What You Need To Know About Ovarian Cysts page 3

Because functional ovarian cysts usually remain quite small, often cause no symptoms, and may disappear on their own, treatment of them is not always necessary. However, since there are so many other types of ovarian cysts, you should see your doctor if you experience any of the following:

• Abdominal pain or pressure that is severe or frequent
• Pain with intercourse
• Unusual vaginal bleeding or any vaginal bleeding after menopause
• Unexplained weight gain or abdominal bloatingIrregular periods for several months or no period with a negative pregnancy test
• Inability to become pregnant after 12 months of intercourse without using birth control

How Your Doctor Goes About a Diagnosis

The doctor will first ask about your symptoms, your medical history, and your family's medical history. If you are having irregular periods, it may be helpful to keep track of vaginal bleeding on a calendar and bring the information with you to your appointment.

Physical Exam and Lab Tests

Next, your doctor will give you a physical exam, including a pelvic examination. The pelvic exam involves inserting a speculum in the vagina to see the vaginal walls and cervix and to obtain a Pap smear or samples of vaginal discharge to check for possible infection. Once the speculum is removed, your doctor will do a “bimanual exam,” (two fingers in the vagina, with the other hand pressing on your abdomen), during which he or she can feel the size and shape of the uterus and ovaries.

If you have an ovarian cyst, your doctor may find that your ovaries feel larger than normal, and you may have more discomfort during the bimanual exam than you normally do. In this case, the doctor may recommend additional laboratory tests to help make a diagnosis.

If you are of childbearing age, a pregnancy test is very important. If the doctor suspects you have polycystic ovaries, he or she may also want to check certain blood hormone levels that could be affected. The doctor may also draw blood for a “complete blood count” (CBC) to help identify a possible pelvic infection or to see if you have developed anemia due to excessive bleeding.

Ultrasound

Ultrasound, also called a sonogram or sonography, is one of the most frequently used methods of diagnosing ovarian cysts. This technology uses sound echoes to provide a picture of the tissues and organs inside the body. A sonogram can help determine the size of the ovaries; the number and size of any ovarian cysts; and whether a cyst is filled with solid or liquid material, or a combination of the two. Ultrasound may also show whether fluid has collected in the pelvis, which could be a sign of a recently ruptured cyst. If a pelvic ultrasound exam reveals that you have a functional ovarian cyst, there may be no need for further diagnostic procedures.

Ultrasound is a painless procedure performed in a radiology laboratory or doctor's office. For an abdominal ultrasound you will be asked to drink several glasses of water about an hour before the exam and to refrain from urinating until the exam is completed. It is important to have full bladder because it enables the technician or radiologist to see all the pelvic organs. The technician will place the ultrasound transducer, a small hand­held device which receives and transmits the images, on your lower abdomen, move it around to get various views, and at certain points, capture these views on film for further review by a radiologist.

DIAGNOSTIC “RADAR”

Using sound instead of radio waves, ultrasound works much like radar, building images of the internal organs from the echoes they produce. In the transvaginal ultrasound procedure shown here, the device is placed inside the vagina, providing particularly accurate pictures. The technique is painless and free of radiation.

The most accurate pictures can be obtained by doing a transvaginal ultrasound, using a specifically designed transducer that is placed in the vagina. Because of the accuracy of the transvaginal ultrasound, some doctors skip the abdominal ultrasound and go directly to this method. The other advantage is that you do not have to have a full bladder.

If your ultrasound results show that your ovarian cyst could be composed of solid material or a combination of solid and liquid material, your doctor may recommend an x­ray (or occasionally a CT scan or MRI). The x­ray is important because it can reveal the pieces of bone or teeth that are sometimes seen in dermoid cysts and because solid growths on the ovaries are more likely to be malignant.

Diagnostic Laparoscopy

Although the technologies of ultrasound and x­ray have helped to simplify the diagnosis of ovarian cysts, in certain cases more investigation is necessary. Sometimes your doctor will want to take a direct look at your pelvic organs in order to make a diagnosis. For example, if you have endometriosis, conventional tests and ultrasound are not very useful. Or, if your cyst is quite large, or not simply fluid­filled, or if you are over the age of 40 when the risk of cancer begins to increase, your gynecologist may wish to look directly at the cyst and the reproductive organs. This is done by performing a diagnostic laparoscopy. (See nearby box.)

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