So, I had my follow-up Transvaginal Ultrasound. From what the Technician was able to tell me, it is now a 3.8 cm Simple Cyst (was a little under 3 cm). The walls seem a little thicker, so it might have a small "complex." Is Thicker Walls a bad thing? She told me it did not have any characteristics of being a cancer cyst....normally, she said when they see a cancerous cyst there is no doubting it, and to her this looks completely benign in her eyes, but this is just her opinion as she is not a doctor. Very little Free Fluid, but again said this is normal through our cycle.
My Endometrial Walls have slightly darker coloring in some spots, which can be the Polyps that they diagnosed me with, but she was unable to say...she did say in another word, it's thicker in some ways. She doesn't see any polyps, but said that sometimes they are hard to see.
Now, Ovarian Cancer is going through my mind like crazy...Does this sound like I should be worried? I did gain a few pounds in the past 2 months (about 4), but I blamed this on my junk I'm eating (not exercising), and the birth control she put me on. I had a X-ray of the stomach and colonoscopy done back in December and nothing unusual was found except Internal Hemorrhoids. If something was wrong would something show up in one of those tests or say my blood work (cbc w/ Auto / Complete Panel, etc)?
Sorry for all the questions, just a little worried now.
I had the same thing happen with my ovarian cyst when I was watching it for that year and a half. My radiologist (I was lucky to have a radiologist do the ultrasound so I received instant feedback) said that unfortunately, these cysts have a tendency to develop thicker walls as they age. In my case, I had a thickening of a few mms in one section of the wall of the cyst and like you, I was very worried. I was strongly reassured, however, that the cyst is still considered a "simple" cyst and that it was not dangerous.
The predictive value of a radiologist's or gynecologist's "impressions" of an ovarian cyst on ultrasound is extremely high (something around the 90% range) and this is very reassuring. This means that ovarian cancer does indeed look different most of the time. Like you, I kept thinking, "But what if I am that 1-2% of the time that does not fit the text book ?" In order to give me more reassurance, my doctors recommended that I take the CA-125 blood test. I took this both near the beginning of the watchful waiting period and also just before my surgery (my cyst grew from around 7 cms to 9 cms in the 18 month period and it was getting bigger so the sucker had to come out .. along with my left ovary and tube). The CA-125 is not as reliable as the ultrasound but I figured that if I had the two together, I could be perhaps up to 95% assured that the thing did not pose a threat.
Four pounds is not much to be concerned about, especially if you can easily explain it, as you just did. A colleage of mine had peritoneal cancer (which is virtually the same as ovarian cancer) and she gained over 35 lbs in a very short amount of time (about a month). She was unable to keep anything down so she drank "Boost" type drinks to stay alive and she had a host of bowel issues. She felt tired and drained all of the time and knew that she was very sick. They drained I don't know how many litres of fluid from her abdomen (quite a bit) when she finally sought help (ascites build up very quickly when you have cancer). She was diagnosed at stage 3-4 and even with that, she had the surgery and lived through the chemo and is cancer free today (touch wood it will stay that way). I too used to freak out when I had a bit of bloating or was temporarily irregular. These feelings were actually the most debilitating part of the watchful waiting about my cyst as I was always jumping on the smallest thing.
I am surprised that your doctor put you on birth control pills. There are now many studies that say that birth control pills are no better than simply keeping an eye on the cyst (ie. doing nothing). Some women develop ovarian cysts while they are on the pill (as I suspect I did .. I am no longer on them and if a doctor tries to peddle hormones to me ever again, he or she will find themselves in the hospital pretty quick). When I brought these studies up to my doctor, he just said that this type of treatment follows a trend and currently the trend is not to prescribe them. I have no idea what the &%?$!! that means because either science has proven them to work or it hasn't and prescribing them should depend on this.
As for the endometrial lining, do you know how thick it was on the ultrasound ? Usually a thickness of 1 cm or more would require an endometrial biopsy (you may want to ask for one of these to put your mind at ease about uterine cancer if it concerns you .. it is a quick test in the doctor's office). Don't forget that if you are close to having your period your lining will be thicker than just after menses. A thickened uterus can also mean fibroids, which sometimes embed themselves inside the muscular walls of the uterus rather than protruding out of it into the empty space. The report should state with reasonable accuracy what the radiologist's impressions of this are so I would get a copy of this final report. In my own case, I know I have a 13 mm fibroid which remained unchanged throughout my 18 month watchful waiting period. Asymptomatic fibroids are harmless and I am not at all worried about mine (I call it Fred).
