Post menopause, hemorrhagic cyst, possible hysterectomy

[popmom]

I just had my follow up u/s--5 weeks after incidental finding of a complex ovarian cyst. Cyst is around 3.5cm and appeared to be a smidge smaller today.

My first ca-125 was normal, and the doctor ordered a second today. 

He said he doesn't think this is cancer because it hasn't grown. And no solid components. But he also said, that's not supposed to be there--because I'm several years post menopause. Apparently hemorrhagic cysts are caused by ovulation?? 

Once we get the ca-125 results, we will discuss how to proceed. Looks like coming back for another u/s in 2-3 months. He said I have the option of going ahead and taking it and my ovary laparoscopically. And he added--he can just take everything if I want. 

Ideally, I would like for this thing to disappear without surgery.

If for some reason I do need to have it removed, I'm looking for advice on whether to just remove the one ovary or have the hysterectomy. I'm very leery of having a full hysterectomy, but the thought of removing potential sources of cancer is tempting. There is someone on the menopause reddit sub that claims that ovaries continue to produce some hormones even after menopause. I cannot verify that anywhere else online so far.

I have never had cancer, but I have had 3 different types of breast tumors. 2 were removed in a partial mastectomy with recontruction. One of those was a type of tumor that has "a high association with malignancy". The last one I had... the pathologist recommended it also be removed, but my wonderful breast surgeon said--lets get another pathologist to look at this. And thankfully I didn't have to have surgery for that one. 

I'm not particularly worried about this. Not that it's cancer, anyway. Praying my blood test is normal because I do not have time for surgery between now and the end of May! I'm booked with 2 graduations and a vacation. 🙃

Obviously, this is a very personal matter, but if someone is willing to pm me with their for or against, I'd be very grateful. Otherwise, just ignore all of this. 🙂 I'll figure it out eventually. I have a friend who just had a hysterectomy about 6 weeks ago. I'm going to talk to her, but she's not far enough out to know about any long term consequences. 

Edited April 15 by popmom

[Melissa in Australia]

Hugs during this stressful time

Sending positive thoughts 

[prairiewindmomma]

Hugs. Since it’s under 5cm and they are doing bloodwork, I think you will likely have some time to decide…enough time to get through graduations, etc.

Do you have history of PCOS or endometreosis? In your shoes I would have both sets of fallopian tubes and the one ovary out if you dont want to do a full hysterectomy. Studies show a lot of stuff starts in the tubes.

[Katy]

Preventative hysterectomy is such an individual decision that I’m not sure any of us can give you advice. The only negative thing I’ve heard about hysterectomy is that it can change or make orgasms more difficult. But even having a baby can cause nerve damage in the area, so how big of a concern that is…. Very personal too. 

[popmom]

11 minutes ago, prairiewindmomma said:

Hugs. Since it’s under 5cm and they are doing bloodwork, I think you will likely have some time to decide…enough time to get through graduations, etc.

Do you have history of PCOS or endometreosis? In your shoes I would have both sets of fallopian tubes and the one ovary out if you dont want to do a full hysterectomy. Studies show a lot of stuff starts in the tubes.

no PCOS or endometreosis. Thanks for the input. That is very interesting. Filing that away.

[kbutton]

41 minutes ago, popmom said:

But he also said, that's not supposed to be there--because I'm several years post menopause. Apparently hemorrhagic cysts are caused by ovulation?? 

How does he know it wasn’t there while you were still ovulating? Does he have an older ultrasound?

No advice for you, but I know hemorrhagic cysts can be really weird. I hope you are able to get answers to your questions.

[popmom]

1 minute ago, kbutton said:

How does he know it wasn’t there while you were still ovulating? Does he have an older ultrasound?

No advice for you, but I know hemorrhagic cysts can be really weird. I hope you are able to get answers to your questions.

Thank you. And good point about it possibly being there all along. I wondered that, too. I cannot remember having an u/s since my youngest was born--which was 18 years ago. I will ask about that.

[prairiewindmomma]

The other tidbit you should know is that ca-125 isnt considered definitive as a ruleout of ovarian cancer as it isnt sensitive enough. There was a 2021 Lancet article about it…cant find the original study though. 
 

But in postmenopausal women, only 1-2% of the cysts are cancerous. Most women get them removed just because they are less likely to resolve naturally and they are sick of the pain.

[Terabith]

Ovaries definitely continue to make hormones even after menopause, but at a lower level.  I did a lot of reading when I had my 20 lb ovarian cyst and had to have a hysterectomy.  I was very glad to be able to keep one ovary.

[popmom]

44 minutes ago, Terabith said:

Ovaries definitely continue to make hormones even after menopause, but at a lower level.  I did a lot of reading when I had my 20 lb ovarian cyst and had to have a hysterectomy.  I was very glad to be able to keep one ovary.

Thank you for sharing that. I did find something today from a study that said they continue to produce androgens for at least 10 years. Also…Bless you! I’m glad you kept an ovary, too. 
 

