January 29, 2025 • 24 mins
Featuring Dr. Shieva Ghofrany, OBGYN & Co-founder of Tribe Called V, and moderated by Meaghan Repko DeShong, Tina's Wish Board Member & Partner at Joele Frank, Wilkinson Brimmer Katcher.
Learn more about Dr. Ghofrany at:
https://www.instagram.com/drshievag/
https://telleveryamazinglady.org/
https://www.tribecalledv.com/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:29):
Hi everyone. I'm Megan Repko and welcome to What
To Know Down Below. Um, I am soexcited to be back. We are here
with board certified OB GYN ,Dr. Shiva Gorani , who might be
my new favorite doctor ever . Um , thank you. So
welcome back and today we aregoing to be covering the basics
(00:54):
of ovarian cysts because Ithink this could be probably a
much longer Yes .
Podcast. Yes . If we, we took adeep dive into it. Mm-hmm
. I also hadovarian cysts. Um, I had gone
through an IVF journey andthat's how I found out that I
had them there and I had themsurgically removed three times.
(01:15):
Um, so I'm familiar with 'em ,but I also was like kind of in
my own head of kind of the IVFworld. And so I think we can
really teach our listeners somestuff today about this 'cause I
know it's also something that'svery common but not always
found. Yeah.
Speaker 3 (01:32):
Very. Yes. Well, hi Megan . How are you??
Speaker 2 (01:36):
Hi. I'm good. How are you?
Speaker 3 (01:38):
Uh, well I'll go through a like ten second intro
in case someone didn't listento our last episode. But
basically I have been an OB GNfor 25 years and myself had, I
mean I, I , I say this, itsounds funny because I feel
like I say it like it's alaundry list as if it's not
important. But it is just likeyour journey. It's very much
part of whom I am. It's verymuch a part of who shaped me as
a doctor and as a woman and asa mother. So I don't mean to
(02:00):
make it sound like no big deal.
They were all big deals. Andyet here you and I are on the
other side of all of these, butI had six miscarriages. I had
endometriosis, I had HPV , I'vehad again multiple other issues
as well. And then I had ovariancancer when I was 46 years old,
eight years ago. Um, and in mysituation, my ovarian cyst that
(02:20):
I first had when I was 29 yearsold was a 17 centimeter. So
again, the size of agrapefruit, it was a 17
centimeter endometrial, whichis a very specific type of
ovarian cyst that hasendometriosis within it. So
something that you and I shouldtalk about is what kind of cyst
did you have and what are thedifferent types of cysts?
Because just like we talkedabout in our fibroid episode,
(02:42):
fibroids are very, very common.
Those are growths of the muscleof the uterus as well. Ovarian
cysts are very common becausethe ovaries change every single
day of the month and everysingle month as we ovulate. So
the most common type of ovariancyst is what we call a
functional cyst or a follicularcyst, you might hear it be
called. Or a simple cyst whichjust filled with water filled ,
(03:04):
just filled with fluid. Thoseare incredibly common, but
there are a variety of othertypes as well. Um, and so what
type did you have?
Speaker 2 (03:13):
I , um, I'm trying to remember it. I think, I
think it was referred to assimple mm-hmm .
But because it was, I was doingIVF mm-hmm .
Right, like they didn't wannado a transfer of an embryo
because just in case they wantit to be as right, like the
perfect home for you know, theembryo to arrive in. Yeah. So
(03:34):
they might've probably left itthere if I wasn't going through
right . IVF but
Speaker 3 (03:38):
Instead . Well, and I wonder, do you remember how
big it was by any chance? Andyou might not,
Speaker 2 (03:43):
Not as large as yours. Yeah,
Speaker 3 (03:45):
No. I'm sure it was not, it's almost not, it's not
impossible, but it's rare for asimple cyst to be that as big
as mine. Yeah . I suspect inyour case, because we talked
about you had fibroids and youwere having surgery for the
multiple fibroids and then theyincidentally also saw the cyst.
There is a chance that had theyonly seen the cyst, which was
in your ovary, not in youruterus, they might have said,
let's leave it alone. It'll goaway within a cycle or two. It
(04:07):
depends. Um, and so that'ssomething really valuable for
people to realize that cystsare not a monolith. I mean,
again, there are simple clearcysts that are just filled with
fluid. Sometimes those simpleclear cysts that come up
because of your cycle, becauseyou ovulate, they either go
away within one cycle becauseyou've ovulated and that cyst
has shrunk from like, let's sayit's two centimeters, three
(04:27):
centimeters, it goes away or itkeeps getting bigger, but
continues to be a simple clearcyst. At which point we would
maybe operate once it gets toobigger than seven to 10
centimeters. Right. Or itsometimes bleeds into itself.
And I don't know if you've everhad that, but it's a very
dramatic term. It's called ahemorrhagic cyst. And it just
means that that simple cystgrew and the wall of the cyst,
(04:49):
so imagine like a balloon hasblood vessels within it and one
of those blood vesselsessentially tore and bled
within the cyst. So now youhave a , a cyst filled with
fresh blood. So they call ithemorrhagic. You're not
hemorrhaging, but it's a cystfilled with blood. And those
cysts can be very painful andthey can take anywhere from,
you know, one to one week to 3,4, 5 weeks to resolve as your
(05:11):
blood , as your body reabsorbsthem. And then even less likely
that cyst wall with the bloodvessel bursts externally. So
you bleed into your pelvis andsometimes in that case you need
immediate surgery. Right . Um ,what's a really common story
that I'm sure friends of yoursor your mom, like you mentioned
your mom in our last episode,or you might have had in the
past is oh my god, terriblepain all of a sudden really
(05:34):
acute to the point where you'redriving to the doctor's office,
you're driving to work andevery bump you hit on the road
makes you double over in pain.
They do an ultrasound, they maysee a cyst or they may see
nothing in your ovaries, butthey see what we call free
fluid, meaning fluid floatingaround in your pelvis because a
cyst had been there and burst.
