Dr Suman Bijlani, Gynaecologist, Sonologist, Infertility Specialist, Obstetrician and Laparoscopic Surgeon, Mumbai.

Ovarian Cysts

Ovarian cysts are one of the most common gynaecological problems that can be a cause for worry. If you have an ovarian cyst, you should have a basic understanding of this condition.

Q. What is an ovarian cyst?

An ovarian cyst is a fluid filled sac inside the ovary. It may be a follicle (egg) which has overgrown ovarian-cyst(hormonal or physiological cyst) or bled inside (haemorrhagic cyst) or it may be a benign or cancerous tumor.

Q. My doctor has told me that I have a physiological cyst? And that I should do nothing about it? What does it mean?

Every month, many eggs (follicles) grow in the ovary. The normal follicle is thus a fluid filled sac which also contains a premature egg. Out of many growing follicles, one becomes the largest (between 18-15 mm) and is known as the ‘dominant follicle’. This dominant follicle ruptures to release the egg. After rupture, the dominant follicle forms a structure known as the ‘corpus luteum’ which contains fluid which contains hormones for implantation. This corpus luteum disintegrates 2 days before expected menses.

Ovarian physiological cysts

 

If the follicle, instead of rupturing, grows further and persists, it is known as a ‘follicular cyst’.

If the corpus luteum persists or grows, it is known as a ‘luteal cyst’.

At any point of time, if there is bleeding in the follicle, the follicle enlarges and gets filled with blood, known as a ‘hemorrhagic cyst’.

The above three types of cysts are hormonal and not tumors. These are therefore known as ‘physiological cysts’. This type of cysts are usually not more than 3-4 cm in size, filled with clear fluid (simple cysts), painless, are accidentally found on a routine sonography and most often require no treatment. They shrink and dissolve on their own in the coming months, or may require some minor hormonal treatment.

PCOS (polycystic ovaries) is a special condition wherein the ovary is filled Polycystic ovaries

with multiple small immature follicles and thus the ovary appears cystic.

Please refer to article on PCOS for more details.  

 

 

 

 

Q. How do I know that I have an ovarian cyst?

Ultrasound is the best way to diagnose an ovarian cyst. It can also tell us whether the cyst is filled with clear fluid (simple cyst), blood (hemorrhagic cyst) or has solid material or septations (tumor).

 

USG simple cyst                hemorrhagic cyst USG

 

Ultrasound can also give some indications about whether the tumor is likely to be benign or cancerous.

Q. Do all ovarian cysts require surgery?

Not all ovarian cysts require surgery. Whether surgery is needed or not depends on the size and type of the cyst. Simple and hemorrhagic cysts may dissolve with time whereas a tumor needs to be removed surgically. Occasionally a very large simple cyst which does not resolve naturally over time, may have to be operated upon.

 A ‘chocolate cyst’ is a special type of hemorrhagic cyst which is found in a condition called ‘endometriosis’ (its management is discussed in the section on Endometriosis).Chocolate cyst

Q. What complications can happen with an ovarian cyst?

An ovarian cyst can cause the following complications:

  1. The cyst can get twisted (torsion) which can cause severe pain and inflammation and may damage the ovary.
  2. The cyst may rupture causing severe pain and internal bleeding.
  3. Hemorrhage in the cyst (bleeding into the cyst) causing severe pain.

Q. How do I know that my ovarian cyst is not cancerous?

Ultrasound (sonography) features can tell us a lot about the cyst. If the cyst is filled with clear fluid (simple cyst), it is almost certainly benign. A vast majority of the hemorrhagic cysts (blood filled cysts) are also benign.

Features suggestive of cancerous cyst are:

  • Solid areas/nodule or papillary(finger like) growths in a cyst
  • Thick septations in a cyst
  • Thick walls
  • Increased blood flow on doppler
  • Free fluid in the pelvis
  • Raised tumor markers in blood (e.g. CA-125. AFP, HCG, LDH)

Please note that these features are only suggestive of cancer. All tumors with one or more of these tumors are NOT cancer. In fact, only a small proportion of them are cancer, but all of them need to be operated upon to remove them and confirm the same.

Q. How do I confirm that the cyst is cancer or not?

MRI or CT Scan can give us a better understanding of the tumor features. If the tumor shows one or more of the above features, CT/MRI will tell us also tell us whether the tumor is infiltrating into the surrounding organs (uterus, pelvic wall, blood vessels, ureters or opposite ovary) and whether lymph nodes, liver, kidneys or spleen are involved, which may mean cancer.

