Dr. Patricia Yarberry Allen is a collaborative physician. This week she asks Dr. Elizabeth Poynor, a gynecologic oncologist, to counsel a peri-menopausal patient who is concerned about newly discovered ovarian cysts.
Dear Dr. Pat:
I am 55 and had only two periods last year. I have ovarian cysts on both ovaries that are each 3 cm in size, according to the radiologist. These are new in the last year and have not changed over a six-month period. I never had children and I never used the birth-control pill; I have read that both of these things may decrease a woman’s chance of getting ovarian cancer. My gynecologist says that the cysts will probably go away when I go into menopause, but I have lost two friends to ovarian cancer, and I’m worried. What are the options for managing my problem, which my doctor tells me is very common?
Dr. Pat Responds:
There are many factors to consider in the evaluation of persistent ovarian cysts in women your age and at your hormonal stage. The ovaries do work harder during this stage of peri-menopause, and sometimes cysts do form as part of this process. But patients and doctors must always be vigilant about the possibility of ovarian cancer.
The imaging report you described did not include an important piece of information: Did the radiologist evaluate the cysts as being simple or complex? This and many other factors must be considered in the decision whether or not to treat persistent unchanged ovarian cysts surgically. I have asked Dr. Elizabeth Poynor, a gynecologic surgeon who specializes in cancer, to answer this important question. Dr. Poynor is an Attending Surgeon at Lenox Hill Hospital in New York City
Dr. Poynor Responds:
There are many types of ovarian cysts, some of which are very common. Indeed, it is very likely that each time a premenopausal or peri-menopausal woman has ultrasound imaging of the ovaries, an ovarian cyst will be found. With the increased use of imaging in the practice of gynecology, it has been realized that many postmenopausal women, too, will be found to have ovarian cysts. It is important to understand the benign and malignant characteristics of ovarian cysts so that the appropriate evaluation can be made.
In menstruating women, the majority of the time, these cysts (called “functional cysts”) will be related to the normal functioning of the ovaries. These cysts are usually only a few centimeters in size; clear; and filled with water. However, they may also contain blood. These cysts will generally decrease in size and go away over one to two menstrual cycles.
Most often, ovarian cysts are benign; however, they can be malignant. Characteristics of benign cysts include small size (less that a few centimeters) and being water-filled. Characteristics of a cyst of more medical concern include (a) larger size (more than a few centimeters), (b) solid areas within the cyst, and (c) abnormal blood flow to the cyst.
When a woman is diagnosed with an ovarian cyst, a number of factors will be considered in the management of her cyst: (a) family or personal history of cancer, (b) symptoms associated with the cyst, and (c) size and characteristics of the cyst. For the majority of women, watchful waiting will be undertaken and a repeat evaluation of the cyst will be recommended in 6 to 12 weeks’ time.
If a woman’s ultrasound shows a concerning cyst that might be malignant, or that a cyst assumed to be benign has been increasing in size, or the woman has symptoms such as pain with the cyst, an operative intervention may be recommended. This can many times be performed with a laparoscopic approach.
Ask your doctor what the characteristics of your cysts are and how she intends to follow them. Ask her also what would indicate to her that an operation would need to be performed. Remember that most small, stable, simple cysts are almost always benign, though they should not be forgotten, and they do require some follow-up.