As long as they can ascertainthat you are stable, that you
(05:56):
are not bleeding internally,which most of the time you're
not, then they should say toyou, okay, this will likely
resolve in the next couple ofdays. You take
anti-inflammatories likeibuprofen and you have pretty
clear guidelines by the doctor,ideally that like in the next
1, 2, 3 days, your pain shouldbe slowly getting better and
then let's revisit and do afollow follow-up ultrasound in
a couple of weeks to make surethe fluid has resorbed. And so
(06:19):
that is an incredibly commonthing. And I have patients who
say to us all the time, oh myGod, I guess it's all the time
they burst all the time and itmust be part of my family
'cause it happened to my mom aswell. And the answer is, it
could be part of your family,but the truth is what's part of
your family is that you're awoman, your mother's a woman,
you have ovaries and ovarianovaries mean that we can get
ovarian cysts.
Speaker 2 (06:39):
Okay, that makes a lot of sense. So I think we
kind of covered that this is avery common thing that can
happen. There's differenttypes, right. But what is, is
there a , I think I know theanswer to this already, which
is who is at risk Yeah . Forhaving, forgetting these. I'm
(07:00):
assuming the answer, and youcan tell me if I'm wrong, is
being a woman, you
Speaker 3 (07:05):
Know , anyone with ovaries, I mean, and here's the
truth. Anyone with ovaries,listen, women, young girls
before they've gone throughpuberty can get cysts. Like,
believe it or not, we havebabies in utero where we
diagnose ovarian cyst in babiesin utero. Not so common, but we
see it. So, and then you canget cyst even before you've
gone through your cycle. Sobefore you've reached your
(07:25):
period, those types of cysttend to be different. Um, and
then even women who arepostmenopausal where their
ovaries are no longer activeand as you might guess
postmenopausal women and andgirls who have not yet gotten
their period when they havecysts, we have to take them
more seriously because bydefinition they are not
functional because theirovaries aren't functioning,
(07:46):
which means they might be cyststhat are actually not benign.
Because the word cyst againjust means basically like a
pocket of fluid in the ovary inthis case. And so outside of
the follicular functionalsimple cysts that we talked
about and the ones that canbleed, you also can have
endometriosis in a, in a cyst.
And those need to be addressed.
(08:06):
You can have cysts that aresolid. I don't know if in your
research you saw somethingcalled a dermoid cyst, derm
means skin and all the thingsthat are on the outside like
hair, nails, teeth. So dermoidmeans those cysts, those
pockets, the ovary can befilled with hair, teeth, nails,
(08:28):
bone. I know they're gross,they sound gross and they are
gross, but they're notuncommon. And if anyone decides
to Google it, they'll see crazypictures of it. But those cysts
are benign but again, can causepain and can cause the ovary to
twist and all kinds of things.
So again, are cyst is a , isone term that encompasses a
lot, but suffice to say again,common to have cyst, especially
(08:51):
the type we talked about firstthat are clear, simple . Yeah .
Speaker 2 (08:56):
And you kind of mentioned this, but like let's
talk symptoms and kind oftypical signs. Yeah . Because
we wanna , you know, this iswhere we can learn the most of
you know what to do as wetalked about in our previous
one of advocating forourselves. Yes . Like if we're
having certain feelings. Yeah .
Like yes . So
Speaker 3 (09:14):
Yeah, so if you have, if you are a person with
ovaries and you have pain thatyou're not used to, do not let
everyone essentially say to youlike, oh, it's normal, it's
normal, it's normal. It mightbe normal. It might be very
common, it might be somethingcompletely that does not need
to be dealt with. But we don'tknow that until we've looked
into it. So if you have painduring your period, outside of
your period pain, during sexpain or pressure for example, I
(09:38):
feel like I have to pee a lot.
It feels like there's somethingsitting on my bladder. I feel
like I have to poop a lot. Itfeels like there's something
sitting on my rectum. These areall reasons that you should go
to the doctor. And even if thedoctor does a pelvic exam where
she doesn't feel anything , sheshould, and if she doesn't you
should ask her for a pelvicultrasound because a pelvic
exam where we put our hand inis really considered to be a
(10:00):
very nonsensitive exam. I don'tmean sensitive emotionally, I
mean sensitive in thescientific sense of it doesn't
pick up a lot. You actuallywould have to have a very, very
large mass in your pelvis andbe very, very lean in order for
us to potentially feel it. Manypelvic exams are normal when in
fact someone had somethinggrowing in their pelvis. And
(10:20):
again, I don't want us to bescared about that 'cause most
of the things that are growingare benign. But if you have
symptoms, you absolutely need apelvic ultrasound. But again,
the symptoms are typicallypain, pressure, bloating,
rarely is irregular bleedingthe sign of a cyst. But it can
be in rare circumstances. UmOkay . Bleeding often is things
like a fibroid or a polyp inthe uterus, whereas pain and
(10:43):
pressure can be fibroids orcysts.
Speaker 2 (10:47):
Okay. And so then that kind of leads me to the
next question, which is how arethey diagnosed? It's, it's so
because as you're saying it'snot just a simple pelvic exam,
you kind of have to go Yeah. Acouple steps further Yes. To
figure that out. Yeah . Right.
Speaker 3 (11:03):
Well, and so first and foremost, we still should
be good diagnosticians, right?
I should be able to listen toyour symptoms and already have,
in my mind I think it could beA, B, C and how am I gonna
differentiate and prove ordisprove. And the first step is
almost always a pelvicultrasound, which is, as you
know, typically done in twoways. You typically come in
with a full bladder and thedoctor puts a probe or the
(11:24):
ultrasound tech puts a probe onthe outside of your pelvis,
right above your bladder. Thenthey have you pee and then they
do a transvaginal probe, whichfor anyone who's had it, it's
of course uncomfortable butshould not hurt. Um, and then
they may be able to diagnoseright from that ultrasound what
type of cyst it is. Butsometimes we need something
further. Sometimes we need forexample, an MRI because an MRI
(11:46):
can sometimes differentiatebetween the different types of
cysts. And so it reallydepends. But first and foremost
almost always should be apelvic ultrasound. Now the
variations are sometimes you goto the ER first and the ER
because they don't have accessto an ultrasound tech, but they
do have the CAT scan machinethere. They might do a , a CAT
scan or a ct. Uhhuh . Rarelywould the emergency room do an
MRI just because the type oftechnology it is and the type
(12:07):
of technician involved. All ofthese are radiology tests.
