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Suggest Treatment For Severe Cramping Abdominal Pain When Diagnosed With Ovarian Cysts
Question: 4 months ago,my daughter Dipti (22) had severe cramping abdominal pain.The usg revealed ----------Right ovary normal in size 2.90 X 2.35 cm.Enlarged left ovary measures 8.79 X 6.04 cm.There is evidence of cysts in left ovary the larger one measures 5.36 X 5.09 cm with echogenic dependent debris within it--left ovarian cyst (?haemmorhagic /D/d--infective)
No lympha denopathy seen
Free fluid in P.O.D. and in Hepato--renal fossa
She was immediately hospitalised and as laproscopicaly operated or left ovarion torsion.The cyst was sent for boipsy and turned a nomal report.
today,4 months later,In order to have a follow up periodical routine usg,we have had it done and it has revealed the following:
ovaries are enlarged in size.Cyst of 28mm size in right ovary with internal echoes in it.An approx 29mm sized cyst with internal echoes also noted in left ovary --------Posibbly intra cystic hemorrhage.Left ovary is normal in size shape and echotexure.
Right ovary measured 45 X 34 mm.Left ovary measured 58 x37 mm
No free fluid in P.O.D.
The persons who were conducting the usg wre talking amongst themelves about Choclate cyst and endometriosis.
The Doctor,on seeing the report has said that there is nothing to worry about.When pressed for an explanation,he said that there is no cure and there is no system or medication of dissolving the cyst.he said that the only way is to artifically stop the menstrual cycle for a few months which will cause the cyst to dissolve and go away.as she is supposed to go for a job training of 21 days next month he said hat the medicine for his would be started after that.Another gyno doctor has said that vitamin e supplements will help and there is no need to go for anything else.I have seen on the net that ascertaining the hormonal imbalance of progestorene and recctifying it will stop recurrences.
In his regard please clarify ;
1.why has the cyst recurred in the left ovary?
2.What has caused both cysts?
3.how can we dissolve them?
4.how can we ensure that cysts do not occur again
5.even if we stop the mens.cycle and let the cyst dissolve will it again recur when he cycle begins?
6.will vitamin E help and cure
7.are vitamins B and C also needed
8.do we need a test for progesterone levels?
Please help,explain and advise
An early reply would be highly helpful and appreciated.
No lympha denopathy seen
Free fluid in P.O.D. and in Hepato--renal fossa
She was immediately hospitalised and as laproscopicaly operated or left ovarion torsion.The cyst was sent for boipsy and turned a nomal report.
today,4 months later,In order to have a follow up periodical routine usg,we have had it done and it has revealed the following:
ovaries are enlarged in size.Cyst of 28mm size in right ovary with internal echoes in it.An approx 29mm sized cyst with internal echoes also noted in left ovary --------Posibbly intra cystic hemorrhage.Left ovary is normal in size shape and echotexure.
Right ovary measured 45 X 34 mm.Left ovary measured 58 x37 mm
No free fluid in P.O.D.
The persons who were conducting the usg wre talking amongst themelves about Choclate cyst and endometriosis.
The Doctor,on seeing the report has said that there is nothing to worry about.When pressed for an explanation,he said that there is no cure and there is no system or medication of dissolving the cyst.he said that the only way is to artifically stop the menstrual cycle for a few months which will cause the cyst to dissolve and go away.as she is supposed to go for a job training of 21 days next month he said hat the medicine for his would be started after that.Another gyno doctor has said that vitamin e supplements will help and there is no need to go for anything else.I have seen on the net that ascertaining the hormonal imbalance of progestorene and recctifying it will stop recurrences.
In his regard please clarify ;
1.why has the cyst recurred in the left ovary?
2.What has caused both cysts?
3.how can we dissolve them?
4.how can we ensure that cysts do not occur again
5.even if we stop the mens.cycle and let the cyst dissolve will it again recur when he cycle begins?
6.will vitamin E help and cure
7.are vitamins B and C also needed
8.do we need a test for progesterone levels?
Please help,explain and advise
An early reply would be highly helpful and appreciated.
Brief Answer:
Can you please provide more details / papers / reports ?
Detailed Answer:
Hello Mr. XXXXXXX
Thank you for trusting me with your health concern.
Before I guide you further, I would like to request for a few details.
I am asking for these precise and detailed inputs because I want to give you a complete and perfect advice.
