There was an article on CNN today about hormone replacement therapy.  Apparently Wyeth, a pharmaceutical giant, paid hundreds of thousands of dollars to deliberately misled people on the benefits on hormonal therapy.

These articles were published in medical journals, and overly stated the benefits of replacement hormones, while underplaying the risks.  CNN said,

The analysis of those articles found that they “implied that estrogen could preserve youth and health.” Further, the study says, physicians were prescribing estrogen to millions of women who had no symptoms.

“In 1975, an eight-fold increase in endometrial cancer was linked to estrogen use and estrogen sales decreased,” Fugh-Berman wrote. “Today, despite definitive scientific data to the contrary, many gynecologists still believe that the benefits of HT outweigh the risks in asymptomatic women. This non-evidence based perception may be the result of decades of carefully orchestrated corporate influence on medical literature.”

The articles were crafted to downplay the perceived risks of hormone therapy and to promote unproved uses for hormone therapy, such as preventing dementia, Parkinson’s disease, vision problems and wrinkles, according to Fugh-Berman’s analysis.

However, the Women’s Health Initiative found that HRT is linked to an increase in breast cancer, ovarian cancer, strokes, and other problems.

The main hormone prescribed was estrogen.  Now, this seems to show that artificially boosting estrogen levels is dangerous. However, this is what most birth control pills will do.

So what should you do if your doctor prescribes birth control to clear up your cysts?

First, try natural methods to get rid of them.  If you absolutely must take birth control, consider doing progesterone only.  This is a little less effective, but it is much safer.

This approach is the primary way of treating ovarian cysts.  As most cysts are functional and noncancerous, this is generally the best approach.  However, it can leave you in a lot of pain while you wait for the cyst to shrink.  It also does nothing to speed the process of cyst removal or prevent future cysts from forming.

How This Treatment is Prescribed

During a pelvic exam, the doctor will feel a mass on your ovary.  Afterwards, he will have you get an ultrasound.  This will show whether the mass is a fluid filled cyst or something else.  If it is filled with fluid, you will be asked to return for another ultrasound in two to three months.

If the cyst is especially large, in danger of bursting or twisting the ovary, or made of solid material, then surgery will be recommended.

Who This Treatment Works For

The majority of women will have their cysts dissolve naturally without doing anything.  As long as you have a functional follicular or corpus luteum cyst, it should disappear within two to three months.  However, if you have painful, large or recurring cysts, you may want to look into other options.  These are hormonal therapy, surgery, or natural treatment.

What Happens If the Cyst Doesn’t Dissolve

At that point, the doctor will recommend either surgery to remove the cyst, or hormonal therapy to reduce it.  However, both of these treatment methods have drawbacks.  They don’t prevent future cysts, and in the case of birth control, sometimes worsen existing cysts.

After a cyst ruptures, almost every hospital will start you on IV antibiotics.  This is to prevent the risk of infection from the rupture, which is one of the biggest causes of complications.  Afterwards, the doctor will assess how much damage was caused by the cyst.

Damage can be caused from the fluid that leaked out of the cyst.  If not quickly absorbed by the body, it may cause scarring.  If the cyst was a chocolate or endometrial cyst, blood may have leaked into the abdomen as well.  This also can cause complications.  To determine what is going on, the doctor will likely order an ultrasound.  In some cases, if your symptoms are severe, exploratory surgery may be recommended.  This is to rule out the chance of internal bleeding.

If you are having trouble breathing, have unusually high or low blood pressure, or other severe symptoms, the physician will order a culdocentesis.  This is a way to measure the type and amount of fluid in the abdomen.

A ruptured ovarian cyst causes a great deal of pain, so the doctor is likely to prescribe you pain medication.  For high levels of pain, the doctor is likely to use morphine or Vicodin. For moderate pain, you may just be given Tylenol.  The type and amount of pain medication prescribed depends on any preexisting medical conditions and what type of antibiotics you are on.

After you are released, the doctor is likely to want to see you again in the office.  He or she will do an ultrasound to make sure everything is healing properly.  Also, you may be started on birth control pills to prevent any ovulation.  This is to prevent any additional cysts from forming while your body is still recovering.

Who Ovary Removal Affects

Risks of Ovary Removal

How Ovary Removal is Performed

Cysts that Require Surgery

The majority of cysts do not require surgical treatment.  However, a few do.  Of those that are surgically removed, only 10% turn out to be cancerous.

