Is medical treatment always necessary for an ovarian cyst?

February 23, 2012 10:45 AM

I have an ovarian cyst, do I *need* to see a doctor? Slightly unpleasant details inside.

I have (had?) an ovarian cyst. I've been getting them for the last 20 years (I'm 31), due to precocious puberty related to a congenital hormone disease. I absolutely know when I have one, and have long since stopped seeking regular medical treatment for them, which usually just consists of a confirming ultrasound if it hasn't ruptured. I've never needed surgery or even had it suggested, and frankly it always feels like a complete waste of time.

However, last year I was experiencing extreme lower abdominal pain to the point where I needed to visit the ER per the nurse I spoke with. They found a small cyst and some small fibroids (which is new), and since the pain was subsiding I was told that there was probably some torsion (also new) which had corrected itself. On top of the time and expense, I had to endure a massively uncomfortable pelvic exam by an unfamiliar doctor in my curtained off room in the middle of a busy ER, which I wasn't expecting and didn't want at ALL. But I didn't feel like I could say no or waste more time by requesting a female doctor (nothing against men, but I've always felt more comfortable with women gyns). Beyond that there was no treatment. I left feeling wrung out and silly for having put myself through all that for nothing.

In the last week or so I've had typical ovarian cyst symptoms: constipation, almost comically absurd bloating, pain in the ovarian region, low back pain, funny moods-- all two weeks after my period. Nothing a hot water bottle and some mild painkillers can't handle. Yesterday and today though, I've been bleeding. This sometimes happens, but not always. I'm not in any pain. My question is: do I need to see a doctor when an ovarian cyst bleeds out painlessly, or can I just stay home and take it easy? The last time I sought treatment for heavy bleeding (not the ER visit), I was told there was no cyst and no explanation for the bleeding (I guess it was already gone?). Again, waste of time.

There is nothing more mentally draining than going to the doctor for no reason. I've spent my entire life being poked and prodded and I avoid it whenever possible, but I don't want to be stupid. From what I've read on the web, everything suggests that's important to seek treatment when you have a cyst, but my experiences have negated that. Right now I'm in a new city where I have no friends or family or doctor, and I'm feeling extremely depressed and alone and have no desire to visit an unfamiliar doctor and get poked and examined and then told there's nothing really wrong. I know you are not my doctor, but what is the right thing to do for myself here?

Thank you for your advice.

posted by anonymous to Health & Fitness (14 answers total)

I've had ovarian cysts and endometriosis, and was told when once I was bleeding as a result that you need to see a doctor if the bleeding is "excessive". Okay, well, what does excessive mean? If you are going through pads ~every two hours, that's considered excessive.

If you have a fever, lethargy or signs of a possible infection, again, you need to see a doctor. If you have other symptoms that don't fit your prior experience with cysts, especially acute pain of any kind, you need to see a doctor, too. And of course if the bleeding doesn't slow down or stop and you are not due for your period, you need to see a doctor.

Otherwise, you are probably okay not to see a doctor right away.
posted by misha at 10:55 AM on February 23, 2012 [4 favorites]

Yes, you need a doctor. You need to find out what is going on - what happened before is not a prediction of the present. It hurts like heck when an ovarian cyst bursts and you should at least find out what's going on. Call the Planned Parenthood clinic in your area. They will have a very sensitive, woman-friendly physician. When I saw one a few months ago, she offered to take me on as a patient, since she only worked at PP one day a week. The clinic was at a women's hospital and it was super safe feeling and professional. Even if she can't screen you for anything, you can probably somewhat trust that they will hook you up with someone good.
posted by Chaussette and the Pussy Cats at 10:55 AM on February 23, 2012 [3 favorites]

The best advice I got about "should I see a doctor if [this vague thing is happening that maybe is normal sometimes but maybe not]" was "there's a difference between 'normal' and 'normal for you'."

Here's what I mean.

