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  • Postmenopausal adnexal cyst???

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    Old 04-11-2010, 06:48 PM   #1
    hopalong_too
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    Unhappy Postmenopausal adnexal cyst???

    I would really appreciate any help but also just any comments PLEASE!

    I had my last period last May. In September, because my Estrogen level was <15 and my FSH was 75, my doctor started me on an HRT. The hot flashes stopped instantly!! I spotted for a couple days and she said that was normal with starting the HRT. I have had NO bleeding since. She also said my FSH and Estrogen levels were definitely menopausal! I am still on the HRT (The generic form of activella).

    I have been extremely tired for quite a while now. I do have HypoT (Hashimotos) but my thryoid levels are ok. I have also had a lot of bloating, need to pee all the time and have a feeling like my period is about to come. I had a CT scan of chest, abdomen and pelvis last week to "rule out malignancy" due to high calcium levels. The doctor's office called and said all was normal with the CT ??? and there was nothing to worry about. The radiologist wrote that nothing was evident on the scan to cause hypercalcemia.

    Now to my concern..........The results from the scan (which I asked for a copy of) say there is a 23mm adnexal cyst (probably ovarian) on the left side.

    Is this not a concern in a postmenopausal woman on HRT? My mom had ovarian cancer, bladder cancer and kidney cancer! I am confused because from what I have been reading it is NEVER normal??? I know it is not HUGS but if size IS a consideration, at what size would there be concern? I have read that with postmenopause size doesn't matter.....it just shouldn't be there!

    Any comments would be appreciated. Thank you!!! Hoppy

     
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    Old 04-11-2010, 08:06 PM   #2
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    Re: Postmenopausal adnexal cyst???

    Hi Hoppy,

    Does your doctor know that your mom has dealt with these cancers? Usually, a doctor wouldn't recommend HRT if you are at risk due to heridetary issues (especially ovarian). I would call my doctors office and ask about the cyst and also question about staying on HRT treatment. I would also request a follow up ultrasound in a few months to see what may be going on. If your doctor refuses, get a second opinion and bring your scan with you. It's always better to be safe than sorry.

    Hang in there,
    Missy

    Last edited by missy222; 04-11-2010 at 08:19 PM.

     
    Old 04-11-2010, 11:12 PM   #3
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    Re: Postmenopausal adnexal cyst???

    Hi Hoppy, everyone!
    I agree with Missy's suggestions here, being it's what I would suggest for you as well.

    And I am also prone to cysts, having my left tube & ovary removed in the late 80's. What I learned is that cysts aren't anything to worry about, UNLESS they rupture (to which mine did). Plus, believe me, you'll definitely know if they've ruptured! You'll be doubled in pain, even in bed in the fetal position!

    If they get too large is also a concern, that being they're growing. So I'd watch them regularly with ultrasound as suggested. Better to know, for your own piece of mind!
    With prayers for you,
    ~Karen

     
    Old 04-12-2010, 05:02 AM   #4
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    Re: Postmenopausal adnexal cyst???

    Hello Hoppy,

    These ladies have made excellent suggestions.

    I would be even more agressive and seek out a second opinion right away. A CT scan is not the best tool for ovarian cysts. The ultrasound is. I would therefore recommend that you get an ultrasound done and seek out a second opinion. If you are menopausal and have an ovarian cyst, you may also want to request the CA-125 test which tests for a certain antigen that is usually present in high numbers when ovarian cancer is present. It is a more accurate test in post menopausal women.

    Make sure that the doctor knows of your family history and you may even want to have a genetic test done to see if you are at extra high risk for ovarian cancer (in light of your family history). Certain genes carry certain risks, such as the BRCA 1 and 2 gene (if you are of eastern european descent, you are more likely to carry these genes and more screening and prevention measures need to be taken).

    Keep in mind that most ovarian cysts, even in post menopausal women, are benign. However, it is better to be safe than sorry so rule this out. Given your family history, this would be a prudent course of action and I am frankly surprised that your doctor put you on HRT and has not investigated this cyst a little further by doing an ultrasound to get more information. Sometimes you need to fight for yourself and get the proper treatment so ask questions and be persistent. If you are hypercalcemic, they need to find out why, especially if this is a new occurence. Sure it may be nothing to worry about but things need to be properly ruled out first.

    If you have any questions or concerns, do not be afraid to come back and bounce things off of these boards as they are extremely helpful. Many of us understand what you are going through and can offer help and support. Like IKaz, I have also had my left ovary and tube removed due to an abnormal cyst (last April). I also had a colleague and friend of mine go through primary peritoneal cancer (equivalent to ovarian cancer .. same symptoms, same staging, same treatment).