Again, ultrasound is the mostbeneficial because it's not
radiation and it's actually theleast expensive.
Speaker 2 (12:17):
Right. So then I , we kind of touched on this,
that there's different, wellthere's so many different types
of cyst. So there's so manydifferent types of treatments I
imagine. Yes . Um, but I think,you know, I think it's good to
say that not every cyst has toresult in surgery. Definitely
Speaker 3 (12:35):
Not . But in fact, the majority of cysts do not
result in surgery.
Speaker 2 (12:39):
Right. And, and for me personally, there was a
reason behind having thosesurgeries because of, you know,
what I was prepping my body todo. Yes . Um, and in carrying a
, a child through IV up . Yes .
So it makes a lot of sense. Um,but I guess it's, I guess my
question is like what, whatsets different cysts apart from
(13:03):
needing surgery Yes. To notneeding
Speaker 3 (13:05):
Surgery. Great question. So the different
reasons would be often size andtype of cyst as well as
symptoms. So let's assume themost common type of cyst is a
simple clear cyst. Right?
Again, just a little bubblefilled with fluid. You might
come in for an ultrasound withme 'cause you have a little bit
of pain and I see a cyst thatlooks simple and clear, which
are words we useradiologically. And that just
(13:26):
means it looks like it was justa black bubble on the screen
and it's filled with fluid. Andif it's two to seven
centimeters, I will likely sayto you, if you're not in a lot
of pain right now, then let'swait and watch, repeat the
ultrasound in six to eightweeks. Give it a couple of
cycles, see if this goes awayon its own. It will most likely
shrink on its own. If it does,we're done. If it doesn't
(13:46):
shrink, then we decide do weleave it alone because it's
stable? So maybe we need tokeep watching it or do we
remove it based on a variety ofthings. Pain your intention
with, again, maybe pregnancy,things like that. Sometimes
putting you on the birthcontrol pill because it stops
ovulation won't necessarilyregress an already formed cyst,
but it will stop new onesbecause it does seem like some
people just create more cyststhan others. Now that's, if
(14:08):
it's again, simple and clear.
If that simple and clear cystlike we talked about, bled into
itself and became hemorrhagic,if I can tell clearly it's just
a hemorrhagic cyst, I wouldstill just wait and watch for a
period of time. Again , six toeight weeks, let's say the
patient is not in a lot ofpain. They have, they
understand they can always callus. If things change, then we
would wait and watch. And if itgoes away, we're done. If on
(14:31):
the other hand we think itlooks like old blood, which is
an endometrioma again fromendometriosis mm-hmm
. I can't sayeveryone should do this,
although I think everyoneshould do this, but it's not
necessarily yet part of thestandard guidelines. I believe
that if it is found on anultrasound and suspected that
person should also have an MRI, because that's often how they
can differentiate between doesit really seem like a benign
(14:53):
endometrioma versus the veryrare. But what happened to me,
which is when my endometriomamalignantly transformed into
cancer. Rare, but it canhappen. And that would be the
difference between surgery ornot because an endometrioma
alone might cause so much painthat you need it removed even
when it's four centimeters. Butother patients live with it at
four centimeters and eitherstay on the birth control pill
(15:15):
to help decrease it fromgrowing mm-hmm .
Or they go on medication justlike we talked about with
fibroids, these, theseanti-hormone medications, like
something called Lupron or theyget it removed. But again, this
is all assuming that yourdoctor has done their due
diligence to figure out maybethrough a series of tests that
it is benign.
Speaker 2 (15:35):
Right. Right. And then you, you kind of just
touched on this, that there'ssome people who they just
develop cysts more, you know,they recur more often. Yes.
Right. And so for those people,like what, what advice would
you give to that, that patient?
Speaker 3 (15:53):
Yeah. And when I say that, the truth is it's not
like we have scientificevidence as to like why do some
people create more cysts ? Butwe hear people and we see
people, and I know people whobe , again, they, many of my
patients who are all off birthcontrol pills and some seem to
have more recurrent cysts thanothers that we've seen and
we've documented. So the truthis the only for sure way to
decrease the chance of thosecysts, assuming they don't want
(16:14):
their ovaries removed, is tostop ovulation. Because again,
the , the majority of theserecurrent cysts we're talking
about are those that we talkedabout follicular, they're
called follicular simple orfunctional cysts, meaning that
ovary, ovulated and that littlebubble of fluid that released
the egg created a cyst andpersisted. So those patients,
(16:35):
when they go on the pill or thebirth control patch or the
birth control ring, all ofwhich stop ovulation, they have
less likelihood of developingthose cysts. So that's the only
concrete scientific way we knowto stop those cysts. Do I think
there are holistic natural waysmaybe I'm, I'm always a fan of
saying like, I don't, I don'tknow what I don't know. Right.
But if you said to me, what isthe best way for me to stop
(16:56):
these cysts? That isscientifically proven, it is
stop ovulation.
Speaker 2 (17:01):
Okay. Um, and I know I asked this question about
fibroids, but I think it'simportant , um, to ask here.
Yeah. Which is, if you aresomeone that develops cyst or
you've had maybe just one , um,does it increase your risk of
other gynecologic issues ?
Speaker 3 (17:19):
Great question. With fibroids, I could say probably
not meaning with peoplecommonly have fibroids, people
come , they have cysts withcyst, it's a little different
because again, it depends onthe type. If it was a
functional follicular simplecyst like we talked about,
doesn't seem like thatincreases your risk of anything
else. If it was anendometrioma, meaning
endometriosis in the ovary,then it means you have an
(17:39):
increased chance ofendometriosis in other parts of
your body and other parts ofyour pelvis, which can
certainly cause pain andfertility issues. Um, if it was
a dermoid that really yucky onethat had the hair and all those
things, it doesn't increaseyour risk of anything else. So
again, it really depends on thetype of cyst that you have.
Speaker 2 (17:55):
And so then it just to reinforce also what you just
said, which is it depends whattype of cyst someone has and,
and it could, depending on thetype of cyst impacts fertility
or pregnancy.