Try to relax and not jump to any conclusions. Get a copy of the report and if you are not reassured by this and by your doctor's advice, you can request more testing to rule things out (CA-125 for more reassurance about the cyst and perhaps an endometrial biopsy regarding the uterus). There is also the option of getting a second opinion, as I did when my own doctor (general practitioner) told me that a 7 cm ovarian cyst was "perfectly normal" and would go away in the next three cycles (needless to say, he was very quiet when it did not go away .. by then I had sought out two different gynecological opinions, neither of which said that this was a normal functional cyst ... to my poor doctor's credit, the radiologist had also said that it would go away in the next 1-3 cycles).
I hope you get the answers that you seek. Hang in there in the meantime and don't freak out. If your doctors are telling you that it is not dangerous and you don't trust the source, get other opinions until you are reassured. In my case I figured that the opinion of four doctors and about 3-4 different radiologists couldn't all be wrong. And they weren't because when I had the thing removed (due to the fact that it was starting to take up space in there) it turned out to be a serous cyst, the most common type of abnormal ovarian cyst.
I hope this helps you a little. Take good care of yourself.
Estria - As always, thank you so much for your posts, you definitely make me feel better when I read your posts! I haven't heard back from the doctor yet, The Technican said that she would have the report within 24 hours.
I did have a endometrial biopsy a few weeks ago due to my abnormal bleeding, the only thing reported was "fragments" of polyps (??). I will be having a D&C & Scope Sept 22nd.
Could the darker shading that the technican saw be the polyps showing? She said she didn't see any, but they are hard to see most times. She was very helpful, I'm sure I was driving her nuts by the time I walked out! All in all to her, it looks completely normal.
Thanks again - I will let you know what the doctor says when she calls me.
Try to get a copy of that report for yourself. Doctors will inevitably "interpret" the report and they may not always tell you what it contains in entirety. The radiologist will describe exactly what he or she sees on the film and will also give his or her impression of what is going on as well as a recommendation. This professional opinion is important and sometimes a physician will disagree and only give you their own opinion and not the radiologist's. I think that you should take both opinions into account and should therefore have a copy of all reports for tests done (endometrial biopsy pathology reports as well). I insisted on getting copies of everything and although my doctor thought this was weird at first, he got used to it and began having copies of the reports ready for me. Let me give you an example. When I had my endometrial biopsy, the report came back that the sample contained a lot of blood and that there was not enough tissue to come to a definitive conclusion. However, the tissue that was in the sample was normal. My doctor interpreted this as everything is OK because to him the lining was so thin (my endometrial stripe was something like 3 mm so this is why it was difficult to get enough tissue) that endometrial hyperplasia (which can be a precursor to cancer) was highly unlikely. The report, however, did not say this .. it said that the sample was inconclusive. Fortunately, when I went off the birth control pill, the bleeding stopped so this was definite proof that the pill had caused endometrial atrophy which in turn caused the bleeding (as further evidenced by my very bloody endo sample). If the situation had not resolved, I would have insisted on either another biopsy or a D & C in order to sample the entire lining. Since you are already scheduled for a D & C, you will be able to have a definite result about your uterine lining as the suctioned tissue will be sent to the lab for analysis. This is a very good thing. I would still ask to have a copy of the endo biopsy report in order to actually see that "pieces of polyps" is indeed what the report says. Don't worry about being a pain in the butt. It is your body and you have a right to have all of the information that is available. You are not a dumb animal that couldn't possibly understand what is going .. you are an intelligent human being who is genuinely concerned about her health. When doctors start treating me like an innocent child, I am always quick to remind them of this and voila ! this attitude disappears.
As far as I know, darker sections on an ultrasound mean that the soundwaves are passing more easily through these areas so they are less solid. I am no expert however so I imagine what the technician said has merit as she must see these things all of the time. I know that simple cysts, for example, appear black on the ultrasound because the soundwaves are passing through the liquid more easily than say a calcification which is denser and which therefore causes the waves to bounce off of it, creating a very white appearance. You probably have what is referred to as a heterogenous endometrial lining, meaning it has a varied topography (like countryside with lots of hills and valleys). This is most commonly caused by uterine fibroids and other things like cysts and polyps (although I would imagine that a polyp must be difficult to see on an ultrasound). See what the radiologist actually says about this in their report. I am sure that he or she will be able to give you the OK on this (they are very good at knowing what all of these things actually are even though they look like goopy muck to us, that's why they make the big bucks). Many women have uterine linings that are not homogeneous, especially at our age.
