Ovarian Cyst Pain During Menstruation
Ovarian cysts, whether simple or complex, tend to cause pain shortly before, during or after menstruation. If your ovarian cyst is functional, the peri-menstrual pain is likely to be because your cyst is responding to the higher concentrations of blood-borne hormones that occur during this phase of the menstrual cycle. A second reason that you may be experiencing ovarian cyst pain during menstruation is because you have a certain type of ovarian cyst known as an endometrioma.
Development of an endometrioma, also known as an endometriod cyst or chocolate cyst, is related to the medical condition endometriosis. Endometriosis occurs when tissues that normally grow inside the uterus grow outside it, in the peritoneal cavity. The uterine tissues tend to grow on the surfaces of other organs in the pelvis or the abdomen. When uterine tissue grows on the surface of the ovary, the growth is known as an endometrioma.
Overall prevalence of endometriosis is estimated to be between one and ten per cent. Although endometrial tissue can adhere to any organs in the peritoneal cavity, more than 80% of pelvic endometriosis is found in one or both ovaries. Endometriomas are filled with dark, reddish-brown blood and may be as large as 8 inches in diameter. They can eventually occlude most of the ovary and cause infertility.
Some women who have an endometrioma will suffer no symptoms, whilst others will endure severe menstrual cramps, pain with intercourse and pain during a bowel movement. Although complications from endometriomas occur only rarely, if a sizeable endometrial cyst ruptures, its contents will leak into the pelvic cavity, causing internal bleeding. The contents of the endometrial cyst may also spill onto the surface of other pelvic organs, including the uterus, fallopian tubes, bladder and intestines. This may cause the formation of adhesions, or scar tissue, on the other organs which in turn may cause fertility problems and pain.
Diagnosis of an endometrioma will happen in much the same way as it would for other ovarian cysts. Your doctor will take a full medical history, and may perform a manual pelvic examination. You will most likely need an ultrasound and possibly a blood test. The blood test will be used to rule out pregnancy and also cancer. The presence of a particular antigen, CA 125, is indicative of malignancy, but also of endometriosis and pelvic inflammatory disease.
Initial treatment for endometriosis and associated endometriomas is likely to be non-surgical. Often, your doctor will prescribe non-steroidal anti-inflammatory drugs (NSAIDs). These will reduce the pain and swelling associated with your cyst and endometriosis. Next, your doctor will want to stop you ovulating – this is known as inducing an anovulatory state. Typically, a birth control pill will be used to achieve this physiological state. If a combination of NSAIDs and oral contraceptives do not work, you may be treated with a progestational agent such as medroxyprogesterone, danazol or gestrinone. You may also be given a gonadotropin-releasing hormone (GnRH) agonist. GnRH agonists can also be combined with estrogen or progestogen to improve efficacy and prevent you from experiencing menopause-like symptoms. Your doctor can help you reach the solution that is best for you.
Women who have endometriomas are usually in their childbearing years. Your doctor will work with you to devise a solution that will reduce your pain and, if you still wish to have children, reduce your risk of infertility. If medical treatment of your endometrioma has not resolved your condition, surgery is likely to be your only remaining option. Indeed, because of the potential of these ovarian cysts to grow quite large, surgery is usually the option preferred by many doctors.
Your surgery may be possible using a laparoscopy, which is a relatively simple procedure. You will recover quickly from this type of surgery and have minimal scarring. Depending on the extent of your endometriosis and the size of your endometrioma, traditional open-abdomen surgery may be necessary. This is a more physically traumatic surgery and that will take you longer to recover from. It is important that you discuss with your doctor what will happen if the damage due to your endometriosis and endometrioma is extensive. In some instances, the doctor may wish to remove your ovaries or your uterus. You need to be prepared for these options before the surgery, especially if you wish to have children.