Speaker 3 (18:11):
Absolutely. Meaning again, if it's endometrioma,
those can impact fertility forsure. We know that if it's a
benign dermoid, again, yes,it's gross, it's got hair and
teeth and things like that init, but it won't impact it. If
it's a simple follicular cyst,then it depends really on the
size, meaning in general, Iwould say those simple cysts
don't impact fertility. But ifit gets too big in theory,
(18:33):
could there be some hormonalreactivity? Maybe in your case,
I think you had mentioned thatit might have also impacted
your, your tube. So if it wasgoing into your tube, that can
impact fertility because wedon't know what kind of fluid
is communicating into the tubeand going back into the uterus.
Um, and then by the way, wedidn't even touch upon, 'cause
that's an entirely differenttopic, two topics, which is can
(18:54):
you have cyst in your fallopiantubes, for example? And the
answer is you can, and andthose are actually less common
and more concerning. One isbecause that can affect impact
fertility 'cause the tubesdirectly communicate with the
uterine lining. Right. But alsobecause we now know that
ovarian cancer actually startsmost fall , most likely in the
tube itself. And so this is whywe know from data that removing
(19:16):
someone's tubes if they're donewith fertility, really
decreases their risk of ovariancancer significantly. Um, and
the other topic which we'llhave to do another podcast on
is polycystic ovarian syndrome.
PCOS. Right . Which is aterrible name because it
actually doesn't imply that youare more likely to get true
cysts in the way you and I aretalking about. That's an
(19:37):
entirely different entity whereyour ovaries just have multiple
tiny little pockets of fluid,but the term cyst in Latin
means pocket of fluid. And sowe, we've kind of wrongly
called that polycystic ovariansyndrome, meaning it's
accurate, but it's not accurateif you think that cyst means
something big.
Speaker 2 (19:56):
Okay . If that makes sense . That's helpful. And do
you think there are any mythsor common misconceptions about
ovarian cysts that we shouldkind of hit on?
Speaker 3 (20:09):
I think the biggest , um, well, two myths that ,
that oppose each other. I thinkthe biggest myth is that people
get scared that ovarian cystsmean cancer. They all mm-hmm
. The good newsis they almost never mean
cancer.
Speaker 2 (20:19):
That
Speaker 3 (20:19):
Right . The contralateral part is sadly
also true. Ovarian cancer still, um, presents itself as a very
challenging thing for us todiagnose. We don't have any
screening tests for it. I'massuming you know that, but
even my smartest of peopledon't know that your pap smear
is not a screening test forovarian cancer. You can have a
normal pap smear, no , a normalpelvic exam, no family history.
And unfortunately you couldstill develop ovarian cancer.
(20:42):
And we don't have a screeningtest. We have diagnostic tests,
meaning you come in with, withpain, we should do an
ultrasound, but no screeningtest. So while most of the time
cysts are not cancer, sometimeswe see cyst and it's hard to
differentiate which ones arecancer or not. Sometimes again,
the majority will be benign. Iwanna keep saying that to
decrease fear mm-hmm . But we have to
be finicky as doctors and Ineed you to know that to kind
(21:03):
of push the doctors who aren'tbeing finicky to really follow
up until they are 100% surethat it is benign.
Speaker 2 (21:11):
Okay. And then we're gonna do our, our last thing.
Rapid fire . Yeah . What arethe three takeaways we did four
last time? Well , you could dofour , um, takeaways
that you'd like the listenersto know about ovarian cyst and
today's episode.
Speaker 3 (21:28):
Okay. So I guess I'll , it'll be kind of similar
to the fibroids. Like, first ofall, cysts are common, not as
common as fibroids as far as weknow, but that's not really
true. We just don't have dataand they're not, again, a
monolith. So it's harder toextrapolate what percentage of
women have ovarian cyst. Butthe truth is, in your lifetime
almost everyone will have acouple of ovarian cysts, even
if they were never diagnosedbecause you ovulate. So cyst
are common. Don't be scared ofcysts, but make sure that you
(21:51):
are advocating for yourself.
And if your doctor is notsuggesting a pelvic ultrasound,
if you have pain, pressure orbloating, then please ask for a
pelvic ultrasound because thisis the fourth one when it comes
to ovarian cancer, which israre, but not easy to diagnose,
the best way for us to diagnoseit is for women to know their
body and understand when theirbody is different and not wait
(22:14):
too long. All the data showsthat women unfortunately push
off their symptoms for six toeight months and doctors
unfortunately don't intervenequickly and easily for a
variety of good and badreasons. Things like our
ultrasounds always covered byinsurance, they're not always
covered by insurance. Right .
Um, so advocate for yourself,if you have pain, pressure,
bloating for more than twoweeks, you absolutely should be
(22:37):
going to see the doctor.
Speaker 2 (22:40):
Okay.
Speaker 3 (22:40):
Okay.
Speaker 2 (22:41):
Good. Well, thank you Dr. Gani . I really
appreciate it so much. Um, andI think these talking about
things that are somewhatcommon, like sometimes get
overlooked. So I'm so happythat we can actually take some
time and hopefully people feela little bit more educated and
empowered to, you know, knowtheir bodies, advocate for
(23:02):
themselves. Um, and I reallyappreciate the time that you've
given us. Thank you. Um , andour listeners, thank you
because it's really importantinformation that not everybody
wants to talk about, but weneed to do more. I know ,
Speaker 3 (23:15):
I know. Well, thank you. I appreciate it . And I
would love everyone to actuallygo over to tell every amazing
Lady Teal . I'm the presidentactually of this nonprofit that
has done some work with Tina'sWish, and it's a wonderful
nonprofit that really helpseducate people mostly on
ovarian cancer. But starting,we're starting to dip our toes
into menopause andperimenopause. Um, so I think
it's really valuable for peopleto support that organization.
(23:35):
But also you and I both know,unfortunately, we cannot leave
our health information up tothe teachers, our mothers or
our doctors because in thatgroup of three teachers,
mothers, doctors, they eitherdon't have the knowledge or
don't have the time. So we haveto learn about it ourselves and
then we Yeah . And then we cando better for the next
generation.
