Ovarian Cyst Decision: Watch or Remove?

Many times asmall, thought to be benign (non-cancerous) cyst is found on a routine pelvicexamination , a check up for yeast,  apelvic examination for a urinary tract infection, or a test being done foranother medical problem: like a CT scan for suspected kidney stone or boweldisease. Most of these ovarian cysts will resolve on their own and do not needfurther treatment. But your gynecologist will want to watch to make sure thecyst in fact does resolve. For young women who are under the age of 40 and inwhom the ultrasound looks like the cyst clearly has a less than 1% chance ofbeing cancer the correct treatment in most cases is going to be a wait andwatch approach. It’s important for women to realize that the watching has nofirm time sequence, but  is stillimportant as rarely do benign cysts transition into cancerous ones, and it’s importantto be watched for any signs of this however remote a possibility it is.  All physicians will agree that you need tohave a repeat checkup within 6 months to be sure the cyst is gone, many willwant to repeat the ultrasound in 3 months. If your case is such that it seems clear that the cyst has been aroundfor awhile even a 4-6 week follow up appointment is reasonable. Screening forendometriosis, by pelvic exam, tubal pregnancy by a HCG blood test, or pelvicinfections, by cultures, can also help to be sure that the cyst is not actuallyanother gynecologic problem.  Mostphysicians recommend following the cyst until it is gone. But there is agrowing group of gynecologists that feel that once the cyst has not changedover a long period of time, if it doesn’t appear to be cancerous, if any bloodtests done (like CA 125) are normal and have stayed normal, and there are nosymptoms whatsoever, you can choose to not have any surgery at all. Often thesecysts turn out to be something completely different than an ovarian cyst: theycould be a paratubal cyst or the presence of scar tissue in the pelvis. Forwomen who can take a birth control pill, the pills we have will not dissolve acyst. If you have mild symptoms of discomfort or irregular bleeding then goingon pills may help to straighten out the bleeding or even partially relieve painwhile waiting for the cyst to resolve so that you can avoid surgery.  On the other hand, if you are not hurting, ifthe cyst has not burst, and if the cyst has not begun to bleed; having the cystremoved surgically can help prevent those problems. As with the othergynecologic issues we have discussed, you do want to talk to your gyno to makeyour own decisions.


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