    I hope this helps a little. Most likely the cyst is benign but you cannot know with absolute certainty until it is removed (unfortunately) so at the very least you need to request an ultrasound (with a second opinion) and a CA-125 test to have more reassurance. In light of your family history, this is certainly a logical course of action. You also need to question the use of HRT as this may increase your existing risk even further.

    Take care of yourself.

    Regards,

    Estria

     
    Old 04-12-2010, 07:57 AM   #5
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    Re: Postmenopausal adnexal cyst???

    Estria, Thank you to IKaz and Missy! An extra special THANK YOU to Estria. The thoughts you provided in your reply are consistent with what I have researched.

    I was started in the HRT last September after complaining of vaginal dryness and night sweats/hot flashes.

    The hypercalcemia has been ongoing for a while now and I was certain that I must have hyperparathyroidism with high calcium/low Vitamin D and abnormally normal PTH. When my GP suggested waiting another 4 months and then retesting calcium, I thought I would prefer to seek another opinion. We have been testing calcium/ionized calcium for 1 1/2 years!! I have had SO many symptoms over this time and even tried anti depressants at one point. (They didn't help and were stopped). My PTH has always been in the 20's (normal) so no clear diagnosis!

    I had an ovarian cyst while I was still getting a period with this same GP. She had me do a CT scan, an ultrasound (in and out) and a CA125. It was only 11mm and was a corpus luteum cyst. It has disappeared as it was on the right ovary. This GP is VERY up on ovarian cysts but she is the one that prescribed the HRT.

    SO now the dilemma.....I went to the new GP about the hypercalcemia. Had multiple blood tests and the CT scan. Somehow, the calcium came back high BUT the PTH was suppressed for the first time. Could this be just an expensive lab error?? Could it be cancer? I hope to find out eventually. The 23mm adnexal cyst was reported but in the report, not in the impression. The MA told me over the phone that all was great with the CT. "I" questioned the cyst and was told the doctor didn't say anything about it. I am still waiting for a call.

    Do I go back to the original GP whom I DO like and admit that I went for a second opinion about the hypercalcemia and this was found? I will see if GP office #2 calls back about the cyst and their recommendation.

    I seem to have a lot of anxiety about my health lately!! Tests are coming back strange/out of range and the doctors are all saying everything is fine. How fine is high calcium, cysts on CT scan, heart palpitations on holter monitor, etc?????

    I am trying to be patient but seem to have to wait so long between communication. What would be a REASONABLE time frame to get further testing for this cyst?

    Once again, thank you all for your help and support. Hoppy

     
    Old 04-12-2010, 08:35 PM   #6
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    Re: Postmenopausal adnexal cyst???

    Hello Hoppy,

    Go back and see the doctor that you feel most comfortable with. You had every right to seek another opinion and they will understand that, it's their job as professionals.

    Health anxiety comes with the peri/meno package. I think that are bodies are changing so rapidly and so many new things keep cropping up that it triggers it.

    Remember, your health matters, no one can take care of it but you. Take the bull by the horns and go for it.

    Missy

    Last edited by missy222; 04-12-2010 at 08:35 PM.

     
    Old 04-12-2010, 09:07 PM   #7
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    Re: Postmenopausal adnexal cyst???

    Thanks Missy.......

    BABY STEPS!! BABY STEPS!!

    I couldn't take it anymore. I called the GP#2 office that did the CT. I spoke to the MA and asked her if she had been able to question the doctor with regard to my question on the cyst. Hold on......She came back and said that the doctor had spoken with the radiologist and since I am still getting monthly periods, there was no need to worry as most times they just go away. I THEN REMINDED HER THAT I HAVE NOT HAD A PERIOD IN 11 MONTHS (aside from the slight spotting when I started the HRT 7 months ago). I also REMINDED her that my Mom had ovarian cancer. Had to hold again......She came back and said the doctor says it is not that far out from cessation of menses and she would do a followup ultrasound in 4-6 months if I still have symptoms. I then asked if it would be possible to have a CA-125 blood test drawn. You guessed it........Hang on again!! Yes but they wouldn't get the slip to the lab until tomorrow!! I told her I would come and pick up the slip today and have the blood drawn today. I did!

    I don't know if I like the communication aspect of this office! Anxiety level is building but I will wait to see the result and decide what to do from there. I don't really want to wait 4-6 months. I know the CA-125 is not a definite positive/negative so when it comes back negative, I will have to decide how to ask for more testing........Thanks for listening.........why does it seem like things are so hard and I have to do all the running around and following up.....what the heck does someone do who is too sick to do this (probably just get lost in the system)

    Last edited by hopalong_too; 04-12-2010 at 09:07 PM.