If there is free fluid in the abdomen, your doctor may test the fluid which would confirm cancer.

Q. My CA-125 is 92, which is high. Does that mean I have cancer? Please help.

CA-125 is one of the tumor markers for a certain type of ovarian cancer (epithelial tumors). It is only indicative of cancer if very high. CA-125 may also be raised in pelvic infections, endometriosis, tuberculosis and peritonitis (inflammation of the peritoneum). Conversely, CA-125 may be quite normal in ovarian cancer too.

Q. Which surgery is best for ovarian cyst?

There are certain rules of thumb in the treatment of ovarian cysts.

  1. Simple cysts – Observation. Should disappear in three months. If does not shrink or disappear, or it grows, consider further evaluation (CT/MRI) or hormonal treatment. If the cyst is very large (more than 6 cm) or undergoes torsion (twisting), it may have to be operated upon.
  2. Hemorrhagic cysts – Observation. Should disappear in three months. If it does not shrink or disappear or it grows or is associated with painful periods, painful sex or pelvic pain, it may be a ‘chocolate cyst’. Please refer to the section on Endometriosis for management of chocolate cysts.
  3. Suspicious ovarian cysts – Cysts with features suggestive of malignancy should be removed at laparoscopy or open surgery.

If you are young (less than 40) and premenopausal, your gynaecologist may prefer to remove only the cyst and not the ovary. He/she would do a ‘frozen section’ (testing of the tumor in the operation theatre). If the tumor is benign, your ovary need not be removed. Some ovarian tumors have a tendency to recur and the gynaecologist may decide to remove the ovary also, after discussion with you.

On the other hand, if the verdict is cancer, it is better to remove your uterus and opposite ovary too along with sampling of lymph nodes and peritoneal fluid.

For all postmenopausal women with ovarian tumors, it is best to remove the uterus and opposite ovary at the same sitting.

Most gynaecologists today prefer the laparoscopic route of surgery due to its various advantages. But in cases strongly suspicious of cancer or confirmed cancer, open surgery may be preferable as it allows for better lymph node sampling and testing of the internal organs. However, today, there are a few experienced oncosurgeons who perform laparoscopic cancer surgery. But these are relatively few experts in the field.

 

 

 

 

 

 

 

 

 

 

 

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Surgical Abortion (D&C)

 

If you have an unwanted pregnancy, you can opt for the abortion pill or you may go for a surgical procedure (D&C) in a legalised abortion clinic.

Q. I am 6 week pregnant. Should I choose the abortion pill or is it better to undergo D&C?

The abortion pill has a success rate of about 95% for up to 7 week pregnancy (49 days from the date of the last menstrual period).

D&C with an experienced gynaecologist is a safe and reliable procedure. You can go back home in about 4 hours (day care procedure). There is no waiting or anxiety about whether the abortion is successful or not. You feel no pain (the procedure is performed under anaesthesia) although there may be mild pelvic discomfort or heaviness for a few days.

Q. Up to how many weeks can I undergo D&C?

You may undergo D&C up to 12 weeks of pregnancy (from date of last menstrual period). Up to 9 weeks, you may take the abortion pill (although they work best up to 7 weeks). After 9 weeks, D&C is your only option for termination of a pregnancy.

Q. How do I prepare myself for a D&C?

You have to be on an empty stomach (no fluids or food) for 6 hours before the D&C.

Please carry all your blood and test reports as well as your doctor’s notes with you on the day of the procedure.

Make sure you have an adult companion along with you.

Inform your gynaecologist about any allergies or medical condition that you may have.

If you are on thyroid, BP, TB or diabetes medicine, please ask your doctor if you need to take a dose on the morning of surgery.D & C

Q. How long would I bleed after the D&C?

Most women would expect something like a normal menstrual period for up to a week. However, the amount of bleeding varies from woman to woman. Some may not bleed at all or bleed very little. If you bleed heavily or for more than 7 days, you should contact your gynaecologist.

Q. What do I expect after a D&C?

On the same day –

You should be on your feet on the same day. If you are very nauseated or giddy, due to anaesthesia (rare), your gynaecologist may give you IV fluids. You can take light meals about 4-6 hours after D&C. You can take a bath and resume your normal activities. However, you should avoid travel and exertion. Try and take as much rest as you can.

The following week –

You may feel weak and may experience some lower abdominal discomfort or heaviness for the next few days. You may bleed for up to a week. You may choose to take rest from work for a week or two to recover your physical and emotional self. You can resume your normal chores. Avoid intercourse till you stop bleeding completely or up to a week, whichever comes later.

