Is this ovarian cyst actually a problem?
August 31, 2023 1:46 PM Subscribe
YANMD, but the one I saw yesterday was so bizarre, angry, and just plain wrong about the things that I do actually know about that I almost walked out in the middle of the appointment. In short, a recent pelvic ultrasound revealed a "3.8 x3.5 x 2.6 septated complex cystic lesion" on my right ovary with good blood flow and no evidence of torsion. I have no pain. I asked him if this was something I needed to worry about and he said "that's up to you" and then went on an angry rant about HRT and it all went downhill from there. So, in short: Is this something I need to worry about?
Response by poster: Sorry, I just realized that those who don't see the headline might misinterpret the question. The question is whether I need to worry about the cyst. Needless to say the doctor is a big fucking problem and I won't be seeing him again. But I'm asking about the cyst because I'm going abroad for several weeks and got absolutely no useful information from him on what actual problems this cyst might cause and on what timeline.
posted by HotToddy at 2:48 PM on August 31, 2023 [4 favorites]
posted by HotToddy at 2:48 PM on August 31, 2023 [4 favorites]
Anecdata, but I've had a large ovarian cyst for about 10 years now. New doctors always remark on it and I need to get an ultrasound once a year but other than that no biggie. The only problem has been when I've had other GI issues and crappy doctors have tried to tell me it's the cyst to avoid further inquiry. Reader, it has NEVER been the cyst.
posted by jeszac at 2:53 PM on August 31, 2023
posted by jeszac at 2:53 PM on August 31, 2023
Since you're not having pain from it, there's no immediate need for treatment, but you should have a follow up ultrasound.
If you're premenopausal, you should have it rechecked in around 6 weeks. There's a good chance it will resolve on its own in that time. If it's still there, it may require further workup.
If you're postmenopausal, you should have it rechecked in 3-6 months. There's a good chance it won't resolve, in that case you're looking for size stability, no growth. If it's growing, you should have further workup.
At that size, you're at fairly low risk for torsion, ovarian cysts are considered normal functional follicles up to around 2.5 cm, and it's not much bigger than that. But if you do have new onset of pain, it's worth getting it rechecked at that point.
Background for my answer - I'm a sonographer, and find or follow up cysts all the time.
posted by dorey_oh at 3:02 PM on August 31, 2023 [25 favorites]
If you're premenopausal, you should have it rechecked in around 6 weeks. There's a good chance it will resolve on its own in that time. If it's still there, it may require further workup.
If you're postmenopausal, you should have it rechecked in 3-6 months. There's a good chance it won't resolve, in that case you're looking for size stability, no growth. If it's growing, you should have further workup.
At that size, you're at fairly low risk for torsion, ovarian cysts are considered normal functional follicles up to around 2.5 cm, and it's not much bigger than that. But if you do have new onset of pain, it's worth getting it rechecked at that point.
Background for my answer - I'm a sonographer, and find or follow up cysts all the time.
posted by dorey_oh at 3:02 PM on August 31, 2023 [25 favorites]
1) this sounds like a shitty doctor, ew. So sorry.
2) MOST cysts go away on their own or don't cause problems.
3) BUT!! (mini rant of on my own.) that "Most" comes from medical studies that may say something like "95% of patients with this problem went on to have no complications." etc. But often those studies don't include a good variety of patients and often EXCLUDE high risk patients or marginalized people. This is all before the issue of "women's" pain routinely being ignored or downplayed. So a lot of that "is this a problem?" will come from your own experience with your own body and your own probability of complications.
If you are concerned or experience pain or hormonal issues, it's ALWAYS helpful to seek a (better doctor's) second opinion. And preferably someone who understands YOU as a unique patient with unique history and risks, rather than a statistic.
I mention this because I was dismissed by someone for my cyst, not my regular doctor. Well, turns out once I went to my regular doctor and got into surgery it was a total shitshow in there in unprecedented ways. My doctor was shocked. And it's because the first doctor didn't take into account my personal history and the ability for my body to be a disaster and defy statistics all the time and rather hand waived at the "it should go away, no followup needed" despite my symptoms.
So my suggestion is monitor for pain and hormone changes or any thing weird on that side of the body or with digestion, and seek care from a better doctor if needed.
posted by Crystalinne at 3:29 PM on August 31, 2023 [1 favorite]
2) MOST cysts go away on their own or don't cause problems.
3) BUT!! (mini rant of on my own.) that "Most" comes from medical studies that may say something like "95% of patients with this problem went on to have no complications." etc. But often those studies don't include a good variety of patients and often EXCLUDE high risk patients or marginalized people. This is all before the issue of "women's" pain routinely being ignored or downplayed. So a lot of that "is this a problem?" will come from your own experience with your own body and your own probability of complications.