If you know from personal experience that you've had the symptoms you're having now, and you did okay in the past, you may be able to get away with waiting a day in this case too. I have a similar situation with cysts in my breasts -- I'm especially prone to them, and every time I got a lump in my breast I would dutifully go to my doctor to have them check it out, only to have them put me through a mammogram AND a sonogram only to find that it was just a cyst. My doctor finally told me, "okay, your rules for BSEs are different." Instead of going to my doctor right away if I feel a lump, I now have to wait a month and see if it goes away on its own. If it does, it was a cyst, and I was fine. If it doesn't, THEN I go to the doctor. (They've always been cysts.)

In your case - if you know you've had spotting before, and it went away on its own, and this time feels a lot like last time, you may be able to get away with waiting a day this time too. Of course, if the bleeding gets a lot heavier, or you feel any pain, then that's a major change and you should indeed go to the doctor after all.

This is just my opinion, and is dependent upon you knowing that this situation is indeed just like the last one.

(And you are also the only other person I've ever met who also had ovarian torsion. Be glad it reverted on its own rather than spinning all the way around, because that hurts like a motherfucker.)
posted by EmpressCallipygos at 10:57 AM on February 23, 2012 [1 favorite]

I haven't been treated for my ovarian cysts for about nine years. I just take Advil and curl up with a heat pad.

I've noticed that every once in a while I'll have some bleeding that doesn't have anything to do with my period. Sometimes I'll get sharp pain first, other times I just get random bright red bleeding. The first time it happened I did just what you did, ER trip and humiliating exam included. That doctor couldn't find any reason for it either.

I bring it up with my OB/GYN every year when I see her and she's said that short of removing my ovaries there is really nothing that can be done. She said that hormonal birth control might help but I don't react well to it so I haven't tried it.

I am not a doctor, this is just my personal experience. I agree with misha that if you're having other symptoms then maybe rethink getting checked out. If this is just the same old thing then just relax and have some chocolate. (That's what I do.)
posted by TooFewShoes at 11:03 AM on February 23, 2012

For me, going to the doctor, even if it ends up being "for no reason", is extremely comforting to me. But if it makes you feel worse to do so, and you're not in any pain right now, and you're not hemorraging, then I would tell you to stay home if you were my friend.

However, if there's a chance of this getting worse, it's better to find a doctor ahead of time when you're not horribly sick than having to scrounge up someone to treat you when it becomes an emergency.
posted by Tesseractive at 11:13 AM on February 23, 2012 [1 favorite]

Sign me up for the ovarian torsion club. I don't have mine any more, but WOW was that part painful!
posted by misha at 11:15 AM on February 23, 2012 [1 favorite]

I had an ovarian torsion thanks to cysts when I was younger that, due to no insurance, was left untreated, went gangrenous, died, made me really sick, had to be emergency removed, very expensive hospital bills, etc.

Now if I have unusual pain, I doctor up. Paranoid, maybe. But my risk/reward ratio sits somewhere along there.

YOMV.
posted by Gucky at 11:36 AM on February 23, 2012 [1 favorite]

I didn't feel like I could say no or waste more time by requesting a female doctor (nothing against men, but I've always felt more comfortable with women gyns). Beyond that there was no treatment. I left feeling wrung out and silly for having put myself through all that for nothing.

I don't know if you need to see a doctor, but I wanted to address this: You can absolutely always say no to a certain doctor. You can also take a breath to figure out what you need and want, and you should speak up for it -- it's your health and your body, after all. If you don't want some strange dude up in your business, you can say so! You're not being offensive/sexist to ask for a female gyn.

I also wouldn't say that you put yourself through all that for nothing. You learned that you have fibroids and some torsion, and that is valuable knowledge. Might you find out something valuable this time?
posted by runningwithscissors at 12:46 PM on February 23, 2012 [1 favorite]

think of it this way--you've moved to a new city, so you need to find yourself a new ob/gyn for your regular checkup. Even if you don't necessarily need treatment now, if and when you do, wouldn't having a doctor who you are familiar with and knows your medical history be a good thing?
posted by inertia at 1:10 PM on February 23, 2012

I sympathize with your not wanting to do much about this. However, you may want to find out a) what type of cysts these are (there are several types) and their size. This can be done via ultrasound. You may also want to try hormonal birth control to see if this affects their size or frequency.