Speaker 2 (23:54):
100%. I agree with that. So another thank you to
all of our listeners. We hopeyou feel like I said,
empowered, educated, all ofthat , um, when it comes to
your gynecological health. Andplease feel free to share this
with your friends and familyand others because if you don't
(24:16):
wanna have the conversationwith folks, we just did it for
you. Um, and so it makes iteasier to educate people about
these very important , um,gynecological health topics. So
thank you for joining us againtoday. Thank
Speaker 3 (24:30):
You.
Speaker 1 (24:37):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:29):
Hi everyone. I'm Megan Repko and welcome to What
To Know Down Below. Um, I am soexcited to be back. We are here
with board certified OB GYN ,Dr. Shiva Gorani , who might be
my new favorite doctor ever
welcome back and today we aregoing to be covering the basics
(00:54):
of ovarian cysts because Ithink this could be probably a
much longer
Podcast. Yes . If we, we took adeep dive into it. Mm-hmm
through an IVF journey andthat's how I found out that I
had them there and I had themsurgically removed three times.
(01:15):
Um, so I'm familiar with 'em ,but I also was like kind of in
my own head of kind of the IVFworld. And so I think we can
really teach our listeners somestuff today about this 'cause I
know it's also something that'svery common but not always
found. Yeah.
Speaker 3 (01:32):
Very. Yes. Well, hi Megan . How are you?
Speaker 2 (01:36):
Hi. I'm good. How are you?
Speaker 3 (01:38):
Uh, well I'll go through a like ten second intro
in case someone didn't listento our last episode. But
basically I have been an OB GNfor 25 years and myself had, I
mean I, I , I say this, itsounds funny because I feel
like I say it like it's alaundry list as if it's not
important. But it is just likeyour journey. It's very much
part of whom I am. It's verymuch a part of who shaped me as
a doctor and as a woman and asa mother. So I don't mean to
(02:00):
make it sound like no big deal.
They were all big deals. Andyet here you and I are on the
other side of all of these, butI had six miscarriages. I had
endometriosis, I had HPV , I'vehad again multiple other issues
as well. And then I had ovariancancer when I was 46 years old,
eight years ago. Um, and in mysituation, my ovarian cyst that
(02:20):
I first had when I was 29 yearsold was a 17 centimeter. So
again, the size of agrapefruit, it was a 17
centimeter endometrial, whichis a very specific type of
ovarian cyst that hasendometriosis within it. So
something that you and I shouldtalk about is what kind of cyst
did you have and what are thedifferent types of cysts?
Because just like we talkedabout in our fibroid episode,
(02:42):
fibroids are very, very common.
Those are growths of the muscleof the uterus as well. Ovarian
cysts are very common becausethe ovaries change every single
day of the month and everysingle month as we ovulate. So
the most common type of ovariancyst is what we call a
functional cyst or a follicularcyst, you might hear it be
called. Or a simple cyst whichjust filled with water filled ,
(03:04):
just filled with fluid. Thoseare incredibly common, but
there are a variety of othertypes as well. Um, and so what
type did you have?
Speaker 2 (03:13):
I , um, I'm trying to remember it. I think, I
think it was referred to assimple mm-hmm
But because it was, I was doingIVF mm-hmm
Right, like they didn't wannado a transfer of an embryo
because just in case they wantit to be as right, like the
perfect home for you know, theembryo to arrive in. Yeah. So
(03:34):
they might've probably left itthere if I wasn't going through
right . IVF but
Speaker 3 (03:38):
Instead . Well, and I wonder, do you remember how
big it was by any chance? Andyou might not,
Speaker 2 (03:43):
Not as large as yours. Yeah,
Speaker 3 (03:45):
No. I'm sure it was not, it's almost not, it's not
impossible, but it's rare for asimple cyst to be that as big
as mine. Yeah . I suspect inyour case, because we talked
about you had fibroids and youwere having surgery for the
multiple fibroids and then theyincidentally also saw the cyst.
There is a chance that had theyonly seen the cyst, which was
in your ovary, not in youruterus, they might have said,
let's leave it alone. It'll goaway within a cycle or two. It
(04:07):
depends. Um, and so that'ssomething really valuable for
people to realize that cystsare not a monolith. I mean,
again, there are simple clearcysts that are just filled with
fluid. Sometimes those simpleclear cysts that come up
because of your cycle, becauseyou ovulate, they either go
away within one cycle becauseyou've ovulated and that cyst
has shrunk from like, let's sayit's two centimeters, three
(04:27):
centimeters, it goes away or itkeeps getting bigger, but
continues to be a simple clearcyst. At which point we would
maybe operate once it gets toobigger than seven to 10
centimeters. Right. Or itsometimes bleeds into itself.
And I don't know if you've everhad that, but it's a very
dramatic term. It's called ahemorrhagic cyst. And it just
means that that simple cystgrew and the wall of the cyst,
(04:49):
so imagine like a balloon hasblood vessels within it and one
of those blood vesselsessentially tore and bled
within the cyst. So now youhave a , a cyst filled with
fresh blood. So they call ithemorrhagic. You're not
hemorrhaging, but it's a cystfilled with blood. And those
cysts can be very painful andthey can take anywhere from,
you know, one to one week to 3,4, 5 weeks to resolve as your
(05:11):
blood , as your body reabsorbsthem. And then even less likely
that cyst wall with the bloodvessel bursts externally. So
you bleed into your pelvis andsometimes in that case you need
immediate surgery. Right . Um ,what's a really common story
that I'm sure friends of yoursor your mom, like you mentioned
your mom in our last episode,or you might have had in the
past is oh my god, terriblepain all of a sudden really
(05:34):
acute to the point where you'redriving to the doctor's office,
you're driving to work andevery bump you hit on the road
makes you double over in pain.
They do an ultrasound, they maysee a cyst or they may see
nothing in your ovaries, butthey see what we call free
fluid, meaning fluid floatingaround in your pelvis because a
cyst had been there and burst.
As long as they can ascertainthat you are stable, that you
(05:56):
are not bleeding internally,which most of the time you're
not, then they should say toyou, okay, this will likely
resolve in the next couple ofdays. You take
anti-inflammatories likeibuprofen and you have pretty
clear guidelines by the doctor,ideally that like in the next
1, 2, 3 days, your pain shouldbe slowly getting better and
then let's revisit and do afollow follow-up ultrasound in
a couple of weeks to make surethe fluid has resorbed. And so
(06:19):
that is an incredibly commonthing. And I have patients who
say to us all the time, oh myGod, I guess it's all the time
they burst all the time and itmust be part of my family
'cause it happened to my mom aswell. And the answer is, it
could be part of your family,but the truth is what's part of
your family is that you're awoman, your mother's a woman,
you have ovaries and ovarianovaries mean that we can get
ovarian cysts.