Cysts that are made up of solid material, such as a dermoid cyst, or cysts that are septated (have more than one section divided by a wall) are removed through surgery.  Solid or septated cysts are considered to be a higher risk of cancer than fluid filled cysts.

Laparascopy

A laparascopy usually involves two to four incisions about 1 inch in length.  One is through your belly button, where the laparascope is inserted.  The others are in the lower abdomen, and used to insert tools to move your organs around as necessary.

After the incisions are made, a lighted tube is inserted through your belly button.  The doctor guides this to the ovary with the cyst.  If possible, only the cyst is removed.  However, if the cyst is large or solid, the ovary is removed as well.  If the cyst is large but fluid filled, it is drained, then removed.

Afterwards, it takes about a week to recover enough to go back to work or school.  Most people say the most painful incision is the one through the belly button, so plan on wearing low cut pants.  Also, air is pumped into your abdomen to give the doctor more room to work during the surgery.  Many people will experience gas pains until this air has been reabsorbed in the blood stream (usually in 2 to 3 days).

There is some research into performing this surgery in less invasive way.  One doctor in Germany is experimenting with going in through the uterus, with positive results.

To read some stories of people’s experiences with this type of surgery, please visit this forum post.

Laparatomy

Laparatomy is abdominal surgery for ovarian cysts.  It is generally only done when cancer is suspected, as it allows the doctor to remove all possible cancerous tissue while in the abdomen.  Sometimes, it is even performed after a laparascopy has been started.  If the doctor discovers evidence of cancer during laparascopy, he will make the incision larger in order to remove as much of the cancerous material as possible.

The biggest difference between this surgery and laparascopy is a larger incision and a longer recovery time.  In most cases, the ovary is removed.  Sometimes the uterus and the other ovary are removed as well, especially if cancer is suspected.

Risks of Surgery

All surgery carries risks.  For ovarian cyst surgery, the biggest risk is that the cyst will return.  As long as the ovary is still present, there is a risk for additional cysts unless the underlying cause of the cysts is treated.

Additional risks include infection and the risk of scar tissue forming.  Scar tissue can damage the fallopian tubes and reduce your ability to get pregnant.  Also, there is the remote possibility of the intestines or bladder being damaged during the surgery.

Image via Wikipedia

The traditional method of treating functional ovarian cysts is hormonal therapy.  Basically, this means that you will go on the pill.  The theory behind this is that the cysts are caused by a hormonal imbalance; thus, having a regular dose of hormones will fix the imbalance and clear up the cysts.  However, it does not always work that way.

Which Types of Cysts are Treated This Way?

Hormonal therapy is prescribed for cysts that do not dissolve within two to three months, cysts that are recurrent, and cysts that are functional.  If a cyst is filled with fluid on an ultrasound, this method is generally used.  A cyst with solid material inside is recommended to be removed surgically, in order to test for ovarian cancer.  The two main types of cysts treated with hormonal therapy are follicular cysts and corpus luteum cysts.

Birth control is usually prescribed when a cyst does not clear up on its own after two to three months.  Also, if you have a lot of cysts or recurring cysts, this will be prescribed.

How Does Hormonal Therapy Work?

If your cysts are being caused by a hormonal imbalance, the birth control pills will help you to keep your hormones at a steady level.  Also, it can help to regulate and lessen your menstrual cycle.

In some cases, the doctor may recommend that you skip the placebo pills.  This will allow your body to stay in a constant state, which may help lessen cyst formation.

What are Some Drawbacks to Hormonal Therapy?

This treatment, although effective in many cases, does not work for everyone.  In some cases, women have reported that their cysts grow worse with the birth control pills.

Also, on the pill, you may experience a range of side effects.  Some of them include break through bleeding, increased risk of heart attack or stroke due to blood clots (especially if you smoke), and not being able to get pregnant.

Pregnant and nursing women cannot use this form of treatment.

Are There Alternatives to Hormonal Therapy?

There are a few being researched now.  The most common prescribed one is surgery.  However, some natural treatments are showing a lot of promise.  Also, some women have found success with using progesterone only therapy.

There are ways to balance your hormones without taking a birth control pill.  This generally involves changing your diet, and exercising regularly.

Some women do not have cysts caused by a hormonal imbalance.  In some cases, it can be caused by problems with the endocrine system or with insulin production.  In these situations, a change in diet can be helpful.