I appreciate y’all taking the time to chime in. I know it’s a sensitive topic. Today was the first day I’ve even entertained thoughts of surgery over this—and then to have the doctor throw in a hysterectomy—-that really threw me off! I hate that I don’t feel like I can implicitly trust my doctors, but I just don’t. Not when it’s not clear cut. I mean…he’s very competent. If I end up having surgery, I do trust him in that respect. 

Edited April 16 by popmom

[Anne]

I don’t have any useful advice, but this is something i so appreciate about the Hive - this wealth of experience that helps inform our decisions!  Doctors are not gods, and they don’t know everything!  It’s such a blessing to have a bunch of questions and things to consider when I’m making these decisions.

 

Anne

[MEmama]

15 hours ago, Terabith said:

Ovaries definitely continue to make hormones even after menopause, but at a lower level.  I did a lot of reading when I had my 20 lb ovarian cyst and had to have a hysterectomy.  I was very glad to be able to keep one ovary.

Not definitely after a hysterectomy though. Typically, yes, but they can suddenly fail after their friends are yeeted. Post menopause, I'm not sure how one would know, given that hormone testing is completely meaningless.

For that matter, I'm not sure how one knows if you have a hysterectomy before menopause either. My peri/menopause symptoms came on with a fury a few months after my hysterectomy --it could have been that they would have anyway (I was49), but since I had been completely regular beforehand the timing makes me think they just gave up. It's not uncommon.

eta: I'm totally pro-hysterectomy though. I wish they were offered as standard care to anyone who doesn't want the extra baggage

 

Edited April 16 by MEmama

[popmom]

1 hour ago, Anne said:

I don’t have any useful advice, but this is something i so appreciate about the Hive - this wealth of experience that helps inform our decisions!  Doctors are not gods, and they don’t know everything!  It’s such a blessing to have a bunch of questions and things to consider when I’m making these decisions.

 

Anne

Exactly!! 

[dirty ethel rackham]

It's entirely possible that it arose when you were still ovulating, but it just didn't resolve for some reason.  I had a 5 cm simple ovarian cyst that we found in ultrasound school.  Since I was post-menopausal, it "shouldn't have been there."  It did, however make it much easier to find my post-menopausal ovary on ultrasound - those babies are tough.  Since it was a simple cyst, we we weighed the risk of ovarian torsion and decided to take a watch and wait approach.  18 months later, a follow up ultrasound revealed that it looked like it was bigger.  Since I was starting to feel some discomfort, we decided to remove it.  The plan was to remove just the cyst via laparoscopic surgery, but we discussed alternate plans if things didn't look as expected.  If they cyst looked wonky, they were likely going to take the whole ovary, and possibly uterus if they felt that it may be diseased as well, which would have needed to be an open surgery rather than laparoscopy. 

Fortunately, it was exactly as they expected, so they were able to drain the cyst and remove it without taking the ovary.  Recovery was easy peasy.  I did have a little reaction to the surgical glue they used to close the small incisions.  

[-----]

nm

Edited May 29 by kathyl

[popmom]

2 hours ago, dirty ethel rackham said:

It's entirely possible that it arose when you were still ovulating, but it just didn't resolve for some reason.  I had a 5 cm simple ovarian cyst that we found in ultrasound school.  Since I was post-menopausal, it "shouldn't have been there."  It did, however make it much easier to find my post-menopausal ovary on ultrasound - those babies are tough.  Since it was a simple cyst, we we weighed the risk of ovarian torsion and decided to take a watch and wait approach.  18 months later, a follow up ultrasound revealed that it looked like it was bigger.  Since I was starting to feel some discomfort, we decided to remove it.  The plan was to remove just the cyst via laparoscopic surgery, but we discussed alternate plans if things didn't look as expected.  If they cyst looked wonky, they were likely going to take the whole ovary, and possibly uterus if they felt that it may be diseased as well, which would have needed to be an open surgery rather than laparoscopy. 

Fortunately, it was exactly as they expected, so they were able to drain the cyst and remove it without taking the ovary.  Recovery was easy peasy.  I did have a little reaction to the surgical glue they used to close the small incisions.  

 

1 hour ago, kathyl said:

I had a radical hysterectomy at 62yo, 2018.  They took out everything (cancer).  It was an easy decision to make, having the hysterectomy.  

I never felt bad before the hysterectomy and didn't even know I had cancer.  But I was very glad I went ahead and had them take out everything.  I didn't notice any difference post-hysterectomy.  The incision healed beautifully and sex was actually better.    

I'm not sure what would have happened had I had so many options as you have, OP.  Those sound like some very tough decisions.  I hope it all works out for you.

Thank you both for sharing. Ethel, I’m thinking more and more that this has probably been there this whole time. 

Kathyl, I'm sorry you had to go through that. It’s  definitely encouraging to hear y’all came through as good or better.