Speaker 2 (06:39):
Okay, that makes a lot of sense. So I think we
kind of covered that this is avery common thing that can
happen. There's differenttypes, right. But what is, is
there a , I think I know theanswer to this already, which
is who is at risk Yeah . Forhaving, forgetting these. I'm
(07:00):
assuming the answer, and youcan tell me if I'm wrong, is
being a woman, you
Speaker 3 (07:05):
Know , anyone with ovaries, I mean, and here's the
truth. Anyone with ovaries,listen, women, young girls
before they've gone throughpuberty can get cysts. Like,
believe it or not, we havebabies in utero where we
diagnose ovarian cyst in babiesin utero. Not so common, but we
see it. So, and then you canget cyst even before you've
gone through your cycle. Sobefore you've reached your
(07:25):
period, those types of cysttend to be different. Um, and
then even women who arepostmenopausal where their
ovaries are no longer activeand as you might guess
postmenopausal women and andgirls who have not yet gotten
their period when they havecysts, we have to take them
more seriously because bydefinition they are not
functional because theirovaries aren't functioning,
(07:46):
which means they might be cyststhat are actually not benign.
Because the word cyst againjust means basically like a
pocket of fluid in the ovary inthis case. And so outside of
the follicular functionalsimple cysts that we talked
about and the ones that canbleed, you also can have
endometriosis in a, in a cyst.
And those need to be addressed.
(08:06):
You can have cysts that aresolid. I don't know if in your
research you saw somethingcalled a dermoid cyst, derm
means skin and all the thingsthat are on the outside like
hair, nails, teeth. So dermoidmeans those cysts, those
pockets, the ovary can befilled with hair, teeth, nails,
(08:28):
bone. I know they're gross,they sound gross and they are
gross, but they're notuncommon. And if anyone decides
to Google it, they'll see crazypictures of it. But those cysts
are benign but again, can causepain and can cause the ovary to
twist and all kinds of things.
So again, are cyst is a , isone term that encompasses a
lot, but suffice to say again,common to have cyst, especially
(08:51):
the type we talked about firstthat are clear, simple . Yeah .
Speaker 2 (08:56):
And you kind of mentioned this, but like let's
talk symptoms and kind oftypical signs. Yeah . Because
we wanna , you know, this iswhere we can learn the most of
you know what to do as wetalked about in our previous
one of advocating forourselves. Yes . Like if we're
having certain feelings. Yeah .
Like yes . So
Speaker 3 (09:14):
Yeah, so if you have, if you are a person with
ovaries and you have pain thatyou're not used to, do not let
everyone essentially say to youlike, oh, it's normal, it's
normal, it's normal. It mightbe normal. It might be very
common, it might be somethingcompletely that does not need
to be dealt with. But we don'tknow that until we've looked
into it. So if you have painduring your period, outside of
your period pain, during sexpain or pressure for example, I
(09:38):
feel like I have to pee a lot.
It feels like there's somethingsitting on my bladder. I feel
like I have to poop a lot. Itfeels like there's something
sitting on my rectum. These areall reasons that you should go
to the doctor. And even if thedoctor does a pelvic exam where
she doesn't feel anything , sheshould, and if she doesn't you
should ask her for a pelvicultrasound because a pelvic
exam where we put our hand inis really considered to be a
(10:00):
very nonsensitive exam. I don'tmean sensitive emotionally, I
mean sensitive in thescientific sense of it doesn't
pick up a lot. You actuallywould have to have a very, very
large mass in your pelvis andbe very, very lean in order for
us to potentially feel it. Manypelvic exams are normal when in
fact someone had somethinggrowing in their pelvis. And
(10:20):
again, I don't want us to bescared about that 'cause most
of the things that are growingare benign. But if you have
symptoms, you absolutely need apelvic ultrasound. But again,
the symptoms are typicallypain, pressure, bloating,
rarely is irregular bleedingthe sign of a cyst. But it can
be in rare circumstances. UmOkay . Bleeding often is things
like a fibroid or a polyp inthe uterus, whereas pain and
(10:43):
pressure can be fibroids orcysts.
Speaker 2 (10:47):
Okay. And so then that kind of leads me to the
next question, which is how arethey diagnosed? It's, it's so
because as you're saying it'snot just a simple pelvic exam,
you kind of have to go Yeah. Acouple steps further Yes. To
figure that out. Yeah . Right.
Speaker 3 (11:03):
Well, and so first and foremost, we still should
be good diagnosticians, right?
I should be able to listen toyour symptoms and already have,
in my mind I think it could beA, B, C and how am I gonna
differentiate and prove ordisprove. And the first step is
almost always a pelvicultrasound, which is, as you
know, typically done in twoways. You typically come in
with a full bladder and thedoctor puts a probe or the
(11:24):
ultrasound tech puts a probe onthe outside of your pelvis,
right above your bladder. Thenthey have you pee and then they
do a transvaginal probe, whichfor anyone who's had it, it's
of course uncomfortable butshould not hurt. Um, and then
they may be able to diagnoseright from that ultrasound what
type of cyst it is. Butsometimes we need something
further. Sometimes we need forexample, an MRI because an MRI
(11:46):
can sometimes differentiatebetween the different types of
cysts. And so it reallydepends. But first and foremost
almost always should be apelvic ultrasound. Now the
variations are sometimes you goto the ER first and the ER
because they don't have accessto an ultrasound tech, but they
do have the CAT scan machinethere. They might do a , a CAT
scan or a ct. Uhhuh . Rarelywould the emergency room do an
MRI just because the type oftechnology it is and the type
(12:07):
of technician involved. All ofthese are radiology tests.
Again, ultrasound is the mostbeneficial because it's not
radiation and it's actually theleast expensive.