1. Please upload the earlier ultrasound scan report.
2. Please upload the latest ultrasound scan report.
3. Please upload all papers and reports related to the surgery ( laparoscopy ) that she had last time.
4. She got the scan done last time due to pain and cramps. Did she have any symptoms now ?
Does she have any symptoms such as painful periods, pain , cramps etc on a regular basis ?
5. Does her mother / sisters / maternal relatives - any of them - have history of endometriosis or chocolate cysts ?
6. Does your daughter have regular periods ?
Please try and upload all the reports and papers pertaining to this condition, because I want to go through everything that has been done so far in this case.
I will then do my best to guide you further.
Looking forward to hearing from you.
Take care.
Can you please provide more details / papers / reports ?
Detailed Answer:
Hello Mr. XXXXXXX
Thank you for trusting me with your health concern.
Before I guide you further, I would like to request for a few details.
I am asking for these precise and detailed inputs because I want to give you a complete and perfect advice.
1. Please upload the earlier ultrasound scan report.
2. Please upload the latest ultrasound scan report.
3. Please upload all papers and reports related to the surgery ( laparoscopy ) that she had last time.
4. She got the scan done last time due to pain and cramps. Did she have any symptoms now ?
Does she have any symptoms such as painful periods, pain , cramps etc on a regular basis ?
5. Does her mother / sisters / maternal relatives - any of them - have history of endometriosis or chocolate cysts ?
6. Does your daughter have regular periods ?
Please try and upload all the reports and papers pertaining to this condition, because I want to go through everything that has been done so far in this case.
I will then do my best to guide you further.
Looking forward to hearing from you.
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
have uploaded three files 1. pre----pre operation sonography
2.dis---discharge after operation 3. recent--recent sonography
to answer your questions;
1.no cramps or pain now.just a routine usg
2.periods are slightly painful,but not very significant
3.her mother has endometriosis/choclate cysts and was operated 5 years ago
4.she has regular periods
2.dis---discharge after operation 3. recent--recent sonography
to answer your questions;
1.no cramps or pain now.just a routine usg
2.periods are slightly painful,but not very significant
3.her mother has endometriosis/choclate cysts and was operated 5 years ago
4.she has regular periods
Brief Answer:
All answered one by one.
Detailed Answer:
Thank you for the updates.
I have gone through them in detail.
The earlier cyst that was surgically removed should have been sent for biopsy to confirm that it was endometriotic / chocolate cyst.
That was an important step that was missed.
Now I will answer your earlier questions =
1. It is likely that she has endometriosis, and that is the reason for recurrence of cyst in left ovary.
2. Mostly endometriosis has caused the cysts, but it was important to get a biopsy diagnosis, which was missed earlier, so we have to go by clinical judgment, and still endometriosis is most likely cause.
3. To resolve such cysts, first medical management is needed. Try taking 3 cycles of oral contraceptive pills ( eg. Novelon ).
Mostly the cysts will disappear, and a repeat scan should be done after 3 months.
If that fails, then further drugs like Danazol , GN rh family drugs ( that suppress menses ) are available for treating it.
IF all medical management fails, only then repeat surgery should be done, and this time the removed tissue should be definitely sent for biopsy.
4. Unfortunately, endometriosis is a disease of recurrence, so there is no way to ensure that it does not happen again.
She can take hormonal therapy for a while until she gets married and completes her family.
5. Yes, it is possible that when the menstrual cycles resume, the cysts will recur.
6. None of the vitamins will bring about a complete cure.
7. There is no need to get progesterone levels measured, they are not relevant here.
Hope my answers have helped you, SIr.
PLease feel free to discuss further.
All answered one by one.
Detailed Answer:
Thank you for the updates.
I have gone through them in detail.
The earlier cyst that was surgically removed should have been sent for biopsy to confirm that it was endometriotic / chocolate cyst.
That was an important step that was missed.
Now I will answer your earlier questions =
1. It is likely that she has endometriosis, and that is the reason for recurrence of cyst in left ovary.
2. Mostly endometriosis has caused the cysts, but it was important to get a biopsy diagnosis, which was missed earlier, so we have to go by clinical judgment, and still endometriosis is most likely cause.
3. To resolve such cysts, first medical management is needed. Try taking 3 cycles of oral contraceptive pills ( eg. Novelon ).
Mostly the cysts will disappear, and a repeat scan should be done after 3 months.
If that fails, then further drugs like Danazol , GN rh family drugs ( that suppress menses ) are available for treating it.