Seven years ago, I was diagnosed with ovarian cysts (one on one ovary, two on another, the largest just under 3cm) and fibroids. My symptoms were mid-cycle spotting and some pain (Advil level). My nurse-midwife sent me for an ultrasound, which defined the above. We waited a bit, while I went on the NuvaRing to see if that would impact them. (Ovarian cysts quite often go away on their own). When it did not, I had a laparoscopy. While it went okay, I had shitty treatment from the surgeon before after after the procedure, and as it turned out, there was nothing they could do for any of it except to drain one cyst, which promptly refilled with fluid (probably endometrial). I was told I had severe endometriosis which had left behind lots of adhesions; again, nothing they can do anything about. I didn't and don't have other symptoms of endo (cramps are mild, not much bleeding at all).

I stopped having follow-up ultrasounds after a while (expensive, a pain in the crotch, and nothing new showed). After some years, the cysts went away.

In hindsight, I paid for a lot of procedures which told me little, and none of shifted my quality of life at all (except for when the surgeon removed my NuvaRing [while I was sedated and without my permission, as he never showed up for our planned pre-op discussion of this issue] causing me to restart my cycle while recovering from surgery. How is that good for anybody?) but did cost rather a lot of money I didn't have at the time.

Even if/when you go to the hospital for a ruptured cyst, there is little they seem to actually do for you except give ou some decent painkillers.

I think it is good for you to think through exactly what is treatable and worth your while to do about the cysts, but you can only do this if you are able to determine their size and type. It is possible you'll decide to do not much. Hope this helps.
posted by Riverine at 1:15 PM on February 23, 2012

Not only am I also a member of the ovarian torsion club, mine BURST while it was twisted around.

I remember being doubled over in pain at the dinner table and quietly asking my then-boyfriend, "honey, what does a burst appendix feel like? I think something just broke inside." He asked, "can you walk?" I stood up and promptly fell to the floor from the stabbing pain. He took me to the nearby hospital, where they did a quick ultrasound (this was Finland and the hospital just happened to be the Helsinki Women's Hospital, how's that for luck). Then, in their very Finnish way, they calmly said, "you need to go to surgery. Now." I knew about eating just before anesthesia being a no-no and asked if it could wait. "No. If we do not operate now, you will die from the internal bleeding."

Well. All righty then. They were able to save my twisted ovary from dying and stop the internal bleeding, but they couldn't tell if that ovary were still viable or not. They also removed cysts from the other, and found signs of endometriosis, which my GP in the US had always suspected.

Soooo I pretty much go to the doctor any time I get "this is not normal" pain or bleeding. As I recommend you do too. Yeah, it is a pain. The trite "better safe than sorry" does work here, though.

FWIW, the Pill solved the worst of my problems, but it's different for everyone.
posted by fraula at 1:26 PM on February 23, 2012

(uh I am a dork. My ovarian cyst burst, not my ovary. Sorry 'bout that, it's late here. The cyst was nearly tennis-ball size and had apparently caused the ovarian torsion.)
posted by fraula at 1:27 PM on February 23, 2012

I was told by my obgyn that another possible explanation for my painful symptoms besides a burst cyst: a Fallopian pregnancy rupturing my ovarian tube, which could be fatal if untreated.
posted by bq at 5:30 PM on February 23, 2012

bq: wouldn't that kind of pain be stronger than can be managed with over the counter pain meds, though? Let's not forget that Anon reports the pain isn't bad (and is even gone today).

Anon, reiterating that if the pain comes back or the bleeding increases, THEN it's doctor time, but if this is something you've been through before and it's usually a big pile of nothing, waiting a bit isn't a TERRIBLE idea, at least.
posted by EmpressCallipygos at 7:48 PM on February 23, 2012 [1 favorite]