Q. What are the warning signs after D&C for which I should see my gynaecologist?

  • Severe tummy pain, vomiting or bloating of the stomach within 48 hours after the procedure
  • Heavy bleeding
  • Persistent giddiness or nausea the next day
  • Prolonged bleeding (more than 7 days)
  • Persistent lower abdominal pain
  • Foul smelling vaginal discharge
  • Fever within 3 days of the procedure
  • Missed period (no period for a month after D&C)

Q. What complications can occur from a D&C?

Complications from a surgical abortion are very rare in good hands. However, the possible complications are:

  • Injury to the uterus or internal organs like the intestines
  • Haemorrhage (heavy bleeding)
  • Incomplete abortion (some bits left inside the uterus)
  • Infection
  • Delayed resumption of periods
  • Adhesions in the uterus (leading to light & painful periods and difficult in conception)

Q. When can I expect my next period?

Most women can expect a normal period about a month after the D&C or after stopping the pack of birth control pills. However, this may vary from woman to woman. If you have missed your period or got your period too soon, do see your gynaecologist.

Q. When can I resume my sex life?

You need to abstain for about 7 days after the D&C or after you stop bleeding completely, whichever comes later.

Q. Can I use birth control pill immediately after D&C or do I wait for the next menstrual period?

Yes, you should start a new pack of birth control pills in the same cycle, within 3-5 days after the D&C.

Q. Can I have an IUD inserted at the time of D&C?

Yes, that is a good idea. Speak to your gynaecologist about it. You can have the insertion pain-free under anaesthesia at the same sitting!

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Abortion Pill

 

 

Do you have an unwanted pregnancy? Looking for a safe abortion? Indian abortion laws permit abortion (surgical or using pills) only in legalised abortion centres by a registered qualified gynaecologist.

Q. I have missed my period. I am worried that I may be pregnant. Can I take the abortion pill to get my period?

No. You have to first get a pregnancy test done to confirm that you are pregnant. The abortion pill does not work if you are not pregnant and have missed your period due to any other cause.

Q. I am 6 weeks pregnant and I don’t want the pregnancy. How do I get rid of it?

For early pregnancy (first trimester) up to 7 weeks (49 days from the date of the last menstrual period), the abortion pill is quite effective with a success rate of about 95%. Or you may choose to undergo a surgical abortion (D&C).

Q. Up to what weeks of pregnancy can I take the abortion pill?

The abortion pill is now permitted for use up to 9 weeks (63 days from the date of the last menstrual period). However, the success rate drops after 7 weeks. Also, the risk of heavy bleeding increases as pregnancy advances.

Q. Is it necessary to do an ultrasound before taking the abortion pill?

It is better to confirm the size of pregnancy and also make sure that you do not have an ‘ectopic’ pregnancy (pregnancy outside the uterus - usually in the fallopian tube), before prescribing the abortion pill.

Q. Where and how do I get the abortion pill? How to take it? What should I expect after taking the pills? Am I going to get pain?

The abortion pill has to be dispensed by or prescribed by a gynaecologist. It is given as two courses – one pill to be taken orally immediately and the other 4 pills about 48 hours later orally or vaginally. After the course of medication, you would start to bleed within about 24-72 hours. The bleeding may last from 3-10 days for most women. The flow could be medium to heavy, and may rarely become severe. Pain is usually quite bearable. Ask your gynaecologist to prescribe a pain-killer or you could take any OTC brand that agrees with you.

Q. How do I know that the abortion process is complete? That my uterus is completely clean?

You would pass pink, fleshy, mucus or jelly-like products along with blood and clots. That indicates that you are aborting. However, you need to do ultrasound of the pelvis after about 2 weeks of taking the abortion pill to make sure that the abortion is complete.

Q. I have had heavy bleeding with clots after taking the abortion pill. I know that everything has come out. Do I still need to do ultrasound pelvis?

Yes, you do. Even if you have had heavy bleeding, that does not ensure that the abortion is complete. Ultrasound can pick up very small retained bits of tissue that may cause infection or bleeding if left behind.

Q. What if the abortion is not complete? Do I need to get a surgical abortion? I am very afraid.

If the abortion pill has failed (no bleeding or incomplete abortion), your gynaecologist would advise you to get a D&C done or give you another course of the abortion pill. That decision would be your doctor’s only.

