Ovarian Cysts & Tumors

POLYCYSTIC OVARIAN DISEASE 2024

 In light of the principles of

The Revolution of Medical and Surgical Naprotechnology 

Welcome to our Gyn Practice for Restorative Reproductive and Robotic assisted Gyn Surgery. 

RELAX—if you have come with some diagnosis of polycystic ovaries, whether you are planning to achieve pregnancy or are just trying to normalize your cycles- we can investigate the issues leading to this syndrome and help you achieve your goals. PCOD is not really a primary ovarian disease---it is secondary to the inappropriate secretion of gonadotropins—once we stabilize and correct this—your cycles can and may return to normal. 

1.HISTORY: the First VISIT…we will listen to your story/ review your records with you

2. Charting:CrMS—Creighton Model System x 2months with FCP; RTO- 2months.

3.:Physical EXAM and Cultures if indicated. 

4. Referral to Endocrinologist: Drs. Madu, Moatteri;; Teresi.

IMPRESSION and PLAN:

Labs/Dx

Comprehensive US Hoag; MRI in Month 4 for Endometriosis (50% of case!)

Meds: MyoInositol; Metformin 500mg; N Acetyl Cysteine 600mg

Diet: Whole 30 and/or intermittent fasting Dr. Anna Cabeca or Dr Kelly Anne

Irregular cycles and PMS—control with CPRT---cooperative progesterone therapy—200-400mg Prometrium Days 16-25

RTO-1 month, then every three months

Ovulatory induction with pregnancy desired: Clomid 25mg CD 3-5

CMR monthly review CD #2

US series CD 12,14,17 -Mon (9am-11:30)and Th (1-2:30P) 

Surgical Approaches

Ovarian Wedge Resection

REE—Robotic assisted Excision of Endometriosis

We will have biomarkers on this from the CrMS with limited mucous, poor follicle size on US series, persistent low Prog; poor sliding sign on US indicating adhesions

Most ovarian cysts are self-limited  and benign. Let us work with you to determine the next step in the care of your ovarian cyst.  In the reproductive years—a 2cm cyst occurs monthly with ovulation. Chances of ovarian cancer are small-so don’t worry too much before your visit—come in and we will develop a diagnosis plan!

The ovaries are two small organs located on either side of the uterus in a woman’s body. They make hormones, including estrogen, which trigger menstruation. Every month, the ovaries release a tiny egg. The egg makes its way down the fallopian tube to potentially be fertilized. This cycle of egg release is called ovulation.

What causes ovarian cysts? Cysts are fluid-filled sacs that can form in the ovaries. They are very common. They are particularly common during the childbearing years.There are several different types of ovarian cysts. The most common is a functional cyst. It forms during ovulation. That formation happens when either the egg is not released or the sac -- follicle -- in which the egg forms does not dissolve after the egg is released.

• Polycystic ovaries. In polycystic ovary syndrome (PCOS), the follicles in which the eggs normally mature fail to open and cysts form.
• Endometriomas. In women with endometriosis, tissue from the lining of the uterus grows in other areas of the body. This includes the ovaries. Endometriosis can be very painful and can affect fertility.
• Cystadenomas. These cysts form out of cells on the surface of the ovary. They are often fluid-filled.
• Dermoid cysts. This type of cyst contains tissue similar to that in other parts of the body. That includes skin, hair, and teeth.

What causes ovarian tumors? Tumors can form in the ovaries, just as they form in other parts of the body. If tumors are non-cancerous, they are said to be benign. If they are cancerous, they are called malignant. There are three types of ovarian tumors:

• Epithelial cell tumors start from the cells on the surface of the ovaries. These are the most common type of ovarian tumors.
• Germ cell tumors start in the cells that produce the eggs. They can either be benign or cancerous. Most are benign.
• Stromal tumors originate in the cells that produce female hormones.

What are the symptoms of ovarian cysts and tumors? Often, ovarian cysts don’t cause any symptoms. You may not realize you have one until you visit your obstetrician/gynecologist for a routine pelvic exam. Ovarian cysts can, though, cause problems if they twist, bleed, or rupture. If you have any of the symptoms below it’s important to have them checked out. That’s because they can also be symptoms of ovarian tumors. Ovarian cancer often spreads before it is detected. Symptoms of ovarian cysts and tumors include: pain or bloating in the abdomen, difficulty urinating, or frequent need to urinate, dull ache in the lower back, pain during sexual intercourse, painful menstruation and abnormal bleeding, weight gain, nausea or vomiting, loss of appetite, feeling full quickly.

How do doctors diagnose ovarian cysts and tumors?

• Ultrasound. This test uses sound waves to create an image of the ovaries. The image helps the doctor determine the size and location of the cyst or tumor.
• Magnetic resonance imaging (MRI)
• Hormone levels. The doctor may take a blood test to check levels of several hormones. These include luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, and testosterone.
• Laparoscopy. This is a surgical procedure. It’s also used to treat ovarian cysts. It uses a thin, light-tipped device inserted into your abdomen. During this surgery, the surgeon can find cysts or tumors and may remove a small piece of tissue (biopsy) to test for cancer.
• CA-125. If the doctor thinks the growth may be cancerous, he might take a blood test to look for a protein called CA-125. Levels of this protein tend to be higher in some -- but not all -- women with ovarian cancer. This test is mainly used in women over age 35, who are at slightly higher risk for ovarian cancer.

If the diagnosis is ovarian cancer, the doctor will use the diagnostic test results to determine whether the cancer has spread outside of the ovaries. If so, the doctor will also use the results to determine how far it has spread. This diagnostic procedure is called staging. This helps the doctor plan your treatment. Most ovarian cysts will go away on their own. If you don’t have any bothersome symptoms, especially if you haven’t yet gone through menopause, your doctor may advocate “watchful waiting.” But the doctor will check you every one to three months to see if there has been any change in the cyst. Birth control pills may relieve the pain from ovarian cysts. They prevent ovulation, which reduces the odds that new cysts will form. Surgery is an option if the cyst doesn’t go away, grows, or causes you pain.