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    2cm Complex Ovarian Cyst
    joleel posted:
    I posted before regarding my symptoms on this. I'm a bit confused. First I was told by my primary physicians that the symptoms were not of my ovarian cyst found in an unltrasound on Friday, that it was too small of 2cm. My symtpoms are: pretty bad abdominal bloating, pain in the groin and where my uterus would be, which is worse when sitting. Heaviness just below my gut with bumps protruding which now my nurse practicioner has confirmed she believes is my uterus either being pushed up or enlarged along with my ovaries, I can literally feel them all very easily at times. I have had a low grade fever of 100 degrees or 99.9 ish. They originally thought I had an infection, they have put me on 2 antibiotics and its not any better. They said give it a week and if its not better we will do a CT scan.

    I called in today to ask for some strong pain medicine so I can work longer because so far 2-3 hours is it in a day. They told me now that the cyst was a complex cyst that does not go away on its own and that I need to see an OBGYN and they are no longer going to treat me for it. If I can't see an OBGYN soon to go to the emergency room for the pain if it gets unbearable.

    After all day of hearing from offices that there is an OBGYN conference somehwere out of state next week, I found one and have an appt for 10am tomorrow.

    my question is..fever or not, can this be from my complex cyst? So far its the only thing they have found after 2 ultrasounds (abdominal and vaginal) and a pelvic exam. And if so, what is a complex cyst and since i"m experiencing this kind of pain, what will happen? I'm so I was going to start trying for a baby in a few months.
    Jane Harrison Hohner, RN, RNP responded:
    Dear Joleel: I am so glad you are going to get seen by a GYN. ...Generally a complex ovarian cyst would not prompt a low grade fever, unless the cause of the complex cyst was an abscess. Usually an ovarian abscess will respond to antibiotics as such infections are caused by the type of bacteria as a pelvic infection. Occasionally a woman may need IV antibiotics if her white blood count is very high, fever is elevated, or other signs of severe infection are present.

    A complex ovarian cyst generates more concern. A cyst that is a mixture of solid and fluid elements, or is solid, is not a simple follicular cyst. The presence of irregular borders, or septations (internal walls dividing the cyst into separate spaces) are more concerning features found in complex cysts.

    Occasionally, there can be a cyst which will have a small blood vessel which continues to bleed into a corpus luteum cyst. This is called a "hemorrhagic ovarian cyst". A cyst of this type can either leak small amounts of blood, or it can rupture, spilling blood into the abdomen. This hemorrhagic ovarian cyst can be linked to prolonged pain, and merits closer follow up.

    Each of the cysts described above can start with a normal process and become a medically significant cyst. They are all described as benign cysts. By contrast there are ovarian cysts which are not related to variations in normal processes. Endometriomas are cysts filled with old blood. This gave rise to the nickname "chocolate cysts" as the cyst fluid looked like chocolate syrup. Endometriomas can grow to 6-8 cm. They are formed when bits of uterine lining tissue ("endometriosis") attach to pelvic organs such as ovaries. These can appear a complex cysts on ultrasound.

    Dermoid cysts ("cystic teratomas") can contain bits of hair, teeth, or other body tissues. They will appear as complex cysts. It is still not known why dermoid cysts form. At an incidence of 66%, dermoids are most common kind of benign tumors of the ovary. The concept of benign tumors sounds like a contradiction in terms. It means that there is a very small chance of this type of ovarian cyst to become cancerous. For example, in one study (Scully, 1973) less than 2% of dermoid cysts showed evidence of malignancy.