Q. What are the possible complications of the abortion pill?

The abortion pill is generally very safe. Very rare cases of allergy can happen as with any other drug. You may feel giddy or nauseated after taking the first or second course of the abortion pills. Some of you may get acidity or loose motions. Heavy bleeding is somewhat common. Be prepared in case you are going to be at work. Rarely, the bleeding may be severe enough to rush you to the hospital. Infection is possible, but is again rare. Your gynaecologist would decide if you need antibiotics along with the abortion pill, or later.

Q. Will the abortion pill harm my future pregnancy?

No. If taken as prescribed, and under supervision of a gynaecologist, you are very safe. Make sure you do your ultrasound after 2 weeks to confirm an empty uterus.

Q. Can I have sex after taking the abortion pill? And how soon can I resume sex after the abortion?

It is best if you do not indulge in intercourse after taking the abortion pill, till the abortion process is complete. There is a small risk of infection. After you have stopped bleeding and the gynaecologist has confirmed on ultrasound that your uterus is empty, you may resume your sexual life with proper birth control!

Q. When can I start the birth control pill after the abortion?

You may start the birth control pill pack immediately after the abortion process is confirmed complete.

Q. What if I do not want to take the birth control pill? What are my options?

Pls refer to the article on Birth Control on this website for a detailed understanding of birth control methods.

If you wish to consult Dr Suman personally, click here.

If you wish to consult Dr Suman online, click here.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Testimonials

 I think Gyneguide Clinic is doing very good work because today this kind of Counselling / consultation for women especially teenagers females is very must .

 Dr. Suman is very good doctor and also good woman, good counsellor and got charmastic personality that person whoever come in her contact get inspired.

 All The Best and My best Wishes too.
- Anuja Mestry


 


 The most important person without whom there would have been no Gyneguide i.e. Dr Suman Bijlani, the owner & creator of Gyneguide. She has thought something really different for patients regarding giving satisfaction & proper knowledge of one’s illness along with proper treatment. She never hesitates going a step ahead for her patients. She is committed, caring & will be there for you. She is full of positivity & that adds to her treatment.

 "With her, you are in complete safe hands."She gives her best. She will not let her patients down. That is what makes Dr Suman Bijlani "The Best" & Gyneguide "Unique".

 The staff are very courteous, helping & create a friendly ambience. A proper call with confirmation of our appointments is done in advance. Proper time, privacy & special attention would make you feel comfortable & at ease.
- Dr. Tazveen Shaikh


 

 Dear Dr. Suman,
 Having surgery is scary, but the personal touch at Gyneguide made all the difference. I got a lot of helpful information about my health and knew Dr. Suman would support me throughout the process.
 Thanks so much! Best wishes...
- Jaeda


 


 After going through experience of Doctors barely spending minutes with patient, the comfort of Gyneguide where Dr Suman actually connects with the patients is really awesome. Medical attention that comes with a sense of concern helps in building patient confidence. Kinds to Dr Suman Bijlani and the entire team at Gyneguide and I wish them all the best for all endeavours.

- Kanchan Patil


 


 I was introduced to Dr. Suman by my sister-in-law. She had excellent experience here and all the credit goes to Dr Suman for her guidance because of whom we have been gifted with sweetest niece. Doctor’s experience and knowledge is tremendous and she is so famous that I happen to read her articles in best selling newspaper. Her way of dealing with patients is very neat and simple. She tries her best to make me comfortable and relaxed. There is always a sigh of relief after talking to her every time. I am sure she will guide me in the best way she can. I and my husband are hoping for a wonderful journey here which will give us tremendous joy in the end with our First Child.
- Swati Pevekar


 


 It is an excellent experience with Gyneguide. I had lost hopes of getting pregnant. After taking 1 year’s treatment with various gynaec, by every going time I was getting upset. With Dr Suman guidance and help I had hopes of getting pregnant and today I am pregnant .The Staff at her clinic are excellent. The service, communication and advice help is too good, apart from pregnancy related advices, Dr Suman has various facilities helpful for mother and the child future like knowledge like Stem cell and the benefit of it, Yoga, Seminars and many other facilities. Thanks to Dr. Suman for all her guidance
- Shobha. D. Pardesi


 

 

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Weekly Live Chat Offline

Once a week, Dr Suman Bijlani will answer your queries on a live chat, the date and time of which would be announced in advance. The conversation with each participant would be one on one, meaning you will be assured of complete privacy!

It was nice chatting with you all on 14th July 2014.

Next live chat is on  28th July 2014, Monday from 10 pm to 11 pm IST! So ladies, prepare to chat online with Dr Suman!

 

Live Chat is currently Offline

live chat with gynaecologist Mumbai is Offline Currently

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