Suspect Ovarian Cyst Even if In Menopause
Understanding Ovarian Cysts in Menopausal Women: Debunking Myths and Embracing Advanced Technology
Ovarian cysts, particularly in menopausal women, have long been a source of concern and confusion. Advances in ultrasound technology have allowed for more precise detection of ovarian abnormalities, prompting a reevaluation of traditional practices. In this article, we explore the insights shared by Dr. Steven Goldstein, a Gynecologist at NYU Medical School, shedding light on the intricacies of ovarian cysts, their potential links to cancer, and the evolution of diagnostic approaches.
The Evolution of Diagnostic Techniques:
Dr. Goldstein emphasizes the revolutionary impact of ultrasound technology on gynecological examinations. While in the past, palpation (the pelvic exam) and inspection (listening to your bowel sounds, and watching for abnormal fluid waves of the abdomen) were the primary methods, today’s sophisticated sonomicroscopy reveals intricate details, uncovering normal and incidental findings like small endometriomas and dermoids. The term “sonomicroscopy” underlines our ability to identify abnormalities that were previously invisible to the naked eye.
Historical Perspective on Palpable Post Menopausal Ovary:
Delving into history, Dr. Hugh Barber’s concept of the “Palpable Post Menopausal Ovary” (PPMO) labeled such ovaries as abnormal and cancerous. This perception persisted for years, leading to the removal of ovaries based solely on palpation findings. Be mindful of the fact that a pelvic exam was such a critical diagnostic tool for physicians. Dr. Goldstein challenges this approach, urging practitioners to consider that not everything seen or felt may be abnormal.
Shifting Paradigms in Recommendations:
By the late 1990s, a paradigm shift occurred in how gynecologists advised menopausal women with ovarian cysts. Dr. Goldstein advocated for observation rather than immediate intervention for cysts measuring 5 cm or less. Research by Dr. Baily in 1999 revealed that approximately 17% of menopausal women have simple cysts. The key, Dr. Goldstein emphasizes, lies in distinguishing cysts with features suggestive of cancer.
The Watchful Waiting Approach:
For asymptomatic women without pain, the watchful waiting approach is recommended. Greenless PLCO cancer screening data showed that a third of cysts spontaneously resolve within a year. Dr. Goldstein assures that non-cancerous benign cysts do not inherently become cancerous when left untreated.
Clarifying the Nature of Pelvic Cysts:
Notably, not all pelvic cysts are ovarian; some may be paratubal, of parts of the bowel, or associated with non-cancerous structures. Generally the uterus itself doesn’t have cysts. Dr. Goldstein advises that tiny cysts measuring under 1 cm are highly unlikely to be cancerous, suggesting that gynecologists might consider not mentioning their presence.
Blood testing, repeated pelvic exams and repeated ultrasounds can clarify the nature of your cyst. It’s not common to need a pelvic cat scan or MRI, but those tests can be used as well. Ultimately, surgery may have to be done to remove a cyst that is change, suspicious, or painful. Thankfully
Conclusion:
In navigating the complexity of ovarian cysts, it is crucial for women to collaborate with their gynecologists. Dr. Goldstein’s insights underscore the importance of individualized management, emphasizing that many findings on ultrasound can be safely observed for several months without invasive interventions. By understanding the nuances of ovarian cysts and leveraging advanced diagnostic technologies, women can make informed decisions about their gynecological health.
