't show anything else.  He thought it was endometriosis which wouldn't show up on ultrasound.  If it isn't anything life threatening I really don't want to have surgery to fix a minor pressure.  Does anyone have thoughts? I probably will follow up with the dr when the world is less crazy but I feel like it is safer to stay home for now.  I'd love any opinions!
I personally would avoid surgery if you aren't having major problems. I have endometriosis and had surgery but I had major pain and bleeding that justified the risk of surgery. I also sought out an endometriosis specialist. If your doctor thinks you have it, maybe seek out a specialist to advise you further. Good luck with everything.
I personally would avoid surgery since your symptoms are mild and nothing can be seen on u/s. You can revisit if symptoms worsen.
Avatar universal
So, I had my follow up today.  The cyst is gone.  I am still having groin pressure and muscle spasms in my thigh so my dr wants to do the surgery to look for/remove endometriosis.  Does this sound reasonable?  Anyone have any experience with this?  Thanks!
Helpful - 0
So sorry I missed your post. The pain from cysts can linger for quite awhile. Are you feeling better and did you avoid surgery?
Avatar universal
For asymptomatic females with ovarian cysts, there are published consensus guidelines available at:
You can skip straight to the figures for the summary.
In general, you first have to determine premenopausal vs. postmenopausal.
In general, premenopausal is more lax with less follow-up.
In general, postmenopausal is more strict with more follow-up.

For symptomatic females (as in your case since you have left-sided pelvic pressure), the recommendations in the paper may also be helpful, but the clinical setting will often determine management in a manner beyond the scope of this consensus panel. In general, if there is a complex cyst on initial pelvic ultrasound, it is reasonable to repeat the pelvic ultrasound in 4-6 weeks or 6-12 weeks. If the abnormality persists, then consider MRI pelvis for further characterization.

To address your case specifically, you had mentioned you had a cyst with internal echoes. Diagnostic considerations include simple cyst (with artifact), hemorrhagic cyst (which is benign, essentially normal to see these in premenopausal female), and endometrioma (which is benign, not cancer, characterized by tissue normally within inner lining of uterus being deposited outside the uterus, but can still cause symptoms such as pain and/or bleeding). The classic look of a hemorrhagic cyst is reticular pattern of internal echoes. The classic look of an endometrioma is diffuse low-level echoes. However, since there can be overlap in imaging appearance, it is common practice to get a repeat pelvic ultrasound in 6 weeks or so, as your gynecologist suggested. If the abnormality improves/resolves, then hemorrhagic cyst is favored. If the abnormality persists, then endometrioma is favored. Hope this answers your question and puts you more at ease!
Helpful - 0
Thank you.  This does make me feel better.  I believe the ultrasound report said there were a few linear internal echoes so it makes sense that they would not know exactly what kind of cyst it is. It sounds like this isn't nearly as bad as I'm making it in my head.  I wish the pressure would go away so I didn't think about it.  I guess I'll try to keep busy until Jan and hopefully it will be gone when we follow up.  Thank you again for your time.
Avatar universal
I am sorry you are going through this. Actually you do need your ovary, you just don't realize it :) Removal of even one ovary has been shown to cause harm. For one, it increases the risk of dementia and parkinsonism. Removal of the uterus also causes harm due to the anatomical changes, its importance for sexual function and its blood supply and feedback mechanism with the uterus. An intact woman's ovaries produce health promoting hormones her whole life.

Ovarian cancer is rare.  Per government stats, 13 women and 1000 will get it in their lifetime.

The key takeaway from the ultrasound is that the cyst is "likely functional". And it is small at 2.9cm. No worries about no blood test (CA125) as it tends to have too many false positives. Things like a benign ovarian cyst can cause an elevated result. There can also be false negatives.

Your gyn sounds very assured that it is not cancer yet at the same time he has to say he can't know without removing it to cover himself. That is standard.

Unfortunately, removal of female organs is far too common for conditions that do not warrant it. So it sounds like you are getting good care.

I had a 9.5cm benign ovarian cyst yet my organs were removed anyway. The effects have been like shattering in every way. I wish I would have known that only 8% of hysterectomies are done for a cancer diagnosis. And I believe an even smaller percentage of ovary removals are done for a cancer diagnosis.

If the cyst continues growing and needs to be surgically removed, it is best to have a cystectomy (cyst removal) that preserves the ovary and its lifelong endocrine functions.

I hope this eases your mind a bit.
Helpful - 0
Thank you, that does make me feel a little better.  It's hard not to worry especially when I'm still feeling pressure from the cyst. . . .it does sound like this is a standard way to handle it so I'll try to stay calm.  Thanks again.
You're welcome. I hope you start feeling better soon.

Correction from my post - Removal of the uterus also causes harm due to the anatomical changes, its importance for sexual function and its blood supply and feedback mechanism with the ovaries (not uterus).
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