5 questions before operating on cysts

Polycystic, luteal, hypoechoic, teratoma? They are not the same! In addition, factors such as age, activity level and pain influence the assessment of risk, which is why Dr. Arturo Valdés, Creafam fertility expert, shares with us the 5 essential questions you should ask before undergoing cyst surgery. Protect your fertility!

  1. How old are you?
  2. What type of cyst is it?
  3. How much and when do you have ovarian pain?
  4. What activity level are you?
  5. Could you freeze eggs?

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What’s up, we already have a couple of videos that explain what a cyst is and the different types that exist. Unfortunately, we continue to receive many patients who have already had one or both or several removed for something as simple as a cyst and this makes me much more angry when they are minors or have not yet had children, which is why today I want to thank you. 5 essential questions to ask before even considering the idea of surgery. They are very simple questions, some you can answer and others your doctor must answer.

And I don’t want them to stay silent or nervous when they are in consultation. Ask! They have to respond to them, they are within their rights and if they don’t want to respond, come to Creafam, remember that #KnowledgeIsSuccess

Question #1: How old are you?

Let’s start with the simplest question but it is surely the most relevant, because the first thing the doctor is going to tell you is: “If we don’t operate on you, that cyst is going to turn into cancer”… And well, first of all A simple cyst does not become cancer, cyst is cyst and cancer is cancer. It’s like saying that if we don’t operate on a pimple that appeared on your face it’s going to turn into cancer, that doesn’t happen.

Now, it can happen that you have ovarian cancer and the doctor mistakes it for a cyst. But how likely is that? Well, the main factor for any cancer is age. Statistically worldwide, if you are under 30 years old, the possibility of having ovarian cancer is 0.26%, that is, out of every 1000 women, only 2 will have ovarian cancer and we must consider that they are surely women with relatives who had cancer. or who have severe hormonal problems and who perhaps began menstruating at the age of 8 or have never had a period, in short, these are cases that are surrounded by other signs that point to cancer.

If you are over 50 years old, you are probably no longer menstruating, so if you suddenly get a cyst, we should be worried, because in theory the ovary is no longer working and those cysts should not appear. Let’s remember that cysts as well as pimples on the face appear due to hormonal reasons, mainly. For those over 50 years of age or women who are already in menopause and suddenly develop a cyst that continues to grow, the first suspicion is cancer.

Question #2: What type of cyst is it?

There are two very different situations with very similar men: Polycystic ovaries and ovarian cysts. Polycystic ovary syndrome is a hormonal imbalance that you are born with and in theory it cannot be cured but we can control the symptoms. What symptoms? Irregular periods, a lot of hair and many small cysts on the ovaries. We call them cysts but in reality they are ovules that failed to free themselves and remained trapped. On ultrasound they look like small chains of balloons or it is called a pearl necklace.

If you see these little balloons on your ultrasound, please watch the video by Dr. Otto Paredes titled “Polycystic polycystic syndrome cannot be operated on”, click on it. Right now! Because you don’t have simple cysts, you have polycystic ovary syndrome… Ok, if they stayed, let’s move on.

If you have normal periods, no facial hair, and an ovary without chains of multiple cysts, then yes, you probably have an ovarian cyst. On the ultrasound it will look like a gigantic chip or you could even have 2 or 3 at the same time. The problem with ultrasounds is that they are subject to the doctor’s interpretation. There are expert doctors who can recognize all the characteristics of a cyst in seconds… But there are also doctors who can take hours and still confuse what they are seeing, so here is a basic explanation:

In ultrasound, the dark parts are hollow or liquid and the white parts are solid or solid. The simple cyst looks hollow, it is completely black inside, sometimes it can have a little hair or internal texture and look grayish, we call these chocolate cysts because they are filled with a dark gelatinous mass but in general the blacker the better.

When it is completely black we call it a simple or hypoechoic cyst. “Hyper” means a lot, “hiccup” means little, and “echoic” means having an echo, bouncing sound; Hypoechoic means that little sound bounces back, so it is pure liquid. When the cyst begins to have subdivisions or solid branches inside, we can suspect that it is a hemorrhagic cyst and the best way to confirm this is to use a Doppler ultrasound because this paints the blood flow red and blue, if there is no flow. It is a cyst that has a little mass inside and nothing else, however, when the cyst looks solid and with many types of textures mixed together we can be pretty sure that it is actually a teratoma.

The teratoma after two weeks or a month will remain the same and will not disappear, however, the hemorrhagic cyst, if we do an evaluation in two weeks, will surely no longer be there because it is reabsorbed.

Now come the most interesting questions, the ones that will allow us to determine whether it is urgent to operate on you or not.

Question #3: How much and when does it hurt? (ovarian pain)

In general there are 2 types of patients when it comes to cysts, on the one hand we have patients who feel intense pain… And when I say pain I don’t mean cramps due to menstruation, but when you are placed in a certain position and right in That moment hurts intensely or perhaps, when you have sex or do some type of exercise or jump and a twinge begins only on one side, on the right or left. These are patients who perhaps did not pay much attention to the pain in the first month, but then several months pass and the pain intensifies, so they come to the consultation and we find the cyst.

On the other hand, we have patients who never felt pain or discomfort but they were due to go for their routine gynecological examination and by pure chance a cyst was detected. Doctors love to say that it is urgent to operate, but if it does not cause you even the slightest discomfort, the ideal would be to wait a few months to see if it disappears on its own, because it disappears on its own in 90% of cases.

In general, my initial recommendation is always to monitor monthly that it does not continue to grow and control it with medication, but if the pain is unbearable or if the cyst measures more than 6 cm, then it would be worth operating.

Question #4: How active are you?

One of the main concerns is that the ovary becomes twisted. If the ovary becomes twisted you will feel sudden and extremely intense pain and unfortunately we will have to remove the ovary, it is an emergency operation, however, even if the cyst is very large that will not cause the ovary to rupture. twist by itself by magic, especially if, for example, you work all day sitting in front of the computer and do not do heavy work at home.

Everything changes if your hobbies include gymnastics, dancing, playing sports, or if in your job you have to make a lot of movements, physical efforts because obviously all that movement or excessive pressure or a strong blow could twist the ovary.

Please, if you already know that you have a cyst, be very careful and protect that area of your body.

Question #5: Could you freeze your eggs?

No woman likes to contemplate the idea of losing her fertility before having children, but as I mentioned at the beginning of the video, we receive many patients, even minors, who have already had one or both ovaries removed. If you have already lost one ovary and want to operate on the other, you should really consider the possibility of freezing some eggs.

First of all, it is not something that expensive, at the time of recording this video the annual cost of keeping the eggs frozen is $6,000 Mexican pesos, which is $16 pesos a day, there are people who spend much more than that on a bag of chips or a daily coffee and secondly, if we want to look at it from the friendly side, the advantage of freezing eggs when you are young is that they are usually very healthy eggs and of very high quality, in such a way that even if you are looking for pregnancy Until you are over 40 years old, it should be relatively simple and with little medication through in vitro fertilization.

I hope this video helps you protect your fertility. Remember that we can review all the studies you have on hand in a video call consultation, but we need you to demand that you provide photos or videos of your ultrasounds. If they only give them a written summary that is not going to help us much, we have to see what it looks like to help them.

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Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
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