Ovary Cyst -Advice please

[Mumstheword1380]

Hi,

I came into hospital 2 days ago after calling 111. I had been constipated (mostly) for 2 weeks and on the day I called 111 I had woke up in the morning feeling really sick and had stomach pains on and off. Also had a high pulse and temperature. The night before I had drank some prune juice to try and get bowels working again which I blamed for the tummy ache and sickness.

went to A&E and they thought it was constipation as infection makers were only slightly raised and everything else must have been okay. As tummy pains weren’t going away it was recommended I stay in overnight and see doctor. Saw doctor that night who said to have CT scan with dye just to see what’s going on.

next day another consultant came who thought pain was due to grapefruit size diverticular abscess. Had Ct scan with dye and when got the results was told bowels looked fine but have 5cm cyst on ovary. Was then transferred to gynaecology for blood test and internal ultrasound. Blood test was done this morning but missed the doctor doing rounds as I had another appointment in the hospital for something else.

nurses came round earlier and I asked them a few questions. Got the impression blood tests were okay. Also that a 5cm cyst would need to be removed. There was also talk of being referred to another hospital. Also scan was mentioned so thinking I’ll get that tomorrow.

can it be seen what type of cyst it is with Ct with dye
also if blood tests showed anything do you think doctor would have come back today to see me after not being there for his first round?
Really worried about it all.
also can ovary cysts cause abdominal bloating, pain even in opposite side, pain behind naval also and constipation.

thank you for reading

I had all those symptoms with a cyst, mine was a chocolate cyst from endometriosis
one was about 15cm and the other a bit smaller

The will likely plan surgery to remove the cyst and keep you maybe a little after to see how you are. Let them know if you have any other symptoms at all. The blood tests likely didn't change - so infection and inflammation markers were still high or they got lower. If they got worse they likely would have told you.

Ovarian cysts can cause abdominal pain, pain of the sides, bloating and all you mentioned. Make sure you tell the doctor all of the symptoms you're having (how long you've had them for and how intense/severe they are and whether it changes with time or activity).

The doctors likely didn't have any updates, and have a solid plan so we're fine to miss you out and will likely see you tomorrow. What was your other hospital appointment for at the time as ward round? It could be linked to this.

Have you had anything like this before, in terms of pain and symptoms? Also are you getting good pain meds - NSAIDs and opiods mainly. Are you getting any other medication? There are different 'bad' ovarian cysts (there are simple cysts that everyone women releases each month during ovulation, no issues) and then cysts which are problematic - dermoid, old blood can form a cysts called endometriomas (also known as chocolate cysts, found in endometriosis, which based on your timeline of symptoms, and it being acute, you likely do not have) and also haemorrhagic ovarian cysts and some others. They are different slightly in how they work, but cause similar symptoms, they'll be able to see what one you have in surgery.

@TheLivelyViper
thank you for your reply with so much information

I think I’m getting the internal scan tomorrow, don’t think there was time today.
Do you think I will get it removed when I’m in hospital just now or would it be a later date?
the other appointment was in outpatients orthopaedics dept, consultant had did rounds when I was there unfortunately.
I’ve had bloating in abdomen before with twinges in my right and left sides near hip bones. I thought left side twinges was bowel related. I was sure all of the issues were bowel related until the CT scan.
I had an ultrasound earlier this year, wasn’t that long ago, maybe month or so. During that was told everything was clear including ovaries (ultrasound was to check for gallstones due to the pains in right and left side)
is it normal for a cyst to grown 5cm in a month or maybe was too small at ultrasound to see?
im taking paracetamol and dihydocodeine.
sorry for all the questions.
thank you x

@beachwalkx
thank you for your reply
did you know you has endometriosis before you had a ovary cyst
also I feel as though I look pregnant with bloating, did you experience this?
thank you x

Ask them in the morning for an abdominal ultrasound and a pelvic one (not the wand) and then also a transvaginal one. Just ask them in the morning, and see if they can do it, at the very least they should add the pelvic ultrasound. Ask the nurse first thing to ask the doctors and when you see the doctors ask them as well, just say for better imaging and to spot any underlying conditions - perhaps if you have anything else, again time dependant and symptom and severity dependant an MRI with contrast.