    Bottom line, your GYN should be able to give you a more "for sure" answer. Fortunately 2 cm is not super big. Hopefully you can get better pain management and a more definite diagnosis.

    joleel replied to Jane Harrison Hohner, RN, RNP's response:
    Hi Jane,

    Thank you very much for your answers. I am sad to say I still have not found the answer to my problem with more visits to Drs. Unfortunately shortly after writing my question yesterday on here, I was crippled with pain and ended up in Urgent Care where I finally got some meds. Again the thought was urinary infection blah blah that came out negative. I just wanted to get through the night and to my appt this morning with the OBGYN. I went today..he is not worried about my cyst at all..and wouldn't at first schedule me a CT scan until my husband convinced him of the pain I was in..(apparently the crying in his office and the severe pain I explained wasn't enough). He doesn't want to see me for 6 weeks again for the cyst, and the CT scan this afternoon found no more than the cyst, I had both an abdominal and pelvic CT scan. I only found out that I now have a low white blood cell count and the OBGYNs office referred me back to my primary care physcian to consult wtih them further. I called them and they explained the white blood cell count is more than likely from antibiotics and they stated there was nothing they could do for me for my pain and if it was bad again to go to the ER.

    Baths are helping, the 4 200mg of motrin every 6 hours is touching it tonight where last night it would not, and I'm on a pressure reliever/some pain relief med from the urgent care that I'm not sure if it helps but I'm taking.

    My thought now, is a second OBGYN opinion, so it starts Monday all over again to see who I can get into and when. I'm hoping the pain subsides eventually so I can go back to work, right now I'm out because I cannot sit for long periods of time as I do administrative work.

    anymore advice or answers Jane would be great, or from anyone else that can weigh in! I really appreciate it!
    apaininthepelvis replied to joleel's response:
    Not that I am an expert, but I have been in your shoes, hon. One thing you might ask about: inguinal hernia. If there is an actual protrusion that you can see when standing or it pushes out when you bear down, this might be the case. Granted, this is just a thought, but might be worth asking about. Good luck!
    joleel replied to apaininthepelvis's response:
    Thank you for your reply apaininthepelvis.

    So the weekend presented more symptoms, and gladly some relief finally now to the pain. I still have mild cramping, major bloating, but finally my fever that spiked to over 101.1 yesterday is now down to normal..but I believe my period is starting..or maybe the cyst burst? I have clots appearing, no real flow, just clots so far for 24 hours now almost, very small so far, and very dark. Anyone else have this with small complex cysts? I'm going to wait and talk to this OBGYN on Friday that I have scheduled unless things go back to the extreme pain I had before. I still cannot sit for long periods of time, only standing and laying down helps, and even those positions still seem to "tug" on my uterus almost. I've never felt anything like this the last month, and especially the last week. I've never had children, and you may call me weak or a wussy for complaining to this degree, but this is completely out of the ordinary for me, and I hope it will be a one time event.
    juliemeger replied to Jane Harrison Hohner, RN, RNP's response:
    I had been having lower right abdomnial pain for approximately 2 days before I ending up in the ER last tuesday. They immediately took me for a CT because they thought it was my appendix. They told me I needed a vaginal ultrasound because they saw a mass on my ovary. After the ultrasound they told me I had a fairly large (approx. 7cm) complex cyst in my right ovary. They told me to see my PCP and/or my OB/GYN. I no longer have an OB/GYN (my PCP does my annual), so I made an appointment with him for that Thursday. Still in the same amount of pain, he referred me to an OB/GYN that when I called to make an appointment, said they couldn't see me until the 14th (two weeks away). [br>Later that evening, the pain became very intense and almost unbearable. I went back to the ER. They performed another CT and ultrasound and said the cyst had grown (almost 8cm now) and would probably go away on its own. I asked if it was complex and they told me yes but I needed to follow up with an OB/GYN sooner than two weeks.[br>All the next day I tried to call other GYNs with no success, they are all that far out. I don't know what to do. I am living on Dilaudid pills everyday. The pain feels like a huge contraction all the time with intermittent stabs of pain. And to use the bathroom is like torture. I don't want to go back to the ER for them to tell me the same thing and just give me more drugs before sending me about my way. What would you recommend? If I go to an ER during the daytime would that be more productive? Is this something I should be concerned with or will this thing go away on its own? [br>I can't eat, I am either nauseous or just feel full all the time. Once I am at home, I lay in a hot bath until it gets cold just to get some relief. I can't keep going like this for 2 more weeks. Please help!!

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