What Is The Cause And Treatment For Complex Ovarian Cyst?

Posted on Thu, 10 Jul 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 10 Jul 2014 Answered on

Fri, 1 Aug 2014 Last reviewed on

Question : I am 47 years old. I went without a period for 4 months. During that time I had two incidents of post coidal bleeding. I went to Ob-gyn, had ultra sound and found a complex ovarian cyst. She said I was perimenopausal and also wanted to wait a few months to see if cyst went away on it own. It has not. I started my periods again and they have been monthly and have not had any further post-coidal bleeding. Dr wants to perform a hysterectomy when she removes ovarian cyst because of my "history of irregular bleeding". I'm not convinced that I need a hysterectomy. what do you think?

Answered by Dr. Vasudha (7 hours later)

Brief Answer:
Surgery needful ,extent decided at operation

Detailed Answer:
Hi XXXX
Thanks for the query.
I understand your concern.
As your doctor has rightly said, most of the cysts resolve within 8 to 12 weeks or 3-4 menstrual cycles. If it does not resolve, it may grow/ turn in Complex cyst.-where it develops multiple sections & may give rise to sister cysts.In such cases usual strategy for treatment is-
* -Watchful waiting . The cyst is observed regularly by-
USG/CT scan
Blood tests ((Ca125) test to exclude malignancy,
* Till the time the USG shows a clear fluid filled cyst/ it is not growing/ asymptomatic/ blood test is -ve-the surgery can be postponed, Along with hormonal pills to if indicated.& other drugs to improve general condition
* - Persistent cyst/ growing/ invading other pelvic organs needs to be removed surgically.
Surgery- Usually starts with opening the abdomen, followed by observing the cyst &
- Removing cyst alone.
- Removal of ovary along with cyst-to avoid chances of recurrence.
- Cyst removal along with removal of uterus, & ovary as per need -in case the cyst has started invading uterus & other female organs. ovary,
The removed organs are sent for histo pathology.
** I would advise you to believe your doctor She will definitely do the best for you in given situation.
Please be brave,you will be out of the problem with expert treatment.
I hope, the answer helped you in taking decision
Any follow up query is welcome.
Thanks.
.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Vasudha (11 hours later)

I understand the cyst situation and I'm going to have it removed along with the ovary. My question is regarding the hysterectomy. Her reasoning for the hysterectomy is because of irregular bleeding and has nothing to do with the cyst. Since I have had no other irregular bleeding in the last 6 months do I really need a hysterectomy???

Answered by Dr. Vasudha (2 hours later)

Brief Answer:
Irregular menses alone don't indicate hysterectomy

Detailed Answer:
Hi,

Thanks for the follow up query.

- Irregular Bleeding you had can either be pre menopausal / symptom of ovarian cyst. These will be controlled either by menopause itself/or after removal of cyst with ovary.

- It's good that You don't have irregular bleeding in last 6 months. nor you have history of profuse bleeding in periods.
* Only point of concern here is that, sometimes( 1-2 % cases) the complex ovarian cysts can turn malignant in menopausal age.specially so with family history of ovarian cancer.
* But as long as the ovarian cyst does not have irregular borders/ it does not invade nearby organs ( this can be observed/confirmed while performing operation) & ( Ca 125)cancer antibody test is -ve ,you just need removal of the cyst & ovary ( to avoid recurrence).as rightly decided by you.
* Mere history of irregular periods can not be indication for Hysterectomy along with removal of cyst & ovary.Uterus can be preserved with above said precautions.

I feel the answer helps you. In case you have any follow up query I will be happy to help.
Thankyou.

Above answer was peer-reviewed by : Dr. Raju A.T