Ovarian Cysts: When Is Surgery Necessary? - Obstetrics and Gynecology

The issue of cysts?

I apologize for the inconvenience.
I would like to ask about the issue of a cyst.
Around mid-February, I visited a gynecologist due to irregular menstruation, and an ultrasound revealed a 2 cm cyst.
After taking medication (Mefenamic Acid) for two weeks, I returned for a follow-up on February 28, and the cyst had increased to 2.6 cm.
A transvaginal ultrasound was performed, but the doctor only mentioned that it had grown larger and advised me to continue the medication.
The doctor also noted that there was abnormal fluid outside the ovaries, which made my family uneasy, so I switched to another clinic.

On March 6, during the follow-up, another transvaginal ultrasound was done, and unlike the previous doctor's description, there were no symptoms mentioned.
However, the cyst had developed into four cysts, with the largest measuring 4 cm within about six days.
This rapid growth seems concerning.
The new doctor suggested that surgery might be necessary, but I started my period right after the examination.

I would like to know if menstruation can significantly affect the size of the cysts.
Is surgery truly necessary in this case? I have researched online and found that cysts under 5 cm or even 6 cm typically do not require surgery.
Is the need for surgery due to the increased number of cysts? Thank you for your help.

Ms. Zhang, 10~19 year old female. Ask Date: 2020/03/09

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is recommended to monitor and track the changes in the tumor.
Wishing you good health.

Reply Date: 2020/03/09

More Info

When it comes to ovarian cysts, understanding when surgery is necessary can be a complex issue that depends on various factors, including the size, type, and symptoms associated with the cysts. In your case, it appears that you have been experiencing changes in the size and number of cysts, which has understandably raised concerns for you and your family.

Ovarian cysts are fluid-filled sacs that can develop on the ovaries. They are quite common and often resolve on their own without the need for surgical intervention. However, certain circumstances may warrant surgical treatment. Here are some key considerations:
1. Size of the Cyst: Generally, cysts that are larger than 5 centimeters (cm) may require closer monitoring or surgical intervention, especially if they are symptomatic. In your case, you mentioned that the largest cyst has grown to 4 cm and that you have multiple cysts. While the size alone does not always dictate the need for surgery, the rapid growth and the presence of multiple cysts can be concerning.

2. Symptoms: If you are experiencing significant symptoms such as pain, discomfort, or changes in your menstrual cycle, this could indicate that the cysts are causing complications. Symptoms can include pelvic pain, bloating, or pressure in the abdomen. If your symptoms are severe or worsening, surgery may be considered to alleviate these issues.

3. Type of Cyst: There are different types of ovarian cysts, including functional cysts (which are related to the menstrual cycle) and pathological cysts (which may be benign or malignant). If there is any suspicion that the cysts may be pathological, further evaluation and possibly surgery would be necessary.

4. Monitoring and Follow-Up: It is essential to have regular follow-ups with your healthcare provider. If your cysts are being monitored and show significant changes, such as rapid growth or new symptoms, your doctor may recommend surgery as a precautionary measure.

5. Menstrual Cycle Influence: Hormonal fluctuations during your menstrual cycle can indeed affect the size and appearance of ovarian cysts. Functional cysts, for example, can change in size depending on where you are in your cycle. However, if you notice a consistent pattern of growth or new cyst formation, this should be evaluated further.

In summary, while the presence of multiple cysts and their growth can be concerning, the decision to proceed with surgery should be made in consultation with your healthcare provider. They will consider the size, symptoms, type of cysts, and your overall health when making a recommendation. If surgery is deemed necessary, it is often done laparoscopically, which is minimally invasive and allows for quicker recovery.

If you have further questions or concerns, it is crucial to communicate openly with your healthcare provider. They can provide personalized advice based on your specific situation and help you understand the best course of action for your health.

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