November 11, 2004

Development of functional cysts, according to doctors is not a thing to worry about, it is only in the case of pathological ones where doctors advise immediate treatment. Endometriosis or chocolate cyst is a fairly common type of pathological cyst, which is sustained by hormones, writes S.K.

Zaib, a banker, is an educated, confident woman, well aware of many things in life. However, life is not rosy for her these days: she has just discovered that she has an ovarian cyst. In her mid twenties, she was recently diagnosed with a cyst in her left ovary and unfortunately, according to the doctors, hers is a serious case. Has she been a victim of ignorance? she asks herself.

What are ovarian cysts? Is it a common complication or should it be taken very seriously? These are a few questions which hound young ladies like Zaib. Some basic information about this complication which occurs in the female reproductive system will save one from becoming a victim of ignorance and it may remove unnecessary fears which can make one dread this common problem.

Zaib regrets, despite the edge she enjoys over other women in terms of her qualification and access to various sources of information, how she could remain unaware about the problem which was gradually strengthening its roots in her reproductive system.

“Since we don’t discuss women’s reproductive health problems openly, whatever happens to us we take in our stride. Our ignorance often makes us neglect little pain, which may be an indication of some complication brewing inside,” she says sadly.

She had ignored symptoms which were indications of an ovarian cyst. The terrible pain, cramps in the abdomen and the sensation of discomfort while passing urine during periods were things she thought occurred in every normal girl.

It was only after she suspected that her abdominal pain during her regular days, which she took as an outcome of her aerobic exercise, was getting too frequent, she decided to consult a doctor. “The doctor thought I was being paranoid as my periods were regular and I showed no alarming symptoms, but on my insistence she agreed on an ultrasound.”

Zaib was alarmed when the radiologist while doing the ultrasound told her that there was a cyst in her right ovary. The gynaecologist she later went to further depressed her by saying the cyst was very large and had to be removed through an operation. Zaib was utterly distressed when the doctor informed her that infertility and gradual decadence of the whole reproductive system were the major complications likely to be caused by the cyst.

Providing details about the subject Dr Shaheen Zafar, head of the gynaecology and obstetrics department, Liaquat National Hospital, said cysts (which could be described as water or fluid-filled sacs) in ovaries were part of a normal ovulation function.

“Cysts, basically, are of two types; the functional ones also known as physiological ones, are smaller in size, about 2 cm, and occur every month during periods,” she said. Since these get dissolved after a month to be replaced by new ones, a woman need not worry if she is detected with such a cyst.

On the other hand, the pathological ones tend to pose danger to the reproductive system and with symptoms which were persistent, cysts larger in size which could be malignant or benign. Some cysts might be congenital and remain in dormancy for a long time.

A pathological cyst can be treated with laparoscopy if its size is less than five cm. “It is a type of surgery performed with a lighted instrument called a laparoscope, which is put in the abdomen through a small incision made near the belly button. But if the size has increased, say about seven cm or more, then an operation becomes unavoidable,” Dr Zafar said.

“We advise its removal because with time it can become malignant and cause serious problems like ovarian cancer,” she said adding there could be some situations where medicines were given to decrease the cyst size, but if it did not work, an operation was the only treatment. Women on birth control pills are protected against these cysts, she said.

Development of functional cysts, according to doctors, is not a thing to worry about. It is only in the case of pathological ones where doctors advise immediate treatment. Endometriosis or chocolate cyst, the type Zaib was diagnosed with, is said to be a fairly common type of pathological cyst, among similar ones of its kind.

Explaining its nature, Dr Zafar said although the exact reasons for its formation are still unknown, it is said these are usually formed when some blood backflows from the fallopian tube into the pelvis during periods and collects in the ovaries and is brown in colour, hence the name chocolate.

“This kind, though not malignant, is related with infertility and it is impossible to get pregnant with it,” she said, adding “it was a bad kind” which gradually encroached upon the whole reproductive system. “It is kind of a self-limiting cyst,” she said, explaining that it grew on hormones released by the ovaries and when it reached an advanced stage, it destroyed ovaries affecting the hormone production. “It is like a parasite eating away the host.”

It is seen that a small cyst gives a lot of pain and a large cyst grows larger without causing any pain or symptoms. Dr Zafar said that often symptoms of this kind of cyst were not too obvious and that is why they go unnoticed.