Speaker 2 (12:17):
Right. So then I , we kind of touched on this,
that there's different, wellthere's so many different types
of cyst. So there's so manydifferent types of treatments I
imagine. Yes . Um, but I think,you know, I think it's good to
say that not every cyst has toresult in surgery. Definitely
Speaker 3 (12:35):
Not . But in fact, the majority of cysts do not
result in surgery.
Speaker 2 (12:39):
Right. And, and for me personally, there was a
reason behind having thosesurgeries because of, you know,
what I was prepping my body todo. Yes . Um, and in carrying a
, a child through IV up . Yes .
So it makes a lot of sense. Um,but I guess it's, I guess my
question is like what, whatsets different cysts apart from
(13:03):
needing surgery Yes. To notneeding
Speaker 3 (13:05):
Surgery. Great question. So the different
reasons would be often size andtype of cyst as well as
symptoms. So let's assume themost common type of cyst is a
simple clear cyst. Right?
Again, just a little bubblefilled with fluid. You might
come in for an ultrasound withme 'cause you have a little bit
of pain and I see a cyst thatlooks simple and clear, which
are words we useradiologically. And that just
(13:26):
means it looks like it was justa black bubble on the screen
and it's filled with fluid. Andif it's two to seven
centimeters, I will likely sayto you, if you're not in a lot
of pain right now, then let'swait and watch, repeat the
ultrasound in six to eightweeks. Give it a couple of
cycles, see if this goes awayon its own. It will most likely
shrink on its own. If it does,we're done. If it doesn't
(13:46):
shrink, then we decide do weleave it alone because it's
stable? So maybe we need tokeep watching it or do we
remove it based on a variety ofthings. Pain your intention
with, again, maybe pregnancy,things like that. Sometimes
putting you on the birthcontrol pill because it stops
ovulation won't necessarilyregress an already formed cyst,
but it will stop new onesbecause it does seem like some
people just create more cyststhan others. Now that's, if
(14:08):
it's again, simple and clear.
If that simple and clear cystlike we talked about, bled into
itself and became hemorrhagic,if I can tell clearly it's just
a hemorrhagic cyst, I wouldstill just wait and watch for a
period of time. Again , six toeight weeks, let's say the
patient is not in a lot ofpain. They have, they
understand they can always callus. If things change, then we
would wait and watch. And if itgoes away, we're done. If on
(14:31):
the other hand we think itlooks like old blood, which is
an endometrioma again fromendometriosis mm-hmm
although I think everyoneshould do this, but it's not
necessarily yet part of thestandard guidelines. I believe
that if it is found on anultrasound and suspected that
person should also have an MRI, because that's often how they
can differentiate between doesit really seem like a benign
(14:53):
endometrioma versus the veryrare. But what happened to me,
which is when my endometriomamalignantly transformed into
cancer. Rare, but it canhappen. And that would be the
difference between surgery ornot because an endometrioma
alone might cause so much painthat you need it removed even
when it's four centimeters. Butother patients live with it at
four centimeters and eitherstay on the birth control pill
(15:15):
to help decrease it fromgrowing mm-hmm
Or they go on medication justlike we talked about with
fibroids, these, theseanti-hormone medications, like
something called Lupron or theyget it removed. But again, this
is all assuming that yourdoctor has done their due
diligence to figure out maybethrough a series of tests that
it is benign.
Speaker 2 (15:35):
Right. Right. And then you, you kind of just
touched on this, that there'ssome people who they just
develop cysts more, you know,they recur more often. Yes.
Right. And so for those people,like what, what advice would
you give to that, that patient?
Speaker 3 (15:53):
Yeah. And when I say that, the truth is it's not
like we have scientificevidence as to like why do some
people create more cysts ? Butwe hear people and we see
people, and I know people whobe , again, they, many of my
patients who are all off birthcontrol pills and some seem to
have more recurrent cysts thanothers that we've seen and
we've documented. So the truthis the only for sure way to
decrease the chance of thosecysts, assuming they don't want
(16:14):
their ovaries removed, is tostop ovulation. Because again,
the , the majority of theserecurrent cysts we're talking
about are those that we talkedabout follicular, they're
called follicular simple orfunctional cysts, meaning that
ovary, ovulated and that littlebubble of fluid that released
the egg created a cyst andpersisted. So those patients,
(16:35):
when they go on the pill or thebirth control patch or the
birth control ring, all ofwhich stop ovulation, they have
less likelihood of developingthose cysts. So that's the only
concrete scientific way we knowto stop those cysts. Do I think
there are holistic natural waysmaybe I'm, I'm always a fan of
saying like, I don't, I don'tknow what I don't know. Right.
But if you said to me, what isthe best way for me to stop
(16:56):
these cysts? That isscientifically proven, it is
stop ovulation.
Speaker 2 (17:01):
Okay. Um, and I know I asked this question about
fibroids, but I think it'simportant , um, to ask here.
Yeah. Which is, if you aresomeone that develops cyst or
you've had maybe just one , um,does it increase your risk of
other gynecologic issues ?
Speaker 3 (17:19):
Great question. With fibroids, I could say probably
not meaning with peoplecommonly have fibroids, people
come , they have cysts withcyst, it's a little different
because again, it depends onthe type. If it was a
functional follicular simplecyst like we talked about,
doesn't seem like thatincreases your risk of anything
else. If it was anendometrioma, meaning
endometriosis in the ovary,then it means you have an
(17:39):
increased chance ofendometriosis in other parts of
your body and other parts ofyour pelvis, which can
certainly cause pain andfertility issues. Um, if it was
a dermoid that really yucky onethat had the hair and all those
things, it doesn't increaseyour risk of anything else. So
again, it really depends on thetype of cyst that you have.
Speaker 2 (17:55):
And so then it just to reinforce also what you just
said, which is it depends whattype of cyst someone has and,
and it could, depending on thetype of cyst impacts fertility
or pregnancy.
Speaker 3 (18:11):
Absolutely. Meaning again, if it's endometrioma,
those can impact fertility forsure. We know that if it's a
benign dermoid, again, yes,it's gross, it's got hair and
teeth and things like that init, but it won't impact it. If
it's a simple follicular cyst,then it depends really on the
size, meaning in general, Iwould say those simple cysts
don't impact fertility. But ifit gets too big in theory,
(18:33):
could there be some hormonalreactivity? Maybe in your case,
I think you had mentioned thatit might have also impacted
your, your tube. So if it wasgoing into your tube, that can
impact fertility because wedon't know what kind of fluid
is communicating into the tubeand going back into the uterus.
