Ovarian Cyst Decision: Watch or Remove?

Many times a small, thought to be benign (non-cancerous) cyst is found on a routine pelvic examination , a check up for yeast,  a pelvic examination for a urinary tract infection, or a test being done for another medical problem: like a CT scan for suspected kidney stone or bowel disease. Most of these ovarian cysts will resolve on their own and do not need further treatment. But your gynecologist will want to watch to make sure the cyst in fact does resolve. For young women who are under the age of 40 and in whom the ultrasound looks like the cyst clearly has a less than 1% chance of being cancer the correct treatment in most cases is going to be a wait and watch approach. It’s important for women to realize that the watching has no firm time sequence, but  is still important as rarely do benign cysts transition into cancerous ones, and it’s important to be watched for any signs of this however remote a possibility it is.  All physicians will agree that you need to have a repeat checkup within 6 months to be sure the cyst is gone, many will want to repeat the ultrasound in 3 months.  If your case is such that it seems clear that the cyst has been around for awhile even a 4-6 week follow up appointment is reasonable. Screening for endometriosis, by pelvic exam, tubal pregnancy by a HCG blood test, or pelvic infections, by cultures, can also help to be sure that the cyst is not actually another gynecologic problem.  Most physicians recommend following the cyst until it is gone. But there is a growing group of gynecologists that feel that once the cyst has not changed over a long period of time, if it doesn’t appear to be cancerous, if any blood tests done (like CA 125) are normal and have stayed normal, and there are no symptoms whatsoever, you can choose to not have any surgery at all. Often these cysts turn out to be something completely different than an ovarian cyst: they could be a paratubal cyst or the presence of scar tissue in the pelvis. For women who can take a birth control pill, the pills we have will not dissolve a cyst. If you have mild symptoms of discomfort or irregular bleeding then going on pills may help to straighten out the bleeding or even partially relieve pain while waiting for the cyst to resolve so that you can avoid surgery.  On the other hand, if you are not hurting, if the cyst has not burst, and if the cyst has not begun to bleed; having the cyst removed surgically can help prevent those problems. As with the other gynecologic issues we have discussed, you do want to talk to your gyno to make your own decisions.

Comments

  1. For women who can take a birth control pill, the pills we have will not dissolve a cyst.ovarian cyst

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  2. For wome with irregular bleeding and with pain symptoms newly starting on a birth control pill when a ovarian cyst is discovered may still be a good choice for overall management of your case. The reader, however, mentions excellent point about the nature of oral contraceptive pills: they prevent future ovarian cyst formation, but are thought to not be able to medically treat a current ovarian cyst. Years ago when contraceptive pills were stronger, and in the days prior to the use of ultrasound, we told women that pills could resolve a cyst. But pills are safer and have better cycle control and fewer side effects with lower hormone dosing. Thanks for the comment!

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