For any girl detection of an ovarian cyst, if it happens to be pathological, could be upsetting, considering the possible damages it can have. Hina, single, in her early 30s, shared her experience with TR and talked about how she handled the emotional setback she suffered after she was diagnosed with a cyst three years ago.

She went to a gynaecologist after she began to have pain during her periods. A subsequent ultrasound revealed a pathological cyst, in one ovary, though a small one. “I had no knowledge about cysts and I was quite unnerved when the doctor told me there was no treatment for it except for an operation,” Hina thinks the doctor presented to her a ghastly picture and misguided her with scary interpretations.

“I spoke to many people and was told homoeopathic treatment was best for such cases so I went to a homoeopath doctor,” said Hina. After taking homoeopathic medicines for some months, she felt relieved when the pain during the periods went away and her general health improved. Encouraged by this, Hina left the treatment. But she had to resume it after she felt shooting pain in the abdomen off and on, which worried her.

She was kept under this impression that the alternate medicines were working well for her and the cyst had subsided. She remained under the homoeopath’s treatment for over two years and not once was she advised to get another ultrasound to check the size of the cyst.

“I was alarmed when the abdominal pain did not go. It would come back after I would stop taking the medicines.” Fed up with this, she got an ultrasound test done. She was terrified to learn that the cyst size had increased to four cm. The findings left her dismayed and she felt embittered against the doctor who had worsened her case and wasted time instead of sending her to some other competent doctor.

Hina has gone through five ultrasound tests. The latest one showed the cyst had increased further and another cyst had developed in the other ovary, too. Doctors say it is endometriosis. The girl became further scared when one of the doctors advised her to get a CT scan and malignancy test, CA 125, done. Fortunately, the malignancy test was clear, but the CT scan did not clarify the nature of her cyst.

“I have spent Rs8,000 over these tests and medicines but still the ambiguity has not been cleared,” she said. She was pushed to the limits when another doctor asked her to get an MRI test for an accurate diagnosis.

“If a girl’s biological functions are working fine; like getting pregnant and having children, then she is less prone to such complications,” Hina said her doctor had told her that getting pregnant was an option that could help her. She has no wedding plans on the cards, and the only treatment she has been advised by more than three allopathic doctors is to get the cyst removed by an operation.

Until Hina gathers enough courage to opt for an operation, which, too, will create some complications and side effects, she has decided to rely on homoeopathic treatment.

Shedding more light on the subject, senior gynaecologist Dr Sadiqua N. Jaffery, said that in women cyst could develop at any age but it was mostly in those above forty that there was likelihood of a cyst being malignant. In girls, in their adolescence, it was mostly benign or non malignant. However, she said, sometimes in young girls malignant cysts may be present.

“It does not happen that a cyst forms in an ovary and gradually turns malignant. If from the beginning it is benign it will remain so till the end,” she said.

Treatment of a pathological cyst, in her view, depended on its size and the individual patient. However, she opined the best thing to do was to remove it. “Treatment is important. Any persistent cyst should not be ignored,” she emphasized.

Pseudopregnancy, a condition in which monthly menstruation cycle is stopped with pills is said to be a treatment specifically for those unmarried girls diagnosed with a chocolate cyst. “For three to more months periods are stopped because the cyst increases in size with periods. If the size decreases it is a good sign, if it does not then it is advised to get it removed.”

However, it may well be noted medicines have side effects. “No treatment can be termed safe. Each one has its own problems. The pills given to stop periods may cause acne, facial hair growth, water retention in the body and weight gain. However, doctors maintain that side effects are not long lasting.

“When girls with endometriosis come to me, I ask them to get pregnant. If they are unmarried I advise them to get married and start a family,” Dr Jaffery opined.

Touching on the suitability of homoeopathic treatment for ovarian cysts, Jaffery said, “There is a trend these days of trying herbal and alternate medicines. I have seen girls taking them but I personally don’t advise that women with this problem should go to homoeopaths.”

Although allopaths express their reservations about referring cases of ovarian cysts to homoeopaths, it is commonly seen that patients have faith in the homeopathic treatment for such problems. “Their medicines do not cause any harmful effect and it is a good alternate to getting operated,” said a patient seeking homoeopathic treatment. The girl said that she had been advised to get an operation, but before she actually gets prepared for one she wants to give homoeopathy a chance.