It should be removed now, during this admission. Why don't you know this - have they not communicated a treatment plan? That's bad, and they should do that, ask to see them tomorrow (ask nurses what time ward round is) and ask about surgery to remove it and when it will be. Also ask them to go over all your bloods, what they found and what the finding each, individually mean? Again ask for the CT findings to be explained in more detail and explain all the findings (maybe check your NHS app as well to get more specific follow-up questions)? Ask about whether you'll be transferred to another hospital - if so, ask when, and to what service and whether or not they'll do the surgery for you or will it be the hospital you're currently at.

Do you have any bowel and/or bladder symptoms. What orthopedic issues do you have? Trying to see if anything is linked at all.

Yes I knew, I had symptoms for years and am disabled by it alongside adenomyosis. Ovarian cysts are not just things that happen if you have endometriosis, however chocolate cysts called endometriomas happen commonly with endometriosis (it doesn't mean you definitely have it) and you may have a different type of cyst (dermoid or haemorrhagic or another one). Ask your doctors what type of cyst they think you have.

Are you symptoms just on your period or elsewhere during the month? (Because if its just on your period, unlikely to be endometriosis). What symptoms do you have during your period? And if you have symptoms not on your period - what are they? Is the pain worse on or off period?

If you had a transvaginal and/or pelvic ultrasound normally it can pick up adenomyosis (different condition).

You likely don't have endometriosis or adenomyosis based on what you said because it's been acute pain, you haven't had symptoms across your life or for a chronic period of time that you would if you had an underlying chronic condition.

Even with endometriosis symptoms (they are very broad, can be bowel or gasto issues or even PCOS and ovarian cysts or fibroids which aren't chronic and can be taken out and normally after that you're fine). There's also dysmenorrhea (heavy bleeding and painful periods with no condition or cause) where you have symptoms but no condition as you don't have all the symptoms. Only go for a primary dysmenorrhea diagnosis once everything has been checked in surgery as well or pain resolves with the contraceptive pill, low-dose NSAIDs and/or opioids - as then you likely have primary dysmenorrhea or asymptomatic/less painful and sevre endometriosis and/or adenomyosis.

Secondary dysmenorrhea so a condition e.g endometriosis or adenomyosis causing it. You will need to try NSAIDs and mirena/pill and Tranexamic acid first before any further scans like a transvaginal ultrasound, ( and also an abdominal ultrasound, a pelvic ultrasound and sometimes a urinary tract ultrasound) and MRI with contrast. Often if the pain is significantly reduced with said treatments its more likely (not 100%) to be primary dysmenorrhea. Also Also very dependant on whether you only have symptoms on your period or across the month as to whether you have primary or secondary.

Then if ultrasounds pick up on anything (pelvic ultrasound or transvaginal) you may need to have an MRI to see endometriosis. However, the only way for definite diagnosis is a laparoscopy and then they will often excise the endometriosis tissue if they find it etc. But endometriosis is a chronic illness and cannot be cured, after surgery it will grow back, it cannot be excised from everywhere to leave organ functioning intact and then post-surgery adhesions often form.

The main symptom of endometriosis is not actually period pain because endo is not a period condition - it's a whole body inflammatory condition where the endometriosis tissue even produces its own oestrogen and the pain is felt throughout the month not just when on your period. Often endometriosis on the ovaries can form cysts containing old blood called endometriomas (also known as chocolate cysts) which can be very painful. But you can have endometriosis without having these cysts, it's only more common in people with endometriosis.

