For a brief history, I am 24 years old. No history of gyn problems prior to 7 months ago. Initial symptoms included pressure and fullness in abdomen as well as strong/severe pain in the upper abdomen just below the rib cage. I also experienced constipation and nausea. I was diagnosed with IBS after a lot of result-less tests. Urinary symptoms (urgency and frequency) followed along with spotting and mid cycle bleeding. Yesterday I had a pelvic ultra sound that showed a complex ovarian cyst on my left ovary. The cyst shows signs of bleeding. I don't understand what any of that means. My doctor has written a script for a new birth control pill and has scheduled an appointment for a follow up ultra sound in 6 weeks to see if the cyst has changed.
In my own research today I have found that all of my symptoms match with ovarian cancer symptoms and that complex cysts should be taken seriously. I am nervous about waiting another 6 weeks to follow up on this, especially since I have been having symptoms for the last 7 months. What should I do? Do I need to see a specialist? I am very confused and I don't know what the next step should be. Please help with advice!
I would try to get a second opinion if you're not comfortable with this doctor. I'm guessing it wouldn't be hard to get referred to a specialist with the symptoms you've had. Might give you some peace of mind. Good luck!
The doctor is my primary care doctor, a family practitioner. There have been no other tests run or ordered, I was just told to wait and see the results of the next ultrasound in six weeks. I guess getting a second opinion sounds like my only option other than waiting.
I am very sorry to hear that you are going through these worrisome symptoms and as difficult as it is at the moment, you need to try to keep a level head. Panicking will only aggravate the gastrointestinal symptoms that you are experiencing. Perhaps I can give you some advice which may help.
1. I would suggest that you first get a copy of the ultrasound report and read it for yourself. What kind of complex cyst do you have ? Cysts come in a wide variety of types and sizes and doctors are supposed to give their impressions of what they are seeing at the end of the report. Radiologist / gynecologist impressions of cysts on ultrasound are quite accurate and they can usually tell what is contained inside the cyst just from the ultrasound. How large is this cyst ? Does it contain only blood ? Are there any septations or divisions inside ? When they say a cyst is bleeding it just means that it is bleeding into itself. Sometimes cysts do this and this causes it to be classified as a complex cyst when in reality there are no solid components, only blood (this type of cyst is also called a chocolate cyst). Most often what a cyst looks like on an ultrasound dictates whether or not it is sinister and radiologists (or gynecologists) are very good at knowing what it and what is not cancer (although this is not 100% and very rarely they are wrong).
2. If you are concerned about ovarian cancer, ask to have a cancer antigen test called the CA-125 test. This test looks for a certain type of cancer antigen which is normally present in large amounts in the presence of ovarian cancer. A reading of 0-35 is considered normal. HOWEVER, before asking for this test, you must be aware that in premenopausal women the CA-125 misses a lot of early stage ovarian cancers (false negative) AND shows high for completely benign reasons such as endometriosis or even menstruation (false positive). The test is more accurate for menopausal women and it is highly likely to show more advanced stage cancer. You must be prepared for this before asking for the test. A radiologist or gynecologist's impressions of a cyst's appearance on an ultrasound has a higher predictive value than this blood test. No one has ever computed the two together (ie. the predictive value of having both a good CA-125 plus a reassuring ultrasound .. I imagine this would be higher than either one alone).
3. Get a referral to a gynecologist if you have not already. You did not mention what type of doctor you are under the care of. Is it a general practitioner ? If so, ask to be referred to a gynecologist. If you are already seeing a gynecologist and you are concerned about waiting the six weeks, then get a second opinion and even a third if you must in order to feel secure that you are doing the right thing. Some of the other symptoms that you mention need to be addressed as well such as the mid cycle bleeding. Have they measured your uterine lining to see how thick it is ? Sometimes an overly thickened lining will cause mid cycle bleeding. The ultrasound report should tell you what thickness they found. Anything over 1 cm usually requires a D & C to clean you out and get rid of the bleeding. As for the bowel, distension issues, I imagine that you have already tried eliminating certain foods from your diet such as dairy and increasing other foods with fibre ? Probiotics are wonderful for bowel issues and you can get these in capsules as opposed to eating them in yoghurt. Metamucil tablets are fibre capsules and a few of these a day can do wonders for bloating and constipation. Just be sure to add lots of water when eating fibre because if you don't, this will have the opposite effect. Since you seem to have a bowel motility issue which does not involve diarrhea (only constipation) you may also want to inquire about a drug called Dom Peridom which speeds up bowel motility and substantially reduces bloating. I would not recommend this for the long term but temporarily, just to see if it resolves while on this medication.
