frustrated - not given approval for lap

[LucieH]

I went to the hospital today to see a consultant about my endometrioma cyst. I thought she'd plan a laparoscopy because the cyst is 5x6,5 cm. I was told they want to wait three months to see if the pill makes any difference. So far the pill helped with the pain, it's almost gone, I just feel pressure sometimes and still have painful bowel movements. Was told I was probably more sensitive because I'm thin so I can feel things moving around... The pill is helping, but I also got a period on my second week which was 15th december and I still have it! I hope it goes away. The consultant said I'd get appointment sooner if the period didn't stop or if the pain comes back. But can the pill really shrink a 5x6,5 cm endometrioma to a size that's considered small (around 3cm or less)? I am also worried about having endo tissue elsewhere in my abdomen but the dr said they wouldn't want to operate just to have a look. My diagnosis is clear without a lap because of the endometrioma, that's obvious so I don't need a lap to find out IF I have endo. I am worried that endo will spread if they just leave it there. Has anyone here been on hormonal treatment only, no lap?

[JeanOsborne]

Hi Lucy. If you have a endometrioma then you have endometriosis, it is a sign of further decease. As for the pill I don't think it will shrink it but help with symptoms. From what I understand if you're having periods then it will continue to grow and should really be removed. Is your consultant a endo specialist in a BSGE centre? If not I would suggest you go back to gp and ask for a referral to one.

[LucieH in reply to JeanOsborne]

Thanks for your reply. I live in Finland, so the health care system is a bit different. I got a referral to a good hospital with a clinic specialized in gynaecology. Not sure if the dr I saw was an endo specialist, I forgot to ask her because I was very anxious and stressed about my appointment. I have been bleeding now since the 15th Dec. so it's been a long time already and I will have to call my gynae and ask her to give me a different type of pills because with endo the point in using the pill is to stop my cycle and AVOID bleeding, but the pill is causing bleeding! I just hope they'll do the lap after my next appointment.

[CP17]

I had a lap that removed some of my endo and adhesions, but it's so widespread that it would be impossible to remove it all and they didn't want to risk damaging certain organs by trying. So, I'm now taking progesterone pills to try to reduce the spread of it. I also have an endometrioma which hopefully the progesterone will keep from growing bigger.

So, yes, it's possible that endo will spread if you leave it there, but it's also possible that a lap will not be able to get it all out anyway. If you have an endometrioma, that could mean your endo is on the more extensive side.

I'm not 100% sure whether the pill can cause a cyst to shrink, but I think that endometriomas can both grow and shrink without surgery and hormones can definitely affect that. What my OB/GYN said is that as long as an endometrioma isn't cancerous (mine isn't, and the vast majority aren't), it doesn't hurt to leave it for a few months to see what will happen before doing surgery. So I don't think it would be a big risk for you to wait a bit and see if the cyst shrinks. But if your pain continues, I hope that you're able to get surgery sooner.

[LucieH in reply to CP17]

Thanks, that was helpful! I don't have much pain anymore, just dull period pain, because I have been having period/spotting for 11 days now - thanks to the pill. But it just feels like I am covering up the symptoms instead of dealing with the real problem. My cyst is not huge, but it's not small either and I hope they take it out if it doesn't shrink. If the pain can be managed, that's wonderful, but I am not thrilled about having 5x6,5 endometrioma inside my belly and some free fluid around.

I can wait a few months to see what happens, but I hope that after that they decide about the lap. I know it doesn't solve everything, but I wonder if waiting with the lap isn't just increasing the chance of my endo getting worse and causing things they won't be able to operate on. The three months are ok but I really want the lap, I want them to check for endo to know how bad it is. There's no other way to find out but lap... Can adhesions be seen on MRI?