Hang in there and let us know what the doctor says.
Got a call. My doctor isn't in today, but another doctor called me...she said it's still a simple cyst (didn't change from last, only slightly bigger by 1 cm) ...nothing abnormal found - thickening of my lining was normal. My doctor will call me on Monday when she comes in and will discuss with me further what needs to be done. Is Irregular periods normal to have with Ovarian Cysts? My doctor said, yes this happens sometimes. I just noticed that - I'm usually right on (28 days) - since my cyst ( and slightly before) was found, I noticed they can be lighter (not by much) or a week late or early. I am going to call the hospital, and like you suggested get a copy of the Ultrasound report. This way I have it for my records. With this being as small as it is, would you suggest I get a 2nd opinion? When you went for your second opinion was it within the same office (my practice has several doctors), or did you go elsewhere? I would feel kind of odd going to the same practice....just different doctor - they would probably look at me strange. I just hate that the fact that most doctors are always acting like they are in a rush, like Hello...this is my body here!!! I am asking questions, just listen!....
She said, it's good that I am having the D&C done in September, this way they can also get a good idea of what is going on and see if anything else is found, but right now said they will most likely monitor it.
What's your opinion on all this?
Last edited by parker19341; 08-07-2009 at 08:21 AM.
A second opinion is not a bad idea but in this case, you should definitely go outside of that group. When I sought out my first second (?!) opinion, I even went to a different city to a gynecologist that was recommended by my sister in law. This person performed an internal ultrasound and gave me her own opinion. My simple cyst was much larger than yours (about 7 cms) and she told me that although she was quite sure that it was not dangerous, she was "not sure I should be walking around with that thing" (her exact words). She was concerned about possible rupture or torsion of the ovary. I felt relieved that this second ultrasound that I had done (the first was an external) was confirmed to be a harmless simple cyst and so I found another gynecologist closer to home (who I stuck with and who did my surgery eventually). She also thought it was a benign serous cyst and gave me the choice of either having it removed or of watching it. I chose to watch it for a while (I was in no rush to have surgery and wanted to avoid it if at all possible).
With cysts that are less than 5 cms and that are simple in nature, they usually do not go in for removal. There is also the chance that such a small cyst will eventually disappear on its own (yes this is still possible). Larger cysts are less likely to go away on their own (as I learned) but smaller ones most often do .. if not in the expected 1-3 cycles, over a much longer time period.
Although ovarian cysts can sometimes causes irregular bleeding, you still need to rule other reasons out for this. My ovarian cyst definitely did not cause any irregular bleeding (even though I blamed it for my irregular bleeding) AND it also did not cause my ovulation pain (again, I had pointed to the cyst). My ovulation pain is still present even after removal of the cyst and my irregular bleeding was due to long term pill use. My cyst was therefore quite asymptomatic except for a few pain episodes which I believe occurred when the cyst grew. At these times, I experienced a type of spasm (probably the ovarian tissue stretching as the cyst grew little by little) .. these I no longer have.
A second opinion might not be a bad idea. It will confirm your doctor's diagnosis and give you additional reassurance. That other doctor is correct in telling you that a simple cyst of that size is usually monitored and not removed. Where I am, cysts that are simple and less than 5 cms are monitored and cysts that are simple and greater than 10 cms are removed. With a cyst between 7 and 8 cms, I sat in a purely grey area and I HATED this. When my cyst hit 9 cms, I guess I was close enough to the 10 cms so my gyne recommended removal (after a year and a half, the thing was still growing and it was obvious that it was probably not going away on its own). Complex cysts of any size are usually always removed in order to rule out anything sinister (although most of these are also harmless).
I hope I have managed to help a little. At the moment, I think you need to address the bleeding issue. The D & C will definitely do this. Keep in mind that sometimes irregular bleeding just happens, for no apparent reason (this is called DUB or dyfunctional uterine bleeding in the medical profession). Often a D & C ends up clearing up the problem. This occurred to my mother in her forties and her D & C fixed the problem for good. In order to get the DUB diagnosis, however, you need to rule out everything else. Irregular bleeding is quite common as women get older and it can be such a huge source of anxiety (I'll never forget how I felt when I started bleeding huge clots in the middle of my cycle .. I thought I was dying ! I had no idea at the time that many women experience irregular bleeding at some time in their lives, most likely because gynecological issues are always kept a big secret). Getting a couple of good professional opinions will help put your mind at ease I think so this may not be a bad idea.