Doing these three things will get you started on helping yourself to get better. I know how worrying these ovarian cysts can be, especially when in the presence of other symptoms. A couple of years ago, I began to experience mid cycle bleeding and pelvic pain around the bellybutton. When they did an ultrasound, they found a 7 cm cyst on my left ovary. It was only a simple cyst but quite large. The reason for the bleeding was eventually found out. It was due to my having been on birth control pills for about 20 years. The endometrial lining was too thin in my case and this caused the formation of varicose like veins which caused my lining to bleed incontrollably (this is called endometrial atrophy and can cause either heavy irregular bleeding or no bleeding whatsoever). Stopping the pill ended that problem HOWEVER I still had the cyst problem and I watched this thing for about 18 months while it grew and even began to form hyperechoic areas and a small solid area of a few millimetres. When it grew to about 9 cms (I had 6 month ultrasounds after my initial round of ultrasounds) it was decided that it had to come out. Last April 28th I had my left ovary and tube removed by laparoscopic surgery (I am 42 and have never wanted children so it is not overly traumatic from a fertility standpoint). The pathology came back benign thank goodness but boy did this thing cause me a lot of anxiety. I read everything there is on ovarian cysts and I can tell you that these damned things are super super common in premenopausal women and quite common in postmenopausal women as well. We form follicular cysts on our ovaries every month which contain our eggs and when they burst at ovulation time they can cause pain and all sorts of problems. Sometimes normal functional (follicular) cysts close off and bleed into themselves and this may be what you have. This is why your doctor has recommended that you wait. Oh and by the way, birth control pills do NOTHING to hasten the disappearance of ovarian cysts. This is an old belief and many studies have since proven that they neither prevent cysts (except of course normal follicular cysts, since the pill is an anti ovulant) nor to hasten their disappearance.
I sincerely hope that I have helped you a little by giving you some information. If you are not satisfied that your concerns are being taken seriously by your doctor, you need to find someone who will take them seriously. There are all sorts of things that you can do to reassure yourself such as perhaps the CA-125 test (although I personally did not want to have this test even though my doctors recommended it as I was not sure I could deal with a false positive result ... I still went ahead on my doctors' advice and fortunately both times I had the test it came out at around 6 or 7), having an internal ultrasound if your first was external and thereby doing a doppler flow analysis to see if there is any blood flowing from outside into the cyst (cancer usually creates blood flow to keep itself fed), having an endometrial biopsy to check on that uterine bleeding (as this may be due to another cause) and even getting a second opinion on the ultrasound.
You should also know that the most common form of ovarian cancer moves very quickly (within a three month period) so if you have had symptoms for 7 months, I am reasonably certain that it would not be due to ovarian cancer. OVCA is also frequently associated with ascites buildup in the abdomen (fluid) and I don't think you mentioned this as a result on the ultrasound. A friend of mine was diagnosed with this disease and within a three month period she has amassed litres of fluid in her abdomen that weighed some 30 lbs. She was unable to keep any food down and her bowels went haywire. She was in a lot of discomfort and pain.
Of course I am not a physician by any means, just someone who has had the same fears and concerns as you. But if I can offer you some reassurance, at your age, you are very unlikely to have ovarian cancer (cancer is not impossible at your age, just highly unlikely). Cancer aside though, you obviously need to have your symptoms addressed and seeking out a second opinion might be in your best interest.
Hang in there and come back and tell us how you are doing.
P.S. Don't take what you read on the internet too seriously ... try typing in "headache" and you will get brain tumour as a possible cause. Do the research but take the results with a grain of salt.
Bravo to ESTRIA! Your explanation was superb! Thank you.
I too have been diagnosed ith ovarian cysts, took Ladogal (Danocrine) and thank God my cysts disappeared.
But I am having trouble now with a bloated feeling (hard stomach, upper mis abdominal pains). Dont know if this is just due to weight gain (stopped smoking for three months now) or other issues, which I hope are not serious.
God be with us all and continue to bless us.
Hi there, just curious is upper ab pain common with cysts? I had pains on and off for yr-they thought it was my pancreas (elevated levels), but then suggested I get my ovaries checked (guess pancreas levels can be high with ovarian issues) My gyn said it would be too high up for ovaries. Now I have been having pelvic pain and bloating, going in next wk but concerned it has been my overies this whole time
I was diagnosed with the same complext cyst and has to follow up with an ultra sound august 4th of 2010. I have a lot of symptoms but i am not bleeding. My uterus a bit enlarge and twisted to the right. You are not alone.