If you are concerned or experience pain or hormonal issues, it's ALWAYS helpful to seek a (better doctor's) second opinion. And preferably someone who understands YOU as a unique patient with unique history and risks, rather than a statistic.
I mention this because I was dismissed by someone for my cyst, not my regular doctor. Well, turns out once I went to my regular doctor and got into surgery it was a total shitshow in there in unprecedented ways. My doctor was shocked. And it's because the first doctor didn't take into account my personal history and the ability for my body to be a disaster and defy statistics all the time and rather hand waived at the "it should go away, no followup needed" despite my symptoms.
So my suggestion is monitor for pain and hormone changes or any thing weird on that side of the body or with digestion, and seek care from a better doctor if needed.
posted by Crystalinne at 3:29 PM on August 31, 2023 [1 favorite]
I had a friend who went through all the symptoms of menopause except her period would not stop. She wanted to stop birth control but that made her periods worse. Finally after pushing for an answer, they found a cyst. It was removed and her issue was resolved. You don't have pain, but if you have any problematic periods in other ways, it could be due to the cyst and I'd have it rechecked with a new doctor.
posted by soelo at 4:38 PM on August 31, 2023
posted by soelo at 4:38 PM on August 31, 2023
I had ~5cm simple cysts on both ovaries removed in 2019 because they were causing me pain and pressure, and I was pissing all the damn time. It was a benefit overall because I was able to get sterilised while the surgeon was working down there (something I'd wanted for a long time and didn't see how I was going to achieve any other way), and my work insurance paid for the procedure.
I strongly suspect they've since recurred, possibly more than once (they can also just go away on their own, apparently) and I haven't done anything about the recurrences, because they're not causing me anywhere near as much pain or frequent urination any more. Prior to the 2019 surgery, both of them were crammed together behind my uterus, pushing down on it, which then pushed down on my bladder; since then, I suspect their partial untethering due to the removal of the uterine tubes has meant that even if they're big, they're not stuck in such a weird position or pushing against anything quite as tenderly, so it's been less of an issue.
I hope to get a hysterectomy one day for gender affirmation reasons, and if they're still cystic at that point I'd probably let them take one out to make extra room in my pelvis, but beyond that I have no plans for further treatment at this stage. I currently take progesterone-based birth control to prevent my period (again, for gender affirmation reasons), and that can definitely contribute to cystic ovaries, but until I can find a more permanent solution to my strong desire never to menstruate again in my life, the birth control is a necessary evil even though I'm already sterile.
One friend chose to get hers removed because she wanted to conceive in fairly short order and had been told that the cyst might make it harder to (though in the end she had no issues conceiving), so if fertility is a concern that could be another reason to get a second opinion about treatment.
posted by terretu at 3:04 AM on September 1, 2023
I strongly suspect they've since recurred, possibly more than once (they can also just go away on their own, apparently) and I haven't done anything about the recurrences, because they're not causing me anywhere near as much pain or frequent urination any more. Prior to the 2019 surgery, both of them were crammed together behind my uterus, pushing down on it, which then pushed down on my bladder; since then, I suspect their partial untethering due to the removal of the uterine tubes has meant that even if they're big, they're not stuck in such a weird position or pushing against anything quite as tenderly, so it's been less of an issue.
I hope to get a hysterectomy one day for gender affirmation reasons, and if they're still cystic at that point I'd probably let them take one out to make extra room in my pelvis, but beyond that I have no plans for further treatment at this stage. I currently take progesterone-based birth control to prevent my period (again, for gender affirmation reasons), and that can definitely contribute to cystic ovaries, but until I can find a more permanent solution to my strong desire never to menstruate again in my life, the birth control is a necessary evil even though I'm already sterile.
One friend chose to get hers removed because she wanted to conceive in fairly short order and had been told that the cyst might make it harder to (though in the end she had no issues conceiving), so if fertility is a concern that could be another reason to get a second opinion about treatment.
posted by terretu at 3:04 AM on September 1, 2023
Most of the folks replying about their own experience with cysts are talking about simple cysts. You have a septated/complex cyst, so there is more to the story. Does the ultrasound report say anything else in the "Impression"? How old are you?
I am a gyn but not your gyn. Definitely see a better gyn.
posted by i_am_a_fiesta at 6:47 PM on September 2, 2023
I am a gyn but not your gyn. Definitely see a better gyn.
posted by i_am_a_fiesta at 6:47 PM on September 2, 2023
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That said you may want to give some feedback about their bedside manner. I have had he experience of having a pretty dreadful first appointment experience with a doctor, who dramatically improved and even apologized after some feedback was shared. Probably a rare occurrence though.
posted by brookeb at 2:17 PM on August 31, 2023