GYN CHRONICLES
Ovarian Cysts : Are They Normal Or Disease ?
By Dr . Maureen Owiti
Pressure is a great thing and I happen to be one of those people who thrive under pressure . Most probably because I can be the mistress of procrastination ( not my best side I must add ), but come crunch time will get the job done .
Here I am thinking and then voila ! A topic - Ovarian Cysts . So , what is a cyst ? A cyst is a cavity or sac that has fluid in it . Cysts can form in any part of your body , that has epithelium . A cyst in the ovary is therefore called an ovarian cyst . This is one of the most common gynecological diagnosis you will ever get and in typical Maureen fashion will teeter off onto a story .
Enter Skylar ( not her real name for obvious reasons ). A young up and coming marketing executive . She had been complaining of lower abdominal pain for over 6 months and came in typical fashion with scan results and surprise ! Surprise ! We can all guess what the ultrasound report said and even if you can ’ t guess it ’ s obvious from the title of this article . Yes , you guessed it she had an ovarian cyst .
Skylar was very traumatized to point of balancing tears and I had to enquire what the major concern was . She had been seen in an outpatient clinic and informed her cysts would have to be removed surgically and further research and consultation with the most famous doctor i . e . Dr Google was giving a similar prognosis . I ’ m just thankful she did not think it was Cancer !!!
In classical Owiti fashion , I had to get on top of the situation and told her let ’ s first get a clinical diagnosis prior to inspecting the results of the Ultra-sound . I always tell my students don ’ t treat results whether laboratory or imaging such as Ultra-sound , X-ray , CT-scan and MRI ; always treat the patient . 70 % of the diagnosis can be elicited from history and physical findings according to our wise sages the professors in medical school . Of course , there are those patients whose presentation defy logic , I leave those to the magicians of medicine ( physicians ), to sort out . Tests just aid you to confirm the diagnosis and guide treatment .
From the horses ’ mouth her pain was a sharp colicky pain that could be very intense for a few days and then go away . On further enquiry she reported the pain came
“ Not all cysts are bad and it is actually normal to have an ovarian cyst and I would actually be concerned for a woman of reproductive age who does not have a cyst on ultrasound performed between the 8th - 20th day of her cycle . This may signify that she is not ovulating .” usually around her mid cycle and was relieved with buscopan . She also commented that the pain was located mostly in the lower abdomen but was not in the midline , it would either be on the right or left side and seemed to alternate every month . Most gynaecologists reading this already have a diagnosis - Mittle Schmarz ! This is a wonderful German phrase that denotes the pain women of reproductive age get during ovulation time . Yes , from her history this was most probably just ovulation pains .
She currently was not mid cycle but physical exam must go on and both her abdominal and pelvic exam were normal . This now meant we could inspect the contents of this ultrasound that was causing emotional turmoil . The Ultra-sound had beautiful images of the uterus and both ovaries and the left ovary had a cyst 2.1 x 1.5 cm . This was very amusing and she looked at me as if I was from Mars . We sat down together and I patiently explained to her that the size of the cyst was not worrying and in fact that if women her age around mid-cycle do no not have a cyst it would be more worrying .
Why am I so casual you may ask ? Well , for starters it is normal to have an ovarian cyst if you are still menstruating . At the level of the ovaries during the menstrual cycle under the influence of a hormone from the pituitary gland - follicle stimulating hormone , the egg / eggs that will ovulate start producing estrogen . The eggs are housed in a sac - what we call the follicle and this estrogen will start forming
18
MAL 47 / 22 ISSUE