     
    Old 04-13-2010, 11:57 AM   #8
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    Re: Postmenopausal adnexal cyst???

    Way to go Hoppy, I'm proud of you!!! Sqeeky wheel always gets the oil!!

    I hear ya, nothing is ever easy is it.

    Keep us posted,

    Missy

     
    Old 04-13-2010, 02:37 PM   #9
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    Re: Postmenopausal adnexal cyst???

    OK so I got the result of the CA-125 and it was normal 15.5 (0-34) That is good news but it is only correct in helping to diagnose 50% of the time.

    Where do I go from here?? They want to wait 4-6 months and do an ultrasound then. Maybe I am making too much of this. I feel like calling and asking if they can guarantee that this will just go away because in 4-6 months it may be too late. And sorry won't help. Then I second guess and think I am being irrational!!

    Estria, Can you give some insight?

    Anyone else........I do SO appreciate the support.

    Hoppy

     
    Old 04-13-2010, 02:46 PM   #10
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    Re: Postmenopausal adnexal cyst???

    Hi Hoppy,

    Yes I definitely hear what you are saying and unfortunately you can never relax and allow the doctor to take care of you completely. This is something I have learned over the years.

    I agree about the communication aspect of the second physician and if it takes your going to see a third doctor then so be it. Perhaps a good approach would be to ask around and see if you can get someone who is recommended. Like Missy, I think you have nothing to be ashamed of and you should see the doctor of your choice. Also, getting a second opinion is not going to make the first doctor feel bad ... I am sure they know that we all do it.

    When my cyst was discovered, my general practitioner told me it was just a normal follicular cyst. However, at 8 cms, I KNEW this was not true so I went for an internal ultrasound and a second opinion from another doctor. This doctor told me that although it was not a follicular cyst, it was most likely benign (it was a simple cyst .. fluid filled). I then went for a THIRD opinion from a gynecologist in my area and she agreed with the second physician. I found that I also liked her way of communicating and the way she ran her office. I stuck with this doctor. Eventually I had to have the cyst removed (along with my ovary) as it kept growing but I had the utmost confidence in this physician. She is right for me and the communication aspect works perfectly. I also have it from a good source that she is an excellent doctor (skill wise) so I'm sticking with her. I am still also with my general practitioner because he is excellent as well (just not an expert on ovarian cysts since it is not his field ... sometimes you just have to know when a doctor has reached his limits and request a referral to a specialist).

    I realize that this is a general pain in the behind, especially when you are dealing with a health problem, but having a doctor you trust and with whom you can communicate is extremely important. If the first doctor is someone you have faith in but you do not agree with in regards to an issue, getting a second or even a third opinion is a perfectly viable option that you should not regret. It is your life and your health in the end. You should also not be afraid to ask for referrals from your doctor to someone who is more specialized in a certain field (for example an endocrinologist for certain lab results etc..). If a general practitioner cannot give you the answer, he or she should be referring you elsewhere so that you can pursue the problem.

    Be honest with your physician and if possible, make an appointment and speak directly to that second physician while he has your file in front of him. Just say that you need to address certain issues that were not addressed before but that are important. Write the questions / issues down before going to the appointment (I do this sometimes so that I don't forget) so that the time limit will not get in the way.

    As for the cyst, find out if it is a complex or simple cyst. If you have a 2 cm simple cyst on your ovary then it is most likely not a threat. Usually fluid filled cysts of under 5 cms are very rarely dangerous. However, you should be followed up closely due to your family history of ovarian cancer. The ultrasound will be able to say whether the cyst is simple or complex.

    Hang in there .. I hope they manage to find the cause of your calcium lab result and that the cyst ends up disappearing on its own as most of them do (even in post menopausal women).

    Take good care of yourself.

    Estria

     
    Old 04-22-2010, 08:29 PM   #11
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    Re: Postmenopausal adnexal cyst???

    I called GP#2 back 2 days ago and spoke with the MA (medical assistant). I told her I was not happy with having to wait for the ultrasound (abdominal cramps, family history, backache, bloating etc.). I seem to be very anxius about this.......menopausal symptom or not! I also mentioned that I "thought" an ultrasound might better describe the adnexal mass. She said she is not sure if it is in the ovary or on the ovary? I got a call back today that the doctor has agreed to the pelvic ultrasound (and vaginal ultrasound) and it will be done on Saturday. Today I noticed that my jeans were VERY tight. I exercise (swim and walk) every day. My waist has increased by 4 inches! The weird thing is that I have only gained two pounds! That's some bloating!

    I have also been accepted by and am going to see a new specialist about the hypercalcemia in May. This doctor only sees patients by referral and only if he decides to take the case!! I hope it's worth it! Thanks GP#2!!

    So until Saturday.......

     
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