I just spoke to my doctor (she just returned from vacation) .. She said there was no change, just that the ovarian cyst got a little larger. She gave me (2) options, continue to watch and get another ultrasound done in 3 months, or since I am already going in for a D&C (September) we can just remove the cyst as well. Told me to have a ultrasound done a few days prior to make sure the cyst hasn't changed, or if it is gone there will be no reason for the Laparoscopy.
What is the recovery time for the Laparoscopy? I was told I will only be out of work for 2-3 days, is this sufficient time to recovery?
I had some irregular bleeding, and she also said that this could be from the Birth Control pills she put me on to shrink the cyst. I did let her know I stopped taking them only b/c the cyst didn't change .... My period is about 10 days now, not heavy bleeding, but odd since I never had any spotting like this before...I am convinced it's the BC pills b/c prior to this I was always like clockwork and never had any problems.
I would plan on a full week, just to be sure, for a lap. Different strokes for different folks so you don't know how quickly your body will bounce back. In my case, I was OK to drive after a few days. The abdomen will still be tender though and you also have to wait for your body to start to have regular bowel movements etc.. Give your body the time it needs to get back to normal.
If you are interested in knowing what I went through for my lap, I have a posting around the beginning of May entitled,"My own (positive) laparoscopy experience" .. or something like this. It may give you some valuable information so that you can be well prepared and recover more quickly.
It sure would be nice if that cyst went away on its own but I totally understand if you want to have it removed and since you are already going under general anaesthesia for the D & C, you may as well kill two birds and just go to the hospital the one time. Keep in mind though that although you are able to move around and do things very quickly after this type of surgery, it is still surgery and you have to be nice to your body. Even after almost 4 months, I still have the occasional bladder spasm at the end of urination. This is going away slowly but surely and it does not impact my life drastically but it is an annoyance that I did not count on (seems my bladder liked the surgery the least).
As for the bleeding, yes the birth control pills definitely have this type of side effect and if you were on them and off them then irregular is a definite possibility. At any rate, the D & C will "clean you out" as it were so this problem is only temporary.
If you have any questions, feel free to come back and ask. I am sure that either myself of any of the other ladies that have gone through this procedure can answer anything you may throw out there (probably better than most physicians in some cases).
I understand Probable Polyp means they believe there are additional polyps to be found. What does Inactive Endometrium mean? Doesn't this come when you are hitting menopause? I'm 38 - seems a little early.
My TV Ultrasound showed - slightly bigger Simple Ovarian Cyst (3.8cm) like she stated. It also states;
- Uterus measures 7.6 x 3.9 x 6.3 cm - and is slightly heterogeneous - What does Heterogeneous mean? Also states my Endometrial stripe is also slightly heterogeneous.
thanks for all your help - I searched the internet, but I am guess I am not looking in the correct areas.
An inactive endometrium is an endometrium that is not being stimulated by hormones to develop a hospitable environment for an egg. Such an endometrial lining is usually very thin (usually 5 mms or less) and it is also referred to as an atrophic endometrium.
When I began to have episodes of heavy irregular bleeding two years ago, they did an ultrasound, and found my endometrium to be extremely thin (around 2 mm) and my bleeding was caused by atrophy. In my case, I had been on the pill for over 20 years and an atrophic or inactive endometrium is a side effect of long term pill use. Normally women stop getting their periods when this happens but in my case, the thin lining became fragile and developed varicose or more like hemmorhoid like veins which began to cause more bleeding instead of less. When I went off the pill, my cycles returned and my periods became normal (since I was off the pill, I was now having real periods and therefore my endometrium began to function again, fortunately for me).
Usually menopausal women have inactive / atrophic endometriums because they experience a drop in estrogen and this hormone is usually responsible for proliferating the lining of the uterus. In contrast, women who are estrogen dominant or who are menopausal and taking estrogen only hormone therapy may experience a heavy thickening of the lining which can in turn lead to endometrial hyperplasia and possibly endometrial cancer.
In terms of uterine cancer, a thin endometrial stripe is usually a very good sign and this is why the birth control pill has been implicated in reducing uterine cancer risk (because it keeps your lining very thin). If you have been on oral contraceptives, it is very possible that this ultrasound finding is due to this and not to the fact that your endometrium is actually inactive. Ask your doctor to explain this for your particular case.
