Managing Ovarian Cysts: When to Monitor and Seek Treatment

Abdominal mass/cyst?

Hello, doctor.
I am currently 33 years old and unmarried.
I underwent laparoscopic surgery for chocolate cysts two to three years ago and have been on medication for follow-up since then.
Recently, due to pneumonia, my follow-up appointment has been delayed by two months.
I would like to ask you if the timing for monitoring the chocolate cysts (via abdominal ultrasound) is appropriate on the 20th or 21st day after my last menstrual period.

Additionally, I would like to ask about a lump I discovered near the laparoscopic incision about a year after the surgery.
When I press on it, I feel discomfort and pain, especially during my menstrual period.
Should I consider surgical intervention for this? Recently, the lump has been getting larger and more painful, and I often find myself worrying about it.

In a previous consultation, the doctor suggested that the ovaries had not recurred and advised me to monitor the abdominal lump or wait until it grows larger before addressing it.
I took progesterone for a year, which reduced the lump, but after stopping the medication, the lump has returned with discomfort and pain during my menstrual cycle.
What should I do?
My menstrual flow has been decreasing, lasting about three to four days, with residual blood remaining.
Could this indicate ovarian degeneration?

cc, 30~39 year old female. Ask Date: 2020/05/24

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is acceptable to have your period for 21 days.
As for the tumor, it is recommended to go to the hospital for a detailed examination.
Wishing you good health.

Reply Date: 2020/05/24

More Info

Managing ovarian cysts, particularly in the context of a history of endometriosis and previous surgeries, requires careful monitoring and an understanding of when to seek treatment. Given your situation, let's break down your concerns and provide guidance based on medical knowledge.

1. Timing for Ultrasound Monitoring
For monitoring ovarian cysts, especially chocolate cysts (endometriomas), the timing of your ultrasound can be crucial. The luteal phase, which occurs after ovulation and before menstruation, is typically when cysts are most prominent due to hormonal influences. Therefore, scheduling your ultrasound around days 20-21 of your menstrual cycle is generally appropriate. This timing allows for a better assessment of the cyst's size and characteristics, as hormonal changes can affect their appearance.

2. Addressing the Abdominal Mass
The presence of a palpable mass near your previous laparoscopic incision site, especially if it becomes more uncomfortable or painful with your menstrual cycle, warrants further evaluation. While your doctor previously suggested observation, the increasing size and discomfort of this mass could indicate the need for intervention. It’s essential to differentiate between a benign post-surgical scar tissue formation (such as an adhesion or seroma) and a potentially problematic cyst or other pathology. If the mass continues to grow or causes significant discomfort, a follow-up ultrasound or even a CT scan may be necessary to assess its nature. Surgical intervention might be considered if the mass is determined to be problematic or if it significantly impacts your quality of life.

3. Hormonal Treatment and Symptoms
You mentioned that you were previously on progesterone (luteal hormone) therapy, which helped reduce the size of the mass. Hormonal treatments can be effective in managing endometriosis-related symptoms and may help in reducing the size of cysts. If you have stopped the medication and noticed a resurgence of symptoms, it may be worth discussing with your healthcare provider the possibility of resuming hormonal therapy or exploring other options, such as birth control pills, which can help regulate your menstrual cycle and potentially reduce cyst formation.

4. Changes in Menstrual Cycle
Your observation of decreased menstrual flow and shorter cycles could be indicative of several factors, including hormonal changes or ovarian function decline. While some reduction in menstrual flow can occur naturally with age, especially as you approach your late 30s, it’s essential to evaluate this change in the context of your overall reproductive health. If you are concerned about ovarian function or potential early menopause, discussing these symptoms with your healthcare provider is crucial. They may recommend blood tests to check hormone levels (such as FSH, LH, and estradiol) to assess ovarian reserve and function.

Conclusion
In summary, monitoring your ovarian cysts and any associated symptoms is vital. Scheduling your ultrasound around the luteal phase is appropriate, and any concerning masses should be evaluated further. Hormonal treatments can be beneficial, and changes in your menstrual cycle warrant a discussion with your healthcare provider to rule out any underlying issues. Regular follow-ups and open communication with your doctor will help ensure that you receive the best care tailored to your needs. If you experience any new symptoms, such as severe pain, significant changes in your menstrual cycle, or any other concerning signs, do not hesitate to seek medical attention promptly.

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