Sharing his views with TR Dr Sharif Haider, a homoeopath practising for over 25 years, maintained that homoeopathy did have a treatment for ovarian cysts. “About 99 per cent of women come to us after having tried the allopathic treatment,” he said.

Describing the method of treatment, he said that homoeopaths took cue from symptoms a patient complained about and then a combination of drugs was given to relieve the pain. Saying mostly women coming with ovarian cyst were married, he said there has been a slight increase in the turn over of patients, which may be attributed to the growing awareness about their reproductive health.

Stressing that a patient should go for multiple opinion before adopting any mode of treatment, Dr Nawaz, another homoeopath doctor, said that surgery could be done at anytime but first a patient should try medicines. “I advise them to get surgery done if I see that medicines are not making any difference,” said Dr Nawaz who has treated a number of women with ovarian cysts. He claimed that about 70 per cent of his patients were freed of the problem with his medicines.

Stating that the majority of females had no or nominal knowledge about their reproductive health, Dr Nawaz said that young girls should be told about the common symptoms and complications linked to their health to prevent late detection of problems which may cause bigger complications later on.

Since the major complication caused by pathological cysts is infertility, in the case of endometriosis particularly, it can be really upsetting for any unmarried girl to be diagnosed with one.

On the condition of anonymity, a girl said that since the day she learnt about her ovarian cyst she has been under stress and cannot stop feeling depressed. The girl is about to get married and she gets double minded if she should break the news to the boy or not. The fear of rejection stops her from doing so, while honesty demands otherwise. “Fair dealing demands that the boy’s side should be told, if a girl has any such problem,” opined one of the doctors interviewed.

Although doctors say that problem in conception is a complication that becomes unavoidable if one has a pathological cyst, sometimes things take place in a miraculous manner leaving the doctors dumbfounded. This definitely brings some hope and consolation to many. Referring to one such case, Dr Zafar said she had a patient with endometriosis cyst and there appeared no chances of her having babies but she had one after four years of marriage. “Such miracles do happen, which we can’t justify,” she added.

Fatima had become alarmed when she started getting symptoms which indicated something was wrong. “I was in my late twenties then. My irregular periods, shooting pain in the abdomen and vomiting provided sufficient reasons for me to consult a doctor,” she said.

Tests confirmed she had a cyst. “I was not devastated by this revelation as I knew most women had it and I could always get it operated. What hindered the operative procedure was the high level of thyroid and prolactin in her body. “Doctors had told me if I get it removed I could conceive as the cyst hindered the process of conception but since neither I nor my husband were too keen about having a baby, I did not show any haste and let the doctor decide when it would be the right time to do the operation.”

Fatima during that time was constantly under observation and would get her regular CA 125 test done to know if she was showing any indication of carcinoma developing. When her thyroid level was controlled she was operated and the cyst was removed.

“I relied not just on allopathic treatment but also on faith healing, the latter helping me tremendously in overcoming the problem. I can never forget the way my gynaecologist briefed me about the whole thing without making me feel scared,” she said.

The concept of sound reproductive health of an unmarried girl is still not very common here, and it raises eyebrows when any young girl, particularly an unmarried one, visits a gynaecologist. Sana found it to be quite an ordeal when she had to face the stares of other patients while walking in a clinic to have her general check up. Another girl Huma who went to have an ovarian checkup for a cyst, said that although she was accompanied by her mother, other women looked concerned and were curious to know what could have brought an unmarried girl to a gynaecologist.

Concurring that awareness regarding reproductive health was not too satisfactory among women and there was little understanding that an unmarried girl could have problems too, Dr Jaffery said in most of the cases, detection of cysts came through accidental finding. However, she said latest methods of diagnosis had made things much easier.

Keeping in mind the complications a cyst can create, and in many cases they might develop and grow without any symptoms, it seems an acceptable suggestion if a girl opts for a routine ultrasound to get a clear bill of health. However, the doctor had her reservations regarding this. “I won’t advise girls to go and have a routine ultrasound unless they show symptoms of some internal complication like getting heavy periods with vomiting and pain. If a physician asks for a check up then they can go ahead with an ultrasound,” said Dr Jaffery.