But you could also be adenomyosis where the lining of the womb grows into the muscle of it, but unlike endo is localised to the uterus only. Thus, symptoms are mainly a couple days before a period and during your period. Main endo symptoms:
• Irregular or heavy periods
• Pelvic pain
• Pelvic pain on opening bowels (dyschesia) and wider gastrointestinal symptoms (diarrhoea amd constipation)
• Pelvic pain on passing urine (dysuria) and bladder symptoms sometimes
• Referred pain to the tops of the legs or back
• Fatigue

Crucially you can still have endo even if they don't see it on the scan, the only clear way for diagnosis is a diagnostic laparoscopy and then mangagement can look like pain medication depending on how severe your pain and symptoms are (can be opioids, NSAIDs) and contraception and hormonal treatments (gonadotrophin releasing hormones).
The links below have much more detailed and useful information.
https://www.leedsth.nhs.uk/patients/resources/endometriosis-2/

https://www.nhs.uk/conditions/adenomyosis/

@TheLivelyViper
thank you. I’ll definitely mention the scans in the morning and see if it’s possible.

the last information I had was bowels looked clear but the 5cm cyst was ovary so moving to gynaecology to get blood test with a marker which looks for cancer I think and the internal ultrasound. Had blood taken this morning but haven’t spoken to anyone since the doctor last night, apart from the nurse this evening who in so many words (I think) said bloods were okay and she mentioned the other hospital but I think this was for discharge purposes and also the mention of removal because it’s 5cm also seemed to be for a later date but the scan tomorrow.
tje hospital that was mentioned is an outpatient hospital but has a gynaecology dept in it.
im in Scotland, we don’t have the NHS app unfortunately.
Will definitely try and ask for those tomorrow.
bowel issues are the bloating, not being able to go to the toilet properly, little pressure in groin area, pain behind belly button area including sometimes with movement and the pains I’m left and right sides
thank you x

I'd ask for them to either do the surgery to remove it now or transfer you to the other hospital where they can do the surgery - before you say that ask if the other hospital can ever do the surgery? They will tell you to wait (estimate how long you've had it from your symptoms, not just the acute and very painful constipation, as it was likely there months before).

So tell them it's been there for almost a year (looking at the ultrasound you had last year), it's getting worse, and explain how it's impacting your life, really emphasise how pain it is. If they say it may go away itslef - tell them that it hasn't for around a year likely, will likely grow as it has been and get worse for you.

Considering how bad the bowel issues are you may have another issue there or the cyst is affecting the bowels more than scans show. Ask for the scans and see what they find - if it's a lot from the scans or something unclear, ask for an MRI with contrast. Again ask to know what specific blood tests they did, what they found and what the findings show. Then tell them all your bowel symptoms and ask whether they can prescirbe osmoic laxatives I think or bowel specific meds and perhaps see a gastrointestinal doctor (perhaps the SHO) to see what they think. Hope the pain isn't too bad, if it is tell them.

Yes, if an ovarian cyst is causing pain it needs removing. The most likely reason for pain with this would be that it's twisting your ovary. They can sort themselves out but, once it has twisted, it will do it again. You really don't want an ovary in full torsion, it's agony.

Sounds like they're looking for other reasons for the pain - they won't want to remove your ovary if it isn't hurting you or malfunctioning. It will probably have to come out at some point, though, so may be best to do it now if that's available. It's important to find out where your pain's coming from: it's good that they're doing all these tests!

Sorry you're so uncomfortable. Wishing you a straightforward diagnosis and easy treatment.

Op, everything you’ve mentioned symptom wise are the very reason women are advised to go to the Dr if they experience any of those symptoms as very often they are due to an ovarian cyst.

You’re in the best place to have your cyst sorted out and I wish you a speedy and comfortable recovery. 💐

Gynaecological issues can cause changes to urinary and bowel function. When I had a post menopausal bleed the GP asked lots of questions about it.

Nope I wasn’t diagnosed then, and yes I looked very pregnant with it

How have you been getting on today @Mumstheword1380? Hope the scans have gone well and you had a good chat with the doctors.

