Are ovarian cysts normal after menopause?What should I tell gyn to do if he cannot do

My gyn has recommended a LSH BSO for me. I am 63 and have a 3cm cyst on one ovary.I want to keep my cervix for pelvic support,and because my pap tests are all normal,and my mother complained her whole life that everything was falling out after her surgery.

He said the cyst would not be alarming if I were younger,but at my age the cyst should not be there.

My maternal grandmother died of ovarian cancer at 66,so I am a little scared.

Two years ago I had post menopausal bleeding and large fibroids. I was taking activilla(HRT). I went off the HRT and the fibroids shrunk and I had a D and C which stopped the bleeding.

After the fibroids shrunk they could see the ovarian cyst.

My question is,"Should I just remove the one ovary or do nothing?" Is there much chance the cyst will become cancerous?

My gyn has told me that if he can not see well enough with the laprocrope he might have to do a supracervical hysterectomy (SAH)+BSO or he might just remove the ovaries and leave everything else. He will consult with my DH while I am out.I am not sure what to tell my DH to tell the doctor.

The problem with only removing ovaries, I could not take estrogen if I still had the uterus. The fibroids would probably grow again.I have been having hot flashes since I went off HRT two years ago.

I have been told that I have a tilted uterus,and I am wondering if this will make it harder for him to see. I know doctors have to prepare you for all kinds of possibilities so I am wondering what are the chances he will back out on the LSH and have to revert to a SAH or BSO only?

If a decision has to be made should I tell my husband I want him to only remove the ovaries, or should I have a SAH complete with the long recovery just so I can go on HRT again ?

I do not want to go through the long recovery,because of other family responsibilities.
Maybe if he only takes the ovaries I will get over hot flashes eventually.(when I am 100). Also I think estogen helps your heart,bones,brain,skin, etc. so that is why I wanted to be on the patch.

I wonder if he is just giving me all scenerios or if there is a chance he will not be able to see with the laproscope and abort the plan.

Should I look into the davinci or should I look into a center for endometriosis where the doctors have lots of experience with the laproscope?

I asked the gyn if he had had experience with LSH and he said he did one last week. He is very smart and with a very reputable group,so I doubt he is not being honest.

Maybe I am just getting cold feet. I honestly feel great now(except for occassional hot flashes),but then again there is that ovarian cancer family history and I am 63.

Help,Please advise me. Surgery is scheduled for next week so I must make a decision.

This is so confusing.

Hi Hot mimi,
It sounds like you have lots of unanswered questions yet. If you were me, I would try to get as many of my questions answered before consenting to surgery and sometimes that means a second opinion.

Most ovarian cysts are benign. Does your doctor suspect cancer? It sounds like he has some question. A couple of tests that he may want to do are a transvaginal ultrasound and a CA 125 blood test. The ultrasound can show them the characteristics of the cysts which can give clues as to whether it is benign or not. An elevated CA 125 indicates it might be cancer although it is not a definitive answer. With the questions of the cysts and with the family history of ovarian cancer, you may want to have a consult with a gyn/onc and he can have a better idea of what kind of cyst this is.

I do agree with you that maybe your doctor is giving you all possibilities of what he may be looking at so you and your husband can discuss and decide what you want to do in each scenario.

If you don't want to put off your surgery so you can explore options and get your questions answered, could you go for an exploratory lap and after this discuss the findings and have further surgery when you know exactly what you are looking at?

s
Jane

Jane,

I thank you for your reply.
I am sure the doctor is considering BSO in part due to the family history(maternal grandmother with ovarian cancer.)
Also,my age 63 being a secondary factor.
He said many people would want to have their ovaries out just based on family history.

Two years ago I was scheduled for a hysterectomy. I was in pain from large fibroids,blood clots etc.
At that time I went for a secondary opinion to a gyn/onc.
After consenting to surgery on the operating table I asked him to do a d&C only. I also stopped HRT. Low in behold fibroids shrank,no more bleeding.

It is my experience that surgeons want to do surgery,so it is hard to get an unbiased opinion.I thought about going to the center for endometriosis where the doctors have much experience with labroproscopic surgery and LSH.(there was a link on the hyster/sister web site). Since surgery is what they do,they probably would recommend surgery,but they would have had lots of experience in laproscopic surgery.

Are many regular ob/gyns doing laprocropic surgery now? The other two older OB/GYNs did not do it. Would it be better to find just a GYN? I believe this LSH surgery has only been around 5 years.

Now two years later, After my last two gyns have retired. I go to the ob/gyn who delived my grandchild. My daughter loves him.

Being as OC is a "silent killer" I can understand his thinking.
He says the CA125 test in inconclusive,so he did not do it. The ultrasound showed a 2 to 3 cm cyst on one ovary.(not a concern if I was younger he said)

I am leaning toward having him just take the ovaries. He will surely have no trouble seeing these. and doing this laproscopically. Then if there is cancer, remove everything anyway possible.Do I really need ovaries anymore? I would like to get rid of the uterus as well as latest finding on estrogen say it is OK to take it after a hysterectomy if uterus and ovaries are gone.(it helps bones,heart etc)

Both my aunt and Mom had hysterectomies(younger than me) due to fibroids, Mother complained about prolapse(bladder incontinence) rectal prolapse all her life.