In her view getting a voluntary ultrasound only creates more tension. “I often get girls who complain of a cyst in the ovary. On examination we find a functional cyst which is not worrisome.” Supporting this view, Dr Zafar said that once it was advised that girls should get an ultrasound done every year. Though it was not too practical, screening could help detect a problem. “One must not go to unexperienced people, ill-equipped ultrasound clinics which might misguide a girl and make her tense unnecessarily.”

Although one gets to hear cases of women with cysts, Dr Jaffery maintained the pathological ones were not a common problem. “Every month, I see five to six patients, though I cannot give any figure of the percentage of women on the basis of this number.” She says that no survey or study has so far been conducted to ascertain the magnitude of this problem among women.

Polycystic ovaries syndrome

It worried Huma, 24, when she did not get her periods for three months; presence of slight facial hair growth on the side and on the chin distressed her even more. She knew something was going wrong inside. But what? She had no clue. “The doctor advised me to get an ultrasound and hormonal test done. Results showed I had polycystic ovaries syndrome (PCOS), something I had never heard about before.”

She started her treatment from an allopath and after some months was assured that the problem had subsided. The girl later got married. However, she faces problem in conceiving a baby and often wonders if it has to do something with the PCOS. This is a genuine for any girl diagnosed with the PCOS, a common complication related to ovaries.

Talking about it, Dr Naeemul Haque, senior endocrinologist at Aga Khan Hospital said PCOS development of multiple cysts in ovaries was caused by various factors. The classical symptoms include; scanty, irregular periods (a condition referred to as aligomenorrhea or amenorhhea), hirsuitism, i.e. presence of hair on places where women normally don’t have hair such as on the chest, chin and thighs, acne, obesity (though less frequent), and infertility in married women.

It is estimated that 10 per cent of the females falling in the reproductive age group from 15 to 40 years suffer from this condition world wide. Dr Naeem said that it was the most common endocrine problem faced by women of reproductive age.

Tracing the causes of the PCOS, he said when the level of male hormones, androgens, increased in females they showed symptoms of PCOS. It is because of an increased insulin resistance in the body which stimulate ovaries to produce androgens.

“Timely detection and treatment, which is a prolonged one, is very important as a patient is prone to become diabetic, which can further complicate the treatment. Besides, he stressed about insulin deposited fats in the body which caused obesity in patients. “Weight reduction through dieting and exercise is important,” he said adding the PCOS could be treated with medicines and operation was not needed.

The treatment could be multi-pronged meaning a patient maybe treated for the cosmetic problems of hair growth and acne, which was naturally upsetting for an unmarried girl. He said that for married women, the stress was on treating infertility, a possible complication caused by the PCOS.

Sharing her views with TR a woman said she was diagnosed with polycystic ovaries when she was in her late twenties and single. She showed some classical symptoms of the problem, which upset her.

When she went to see the doctor, she became worried after hearing about the complications in her reproductive system. “My reports clearly mentioned that infertility was a possibility I could face,” she said adding that she took treatment for more than six months and also went for laparoscopy.

The woman now in her mid thirties, says that although the nature of her problem was complicated and doctors, too, gave up on her in a way, one should let nature takes it course. “I am a mother of two kids now and feel like laughing over what my reports said.” She believes doctors are not always accurate in their opinion and often complications in a woman’s reproductive system tend to disappear after getting married. — S.K.

What are symptoms of ovarian cysts?

Although gynaecologists say that ovarian cysts usually develop and are likely to grow silently without showing any clear or alarming symptoms, there a few signs generally taken as indicators of ovarian cysts, which commonly develop in girls of childbearing age. In some cases a cyst will become large in size and it may lead to severe abdominal pain or pressure because of torsion or it may put pressure on the urinary tract and cause pain during urine flow.

Painful menstrual periods, pelvic pain and cramps during periods are common complaints and many girls tend to ignore them.However, these conditions accompanied with heavy or abnormal bleeding is said to be a common symptom of endometriosis. The best way to remove one’s fears and doubts is to consult a good gynaecologist and seek expert advice regarding its diagnosis and treatment. — S.K.

Please Visit our Sponsor (Ads open in separate window)