Um, and then by the way, wedidn't even touch upon, 'cause
that's an entirely differenttopic, two topics, which is can
(18:54):
you have cyst in your fallopiantubes, for example? And the
answer is you can, and andthose are actually less common
and more concerning. One isbecause that can affect impact
fertility 'cause the tubesdirectly communicate with the
uterine lining. Right. But alsobecause we now know that
ovarian cancer actually startsmost fall , most likely in the
tube itself. And so this is whywe know from data that removing
(19:16):
someone's tubes if they're donewith fertility, really
decreases their risk of ovariancancer significantly. Um, and
the other topic which we'llhave to do another podcast on
is polycystic ovarian syndrome.
PCOS. Right . Which is aterrible name because it
actually doesn't imply that youare more likely to get true
cysts in the way you and I aretalking about. That's an
(19:37):
entirely different entity whereyour ovaries just have multiple
tiny little pockets of fluid,but the term cyst in Latin
means pocket of fluid. And sowe, we've kind of wrongly
called that polycystic ovariansyndrome, meaning it's
accurate, but it's not accurateif you think that cyst means
something big.
Speaker 2 (19:56):
Okay . If that makes sense . That's helpful. And do
you think there are any mythsor common misconceptions about
ovarian cysts that we shouldkind of hit on?
Speaker 3 (20:09):
I think the biggest , um, well, two myths that ,
that oppose each other. I thinkthe biggest myth is that people
get scared that ovarian cystsmean cancer. They all mm-hmm
cancer.
Speaker 2 (20:19):
That
Speaker 3 (20:19):
Right . The contralateral part is sadly
also true. Ovarian cancer still, um, presents itself as a very
challenging thing for us todiagnose. We don't have any
screening tests for it. I'massuming you know that, but
even my smartest of peopledon't know that your pap smear
is not a screening test forovarian cancer. You can have a
normal pap smear, no , a normalpelvic exam, no family history.
And unfortunately you couldstill develop ovarian cancer.
(20:42):
And we don't have a screeningtest. We have diagnostic tests,
meaning you come in with, withpain, we should do an
ultrasound, but no screeningtest. So while most of the time
cysts are not cancer, sometimeswe see cyst and it's hard to
differentiate which ones arecancer or not. Sometimes again,
the majority will be benign. Iwanna keep saying that to
decrease fear mm-hmm
be finicky as doctors and Ineed you to know that to kind
(21:03):
of push the doctors who aren'tbeing finicky to really follow
up until they are 100% surethat it is benign.
Speaker 2 (21:11):
Okay. And then we're gonna do our, our last thing.
Rapid fire . Yeah . What arethe three takeaways we did four
last time? Well , you could dofour
that you'd like the listenersto know about ovarian cyst and
today's episode.
Speaker 3 (21:28):
Okay. So I guess I'll , it'll be kind of similar
to the fibroids. Like, first ofall, cysts are common, not as
common as fibroids as far as weknow, but that's not really
true. We just don't have dataand they're not, again, a
monolith. So it's harder toextrapolate what percentage of
women have ovarian cyst. Butthe truth is, in your lifetime
almost everyone will have acouple of ovarian cysts, even
if they were never diagnosedbecause you ovulate. So cyst
are common. Don't be scared ofcysts, but make sure that you
(21:51):
are advocating for yourself.
And if your doctor is notsuggesting a pelvic ultrasound,
if you have pain, pressure orbloating, then please ask for a
pelvic ultrasound because thisis the fourth one when it comes
to ovarian cancer, which israre, but not easy to diagnose,
the best way for us to diagnoseit is for women to know their
body and understand when theirbody is different and not wait
(22:14):
too long. All the data showsthat women unfortunately push
off their symptoms for six toeight months and doctors
unfortunately don't intervenequickly and easily for a
variety of good and badreasons. Things like our
ultrasounds always covered byinsurance, they're not always
covered by insurance. Right .
Um, so advocate for yourself,if you have pain, pressure,
bloating for more than twoweeks, you absolutely should be
(22:37):
going to see the doctor.
Speaker 2 (22:40):
Okay.
Speaker 3 (22:40):
Okay.
Speaker 2 (22:41):
Good. Well, thank you Dr. Gani . I really
appreciate it so much. Um, andI think these talking about
things that are somewhatcommon, like sometimes get
overlooked. So I'm so happythat we can actually take some
time and hopefully people feela little bit more educated and
empowered to, you know, knowtheir bodies, advocate for
(23:02):
themselves. Um, and I reallyappreciate the time that you've
given us. Thank you. Um , andour listeners, thank you
because it's really importantinformation that not everybody
wants to talk about, but weneed to do more. I know ,
Speaker 3 (23:15):
I know. Well, thank you. I appreciate it . And I
would love everyone to actuallygo over to tell every amazing
Lady Teal . I'm the presidentactually of this nonprofit that
has done some work with Tina'sWish, and it's a wonderful
nonprofit that really helpseducate people mostly on
ovarian cancer. But starting,we're starting to dip our toes
into menopause andperimenopause. Um, so I think
it's really valuable for peopleto support that organization.
(23:35):
But also you and I both know,unfortunately, we cannot leave
our health information up tothe teachers, our mothers or
our doctors because in thatgroup of three teachers,
mothers, doctors, they eitherdon't have the knowledge or
don't have the time. So we haveto learn about it ourselves and
then we Yeah . And then we cando better for the next
generation.
Speaker 2 (23:54):
100%. I agree with that. So another thank you to
all of our listeners. We hopeyou feel like I said,
empowered, educated, all ofthat , um, when it comes to
your gynecological health. Andplease feel free to share this
with your friends and familyand others because if you don't
(24:16):
wanna have the conversationwith folks, we just did it for
you. Um, and so it makes iteasier to educate people about
these very important , um,gynecological health topics. So
thank you for joining us againtoday. Thank
Speaker 3 (24:30):
You.
Speaker 1 (24:37):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
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