I think I will tell him to remove the ovaries,plus the uterus if he can do this laproscopically and can see exactly what he is doing. If not leave the uterus in tack for now.I will just have to not take estrogen,but maybe this is OK. I could rethink it

I would hate to undergo a TAH now because of the recovery time. I have a sister with cancer who I take care of. She has a rare cancer which at first was diagnosed as a fibroid. Later it was found to be a GIST(attached to the small intestine)so the gyn/onc called in a colon surgeon.

I know that I have put off thinking about this,and now I am wearing the red arm band and scheduled for surgery on Thursday morning.

The only time I could get a second opinion would be Tuesday(maybe),but with whom?

I could call in sick and cancel surgery,but what if it is cancer?

Perhaps I could call his office and ask him if he is recommending surgery only based on age and family history or does that cyst look cancerous?

Well,he said ,"it didn't look terrible!" What does that mean? Doesn't look cancerous? He said it wasn't normal to have a benign cyst at 63. If I was younger this cyst would not be a problem. Is this true? Do older people get benign ovarian cysts?

I am so sorry for all this long email. It seems my life is so hectic taking care of my very sick sister. I am scheduled to take her to New York in two weeks to try a clinical trial. It seems I am much better at taking care of other people than myself. The funny thing is my grandmother was the same way. She kept putting off her hysterectomey until it was too late.

Help, I am going crazy

It sounds like you are sorting through some of your questions. I can not answer how many do LSH's as the reason for my hyster was "more than likely" ovarian cancer so had the abdominal surgery with vertical incision.

There are characteristics they look for on the scans of the cysts. My family doctor said they could see signs of necrosis in mine which was a red flag. If your doctor is not seeing the characteristics they look for, that is good.

The CA 125 is not good at diagnosing cancer, but it does come into play if there is cancer and it helps in determining whether treatment is working. Mine dropped a long ways following surgery and then more following treatment.

One thing to ask your doctor is what he would do if the cyst shows it is cancer. Would he do what is called a frozen section right away and proceed with the necessary debulking surgery, close and have you undergo further surgery with a gyn/onc, or if he continued that same day would he call in a gyn/onc.

I know that the call ovarian cancer the silent killer although they are confirming that there are symptoms. Here is a site with further information there: http://www.ovarian.org/

I understand that you have the responsibility of taking care of your sister, but if you don't take time to take care of yourself, who will take care of your sister if you don't care of things when they are "small" problems instead of waiting until they are "big" problems?

At the very least, could you make an appointment with your doctor, ask for a long appointment so you can take your questions to him before surgery.

http://women.webmd.com/tc/functional...s-what-happens

from another site I found this:
In the US: Ovarian cysts are found on transvaginal sonograms in nearly all premenopausal women and in up to 14.8% of postmenopausal women. Most of these cysts are functional in nature and benign.

I am sorry I can't answer any of your questions, but it looks like you have been doing some thinking "out loud" here which can help you sort through your questions.

s
Jane

Jane,
Thanks for your advise.
I will call the doctor tomorrow.
I probably could not get an appt before surgery,but he will return my call I am sure.
Do you think it would be better for him to go ahead and debalk or just send me home to see onc/gyn if he does a frozen section and finds cancer.

How soon can they tell if it is cancer?

How large was your cyst?

I am sure that I will have more questions if it turns out to be cancer.

If he finds it is cancer, it is better to have a gyn/onc do the debulking surgery.

When they do a frozen section, they send the tissue to pathology while you are still in the OR and once they receive the preliminary path report, proceed with the surgery based on the findings. My final path was in two days later. If they don't do the frozen section, it would a few days at the least when they have the results.

My cyst was 17 cm, yeah big. I was having a few problems about 2 weeks or so before. The cyst had divisions in it and showed signs of necrosis. My Family Doctor, the Gyn and the Surgeon in my office did not want to touch it so I was sent on. It was less than a week later that I had my surgery.

At this point, ask your doctor about different scenarios and then proceed as if this is benign. IF it should be cancer, we can deal with that at the time. It is nice to be prepared, yet we don't want to borrow trouble if there is no trouble.

Another thing to remember is that there are about 20,000 to 25,000 new diagnosis of ovarian cancer each year. While none of us want to be find ourselves in that number, the odds of being diagnosed with it is pretty low. It accounts for about 3% of cancer in women.

I was reading this site and it sure seems as though you are well versed and are giving some good advice. I would like to ask you about something else. I also had TAH/BSO, same reasons as you and also cyst was 18 cm.
Mine was 11/26/07. I am 55 and had already been thru menopause the year before. I work, keep in fairly good shape. My concern is that I am still having abdominal pain usually right side, over 7 weeks post op.
My cyst ruptured during surgery and they did a lot of cleaning and suctioning, I imagine as I was under 4 hours. 7 wk. PO eval, doc said I looked OK. Any cause for concern?