IF all medical management fails, only then repeat surgery should be done, and this time the removed tissue should be definitely sent for biopsy.
4. Unfortunately, endometriosis is a disease of recurrence, so there is no way to ensure that it does not happen again.
She can take hormonal therapy for a while until she gets married and completes her family.
5. Yes, it is possible that when the menstrual cycles resume, the cysts will recur.
6. None of the vitamins will bring about a complete cure.
7. There is no need to get progesterone levels measured, they are not relevant here.
Hope my answers have helped you, SIr.
PLease feel free to discuss further.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1.The biopsy report said---no evidence of malignancy seen
2.3 cycles of OCP---please clarify what it means
3.what is hormonal therapy and when and how it should be taken
4.does she run a risk of infertility,or ovary removal or any other major risk?
5.please advise what to do immediately and when to begin hormonal therapy
6.if after 3 months of OCP,the cyst disappers,then what is to be done after that
7.By repeat surgery do you mean cyst removal through laproscopy?
8.what will be the physical effects of 3 cycles o f OCP.will it cause a problem in her work and job?
2.3 cycles of OCP---please clarify what it means
3.what is hormonal therapy and when and how it should be taken
4.does she run a risk of infertility,or ovary removal or any other major risk?
5.please advise what to do immediately and when to begin hormonal therapy
6.if after 3 months of OCP,the cyst disappers,then what is to be done after that
7.By repeat surgery do you mean cyst removal through laproscopy?
8.what will be the physical effects of 3 cycles o f OCP.will it cause a problem in her work and job?
Brief Answer:
All clarified.
Detailed Answer:
Hello again.
Thank you for the update.
1. It is not malignancy, I wanted to know if the biopsy report confirmed endometriosis or a chocolate cyst. Can you upload the report ?
2. OCP - oral contraceptive pills - hormonal pills. I meant that she should take 3 months of these pills, they are known to act upon endometriosis.
3. Hormonal therapy is a wide term . First step is OCPs as I explained above. Then stronger hormones are the next line of therapy. They are tried for 3 months duration each.
4. Yes, she does run the risk of difficulty in conception later on in life, the ovaries too might have to be removed or they might be reduced in size later on in life. Sometimes, endometriosis gets very advanced in later age to involve bowel or bladder. For patients with endometriosis who desire children, it is best to complete their families at a younger age when the disease is under control.
5. Immediately, she should start OC pills from day 2 of her next period - for 3 months. Then get a repeat scan done, and let me know the report.
6. If the cyst disappears, nothing has to be done except monitoring her by ultrasound scan every 3 months.
7. Yes, I mean a repeat laparoscopic surgery if possible.
8. The OCP will not cause any problem in her life or work or job. Lots of women take it for years together without any issue. There will be almost no physical effects for her, they are quite safe.
Hope I have clarified all your doubts.
You can reach me directly anytime, using the following direct link -
http://doctor.healthcaremagic.com/doctors/dr-aarti-abraham/64623
Take care.
All clarified.
Detailed Answer:
Hello again.
Thank you for the update.
1. It is not malignancy, I wanted to know if the biopsy report confirmed endometriosis or a chocolate cyst. Can you upload the report ?
2. OCP - oral contraceptive pills - hormonal pills. I meant that she should take 3 months of these pills, they are known to act upon endometriosis.
3. Hormonal therapy is a wide term . First step is OCPs as I explained above. Then stronger hormones are the next line of therapy. They are tried for 3 months duration each.
4. Yes, she does run the risk of difficulty in conception later on in life, the ovaries too might have to be removed or they might be reduced in size later on in life. Sometimes, endometriosis gets very advanced in later age to involve bowel or bladder. For patients with endometriosis who desire children, it is best to complete their families at a younger age when the disease is under control.
5. Immediately, she should start OC pills from day 2 of her next period - for 3 months. Then get a repeat scan done, and let me know the report.
6. If the cyst disappears, nothing has to be done except monitoring her by ultrasound scan every 3 months.
7. Yes, I mean a repeat laparoscopic surgery if possible.
8. The OCP will not cause any problem in her life or work or job. Lots of women take it for years together without any issue. There will be almost no physical effects for her, they are quite safe.
Hope I have clarified all your doubts.
You can reach me directly anytime, using the following direct link -
http://doctor.healthcaremagic.com/doctors/dr-aarti-abraham/64623
Take care.
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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