As to the heterogeneity of the lining, normally a heterogeneous lining is due to polyps and mainly fibroids. For example, I have a 13 mm uterine fibroid which would make the walls of my uterus appear slightly heterogeneous (meaning the thickness is not uniform throughout). If you have endo polyps and possibly fibroids (most women have fibroids, especially as they get older) this would explain the finding.
I hope this helps explain things a bit. I guess the radiologist did not actually say how thick your endometrial stripe is ? Usually a lining of less than 1 cm is OK and of course this changes as your cycle progresses, being thicker just before your period and thinnest just after. Linings of more than 1 cm are usually looked into with endo biopsies or perhaps D & C's in order to test for possible endometrial hyperplasia (where the cells begin to change slightly) which can be a precursor to uterine cancer.
Sounds like you are OK. I am sure that the D & C will give you more definitive reassurance, as will the removal of the ovarian cyst if you opt for that route.
Take care of yourself and don't be afraid to come back and ask more questions.
It does state how thick my endometrial stripe is - currently 0.8 cm thick. I am guessing this is pretty normal.
I was on birth control for (2) months - since the first ultrasound in June, but since the follow up in August I decided to stop taking them. I had my tubes tied, so I really don't need anything. Since everything I read, they normally don't help with shrinking the cyst and this so happened to be my case. I asked my doctor why my cyst got bigger, and that they don't know why it happens, but she did say sometimes she seen cysts get bigger and slowly disappear and get smaller. Hopefully I can get my cycles on track now that I stopped taking the pill.
Yes 8 mms is a normal thickness and I am not sure why the radiologist said that this was an inactive endometrium. Perhaps when she asked you where you were in your cycle, she then expected a particular thickness and she saw something thinner than that. If you were on the pill at that time, this makes sense as the progesterone in the pill keeps the lining thin and "inactive" (the period from the pill is not a real period, just a withdrawal bleed).
You are right about the pill and ovarian cysts. They are now known to be ineffective at shrinking cysts and this medication used to be used in the 1980's and early 90's. The idea being that by stopping ovulation, the cyst will regress back into the ovary. Then they conducted some studies and realized that the pill is no more effective than watchful waiting when it comes to cysts. They also don't believe that abnormal cysts can be prevented with the pill (as a matter of fact, mine may have developed while on oral contraceptives). The reason the pill insert states that it prevents ovarian cysts is because it is an anti ovulant so it should be blocking the ovulation process and thereby keeping the ovaries from developing normal follicular cysts. Well DUH !! I guess those pharmaceutical companies must think we are idiots or something.
Believe me, I did A LOT of research on this as I was quite desperate to get rid of this thing without having to resort to surgery. I have multiple scientific studies on the subject here at home. Every study that I read states that simple cysts can be watched to see if they go away on their own. In my case, my cyst was getting bigger and it was there for such a long time, I figured that I would rather have surgery now than later, when I am older. However, my cyst was about 3 times larger than yours so you may still benefit from some watchful waiting. I know how annoying this watchful waiting can be. Thankfully, my radiologists were good looking and a good thing too because they started to recognize me when I went into the clinic for my 6 month interval ultrasounds.
Just had a updated pelvic ultrasound (she did stomach & Transvaginal - don't ask why?!?) to follow up on my Ovarian Cyst. I just got a return call from the doctor and both my ovaries are normal. I had (2) other ultrasounds done in the past and last time my Ovarian Cyst grew 1 cm (3.0) to 4.0cm. Is it possible for them to grow and then just totally disappear? I swear I am still have Pelvic discomfort, but that could always be in my head.
Unfortunately, I still need to go into the hospital next week for my D&C for my Uterine Polyps.
Estria - Wanted to say Thank you for your help during all of this! You are great!
Glad to hear that what you had were normal follicular cysts. Yes cysts can grow and then disappear. As a matter of fact, this is what happens when you begin your cycle. The follicular cysts grow until you ovulate and then they release the egg and regress back into the ovary. This is probably what happened to you. Good thing they saw this before the surgery so that there was nothing done unnecessarily. Recovery from a D & C should be faster than even a laparoscopy so this is extremely encouraging.
All the best for the upcoming surgery. My mother had this done in her forties when she was having irregular bleeding and this completely solved her problem. Hopefully this procedure will take care of everything and give you the complete reassurance that you need. In the meantime, make sure that you eat well and get enough sleep so that you are in great shape for the surgery. I still remember that when I had my surgery I had a terrible cold and this was not fun in recovery (coughing with stitches is no fun AT ALL).