@TheLivelyViper
Hi, thank you for asking how things are going.
Saw the gynaecology consultant this morning but I’m still under surgical but haven’t seen them since being moved here 40 hours ago. The gynaecology consultant asked me what’s happening/how I’m feeling.. still to get the scan. Just spoke to one of the nurses who said one of the junior doctors is just back from surgery and she would ask him to come and speak to me that’s who’s doing internal scan but needs consultant to be there as training. At this moment still not sure x

Have you had the scans yet or not? If so do you know the results etc? Being on the surgical assessment unit (I assume you are isn't bad and gynaecologist are surgeons and as long as they see you it's fine). Make sure you emphasise everything you talk to the doctors the impact the oaina and symptoms are having and press them on the scans and surgery. You have to be your own advocate, but hoping progress has been made today.

@TheLivelyViper
i got my scan this evening. There is a cyst on right ovary and it’s 6cm, I was shown it on scan and it looks larger than I imagined it would. The consultant wasn’t concerned by its appearance but also found endometriosis. Tried to see left ovary but was too far out the way for the probe. Was asked if I wanted to go home and then have follow up later. I then mentioned how I’ve not been able to go to toilet and the pains I’ve been having in centre abdomen (the worst of them all) and the pains left and right side which was reason I went to hospital. I’m being given a strong laxative and then see if it makes a difference to pain levels. Didn’t know whether to leave it to see if it goes away by itself although it was said that ones at that size tend not to. She’s going to see me in the morning to discuss endometriosis and see what’s happened with the laxative. Im
quote worried incase the cyst and/or endometriosis is what’s affecting my bowel and wouldn’t that need fixed before bowels improve x

@beachwalkx
the scan today showed I have endometriosis
how was yours treated if you don’t mind me asking and is it better now? Did you manage to get to a point where tummy doesn’t look pregnant?
thank you

I had a 10cm x 6cm cyst removed. They couldn’t say what it was until it was tested in pathology. They can’t tell what they are from the scan. I would definitely want it removed in your shoes, just to rule anything out.

@GarlicLitre
thank you for replying .
i found out today i have endometriosis so that’s probably what’s caused cyst

Said not sure whether it would go away itself although doubts it as it measures 6cm diameter
still having the bowel issues which is why I came to the hospital so getting a strong suppository type laxative to see if that helps the pain and if so could hi home but I don’t think it would be a long fix if it did as the cyst or endometriosis must be doing something to my bowels

@Yachtingaroundtheworldiwish
thank you for your reply
i hope you’re feeling better note
was your cyst causing any issues? do they ever return?
thank you

Yes I had bloating and bowel issues. Eleven years on and completely fine thanks.

That's great obviously very painful but very good they found something. What scan was it?

What does the consultant mean by "found endometriosis on the scan or what"? The left ovary could be attached to the bowels due to adhesions or endometriosis tissue.

Ask for a urologist or uro-gynaecologist to come and see you and do a through history of bladder issues. Alos ask for a Urinary tract ultrasound as well. Ask for a temporary prescription of the laxatives. Also ask about starting antispasmodic medication and also stronger opiods? I also have endometriosis and other conditions btw @Mumstheword1380 and am disabled by mine which is all over by sciatica and abdomen including my bowels and bladder and I may need some of my bowels out soon.

Are you symptoms just on your period or elsewhere during the month? What symptoms do you have during your period? And if you have symptoms not on your period

• what are they? Is the pain worse on or off period?

If you had a transvaginal and/or pelvic ultrasound normally it can pick up adenomyosis. Ask them about that.

I recommend asking the GP to try the pill and/ or mirena coil can be amazing with heavy bleeding and pain. The mirena will may the uterus lining thinner, less bleeding and less cramps). So definitely try that, sometimes the progesterone only pill (mini-pill) can be better for some.

Also ask your GP for mefenamic acid and/or naproxen (NSAIDs which help a lot) and tranexamic acid (helps reduce heavy bleeding) - you need to start taking it days before your period starts so that it can work at best capacity.

But endometriosis is a chronic illness and cannot be cured, after surgery it will grow back, it cannot be excised from everywhere to leave organ functioning intact and then post-surgery adhesions often form.

The main symptom of endometriosis
is not actually period pain because endo is not a period condition - it's a whole body inflammatory condition
where the endometriosis tissue even produces its own oestrogen and the pain is felt throughout the month not just when on your period. Often endometriosis on the ovaries can form cysts containing old blood called endometriomas (also known as chocolate cysts) which can be very painful. Another popular cyst is haemorrhagic ovarian cysts with endometriosis.

