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Which treatments are available and recommended for ovarian cyst and serious bleeding?
An_252782 posted:
I'm a 47 year-old woman. Three years ago, after loss of my father, I was so depressed; my menstrual period had some months of delay, so the doctor gave me LD hormones for two months, which caused my blood to get dense and finally I had a partial brain stroke at that time; so I have been prohibited to consume hormone drugs after that. My menstrual period got regular then.

After May 2012, my menstrual period was lost for several months after my mother's death, and I had no bleeding. I consumed some herbal drugs (because of being prohibited from hormone drug consumption) and after two weeks I had serious and continuous bleeding. so I had a curettage surgery (5 months ago).

After the curettage, I get regular period for three months, but after that I have had serious and continuous bleeding till now.

The serious and continuous bleeding was diagnosed to be caused by an ovarian cyst (with thick wall and mural nodule with size of 35 * 24 mm) in the left ovary.

The doctor told me that the possible treatments are surgery and hormone therapy; but because I'm prohibited from hormone therapy (due to my brain stroke 3 years ago), he told me that surgery seems to be the only option for me.

Also, he said that if this ovarian cyst isn't removed by surgery, it may get into ovarian cancer. The doctor told me that the ovary and the womb need to be removed.

I now consume these drugs: aspirin 80 + citalopram 20mg + atorvastatin 10mg + easy iron + multivitamin

Different doctors have provided me some options:
1. removal of ovary and womb;
2. ablation
3. Maybe other options? ...

I wanted to ask which of these treatments is better for me and to see if there are additional options? If necessary, I can send some medical documents (pathology and sonography).

Anon_6061 responded:
This board isn't very active and there aren't any WebMD experts that post here.

First of all, female organ removal is the most overused surgery after c-section. Per this study, 76% of hysterectomies did not meet ACOG criteria. Healthy ovaries are removed at the time of hysterectomy 73% of the time. Ovaries are the equivalent of a man's testicles and produce hormones into our 80's for optimal health and well-being.

Ovarian cysts are VERY common and most resolve on their own and are NOT cancerous (only about 2% are cancerous). Yours is still relatively small so monitoring may very well be all that's needed for now. And if surgery is eventually needed, it's best for your health to keep the ovary and have just the cyst removed (cystectomy) if it's benign. Removing one ovary may disrupt your body's hormone production. If the uterus is also removed, there's about a 50/50 chance that remaining ovary(ies) will fail. It seems too many doctors remove the ovary instead of just the cyst, probably because it's quicker and/or they don't have the necessary skills. This website is helpful - One of the authors is Dr. William Parker, author of the book "A Gynecologists Second Opinion." He uses organ-sparing surgeries that preserve the uterus and ovaries and their LIFELONG (non-reproductive) functions.

The uterus along with its ligaments have lifelong anatomical, skeletal, hormonal, and sexual functions for which there's no replacement. Why not treat the heavy bleeding instead of removing this essential organ? There are non-hormonal meds to stop the bleeding. These include OTC and Rx NSAID's (such as Aleve or Motrin) and Rx tranexamic acid (Lysteda - a synthetic form of lysine). Here's a complete list of hormonal and non-hormonal meds for heavy bleeding - If you have a uterine polyp or fibroid, this could also explain the heavy bleeding. These growths can also be removed without removing the uterus (if you have the right surgeon).

Ablation doesn't always work to keep bleeding under control. And it can cause long-term permanent problems (chronic pelvic pain). This risk increases the younger you are at the time of ablation because the uterus continues to try to build the lining based on the hormonal actions of the ovaries. But the lining is scarred so the uterus can become engorged with blood. There are 195 posts about women's post ablation experiences here - You can find others on the web by searching for "post ablation syndrome."

This study indicates that ablation may lead to hysterectomy and this risk increases up to 8 years after the procedure and is greater the younger you are at the time of ablation -
"Cox regression analysis found that compared with women aged older than 45 years, women aged 45 years or younger were 2.1 times more likely to have hysterectomy (95% confidence interval 1.8—2.4). Hysterectomy risk increased with each decreasing stratum of age and exceeded 40% in women aged 40 years or younger."

Like you, I had an ovarian cyst. My gynecologist whom I'd trusted for many years rushed me into surgery and removed all my sex organs (uterus, cervix, ovaries, tubes) even though the frozen section of the cyst done while I was under anesthesia was benign. Every aspect of my life (and even my appearance) has suffered dramatically despite being on estrogen.

So please do your homework and understand the adverse effects of hysterectomy and oophorectomy. Also, carefully read the consent form if you do go into surgery. Revise as needed to state what may and may not be removed under what circumstances and have the surgeon sign off. Keep a copy.

I'd be curious to know how this progresses. Best to you!
sam1985 replied to Anon_6061's response:
Ultrasound is used to determine the treatment strategy for ovarian cysts because it can help to determine if the cyst is a simple cyst (just fluid with no solid tissue, seen in benign conditions) or a compound cyst (with some solid tissue that requires closer monitoring and possibly surgical resection).

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