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Follicular cysts.

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I had a gyn exam last Friday as I had a cyst. before that the doctor gave me pills to cause a period so the cyst goes away. After checking on Friday cyst was gone. Now I have light pain on left side where he pressed down from outside to check for cyst. I'm peri menopausal and in the middle of my cycle. Could it be that from Friday to today another cyst has formed. Having this light pain since visit. Thanks for your answer.


Category: OBGYN

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello
Thanks for writing to us with your health concern.
Could you please provide a few more details , such as, what kind of cyst, size etc.
I think you are referring to functional or follicular cyst.
These are small fluid filled cysts within the normal egg follicles contained in the ovary, most often occurring due to hormonal disturbances, which are common in your age group.
They do go away with oral contraceptive pills or antibiotics.
It is very improbable that just in two days, a new cyst has come up.
More likely, the cyst got resolved, and the release of the cyst contents would mildly irritate the surrounding pelvic structures, leading to sensation of pain.
Also, an internal check up often presses on pelvic nerves.
Give it a day or two, if the pain is noticeable, take an antispasmodic.
Take a hot water bottle to bed with you.
All the best
Please feel free to discuss further.


Patient replied :

What I forgot to mention is that I have adenomyosis. My gyn thought it was a chocolate cyst. He prescribed me pills (hormone) that I had to take for 14 days. I got my period a couple of days later. Had a heavier and longer one ( about 9 days). What I like to know does a cyst get away with the period? Or can it also happen thereafter?? Because on day ten of my cycle I had some kind of fluid come out of my vagina? Could that have been the fluid of the ruptured cyst? ( I had no pain though).
What concerns me also is. A day later (D11) he took some blood work as we wanted to check my hormonal status. At my visit last Friday he told me he had also CA125 checked. I didn't even know what it was until I checked that it is a tumor marker. And that women with endometriosis, adenomyosis and mainly after having a ruptured cyst can get a positive false result with a high level. I honestly wonder if my gyn knew what he was doing because when he saw that the cyst was gone, he told me he just ordered the tumor marker "out of the blue"! I'm really worried now that the result is showing high levels. Do I have to be concerned then or shall I ask for another blood test?
Sorry that this got so long now. But no it's really detailed.


Expert:  Dr. Aarti Vazirani replied 3 Days.

The details are welcome, they shed light on what was earlier a very vague question.
Both adenomyosis and endometriosis ( a chocolate cyst is a manifestation of endometriosis ) can lead to raised CA 125 levels.
Once the cyst has gone, there is NO INDICATION to have the levels measured.
IT just does not make sense to me, you should sound out your doctor about the reasons for this blood marker being measured.
Anyway , irrespective of the levels found, as long as there is no cyst anywhere, the levels do not matter really, so rest assured.
Cysts do not go away with periods, however endometriotic chocolate cysts are hormone responsive, so they sometimes regress with the kind of hormonal treatment that you had.
Also, ruptured cyst would not lead to fluid coming out of the vagina.
By day 10, in a natural cycle too , as ovulation nears, there is excessive clear watery mucus secretion from the vagina, so that is what you felt.
The mild pain could be attributed to the endometriosis and the adenomyosis both.
Do not worry.
Just have regular scanning to monitor the progression of both conditions.

All the best
Please feel free to discuss further.


Patient replied :

My first CA 125 came back with the result of 337! But that was measured at day 3 of my period and i guess while having the cyst that might have ruptured or resolved during that time. Therefore my gyn took another blood test and it came back with 82!!
Now my doc still insists on doing another CA 125 in about a month and having a CT scan.i slowly get doubtful if this is just about my health or about making money out if this as he even wanted me to come in again for another exam of my ovaries. Although he did an exam two weeks ago. When I talked to him today he told me he would act carelessly if he wouldn't proceed finding out why the CA 125 is still higher than it should be.
When I asked him what could have caused the high level, he still had no answer. I knew more about it now through you than he did. I.e. That levels can be higher when measuring it during menstruation or because of the cyst.
I'm going on vacation in 5 weeks and will be gone for about a month. That would be 3 month from today until doing another CA 125. But he doesn't want to wait that long.
Is this all really necessary? I really don't know what to do?? Shall I listen to him or change and go to another gyn?


Expert:  Dr. Aarti Vazirani replied 2 Days.

In my opinion, you can have an exam for your ovaries again in 3 months' time, does not have to be a CAT scan, even a pelvic ultrasound scan and digital exam will suffice.
I recommend seeking a second opinion on what your doctor insists for, I find it unnecessary and a very panicky reaction .

Hope this helps
Thank you


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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