But you could also be adenomyosis where the lining of the womb grows into the muscle of it, but unlike endo is localised to the uterus only. Thus, symptoms are mainly a
couple days before a period and during your period
. Main endo symptoms:

• Irregular or heavy periods

• Pelvic pain

• Pelvic pain on opening bowels (dyschesia) and wider gastrointestinal symptoms (diarrhoea and constipation)

• Pelvic pain on passing urine (dysuria) and bladder symptoms sometimes

• Referred pain to the tops of the legs or back

• Fatigue

Crucially you can still have endo even if they don't see it on the scan, the only clear way for diagnosis is a diagnostic laparoscopy and then mangagement can look like pain medication depending on how severe your pain and symptoms are (can be opioids, NSAIDs) and contraception and hormonal treatments (gonadotrophin releasing hormones).

The links below have much more detailed and useful information.

https://www.leedsth.nhs.uk/patients/resources/endometriosis-2/

https://www.nhs.uk/conditions/adenomyosis/

I had surgery on May to cut out the endo and also remove the cysts, and a mirena coil
pics before surgery, after and now

They can return after removal as in new ones can form, with regular medication (pill, mirena coil, gonadotrophin releasing hormones, NSAIDs and laxatives etc) - people often manege it well, if they have worsening symptoms despite being managed they go for scans and often it's a cyst causing the issues etc. Sometimes, they may be (depending on the size of them and the amount removed or left to see if they go away over time). Each new cyst needs to have a new discussion - depending on symptoms, etc, and the size, to decide treatment options.

Till now you seem to have asymptomatic/ less severe symptoms (from what you've said before which is good as the pill and NSAIDs should resolve it longterm after the cyst is removed. It doesn't mean this isn't painful and you may need to be seen by the Colorectal team (ask your consultant about this) before you leave the hospital.

However, your endo doesn't seem to be causing (outside from the cyst flare-up) too many issues day-to-day - perhaps you have issues on your period (do you?). But otherwise you haven't mentioned* long-term and chronic issues with mobility, back and legs and sciatica, debilitating pelvic pain, pain with sex and insertion to the vagina, severe vomiting and nauesa, cycles of severe constipation and/or diarrhoea etc. *The bowels seem to be an issues so see the colorectal team in the hospital - the ovarian cysts may be adhered to them and thus causing issues. I'd guess you can be managed quite well long term with a GP and regular ultrasound scans every year.

Secondary dysmenorrhea is where a condition e.g endometriosis or adenomyosis causing it. You will need to try NSAIDs and mirena/pill and Tranexamic acid (used for heavy bleeding) and if your endometriosis pain and symptoms are managed quite well/go away then you likely have less severe endometriosis in terms of symptoms and impact.

The stages of endometriosis are actually about how it impacts your fertility - a higher stage is about a bigger impact on fertility but not pain.So a person with stage 1 endo could be disabled by it and have severe complications, but a person with stage 4 may not.

Spot on.

Having had a history of ovarian cysts that were monitored over a few years I still managed to grow one a few years later that weighed 6kgs when removed and was malignant. My CA125 was 53 when it was removed and not thought to be a concern but my gynae- oncologist made it very clear ‘its only when we biopsy it that we’ll know’.

Never ever ever mess about with anything ovarian ladies. Learn what the symptoms of an ovarian cyst are and be proactive with your reproductive health. Thankfully my cancer was caught very early and a huge surgery where I was filleted like a blooming fish from just under my sternum to almost at my pubic bone, with the removal of everything I could live without cured me and no chemo was needed - though the 5 years of follow up was terrifying. Along the way I’ve met so many woman online, also my own sister in law who was diagnosed within days of me and died 3 years later, who are testimony to the fact our ovaries can a do kill us in the most sneaky and coniving little bastard ways and any sign of even one of the ovarian (or other gynae) symptoms should never ever be ignored.