Implosion Within: A Ruptured Ovarian Cyst

I woke up early yesterday morning to go to the bathroom. It was oddly annoying to be awakened from a sound sleep to move my bowels, but when nature calls….Shuffling back to bed I began to feel pain in my lower right side. “Perhaps I’m not done,” I thought and shuffled back into the bathroom. The pain increased. This was not coming from my bowels. Lying down was completely out of the question, so I meandered around my house for a bit, trying to find comfort. The more I wandered, the stronger the pain got until I finally climbed back into bed in a fetal position. When the pain became so intense that it was difficult to breathe, I woke up my husband.

“Something’s wrong,” I said. “I’m in pain.”

My husband sprang up from his sound sleep and after frantically groping for his glasses, began firing questions at me. “Do you need to throw up?” “Are you having diarrhea?” “Describe the pain; is it sharp, dull, does it move…”

While I realize that he was trying to be helpful, if I could have uncoiled from my fetal position, I would have belted him in the mouth. Instead I did my best to answer his questions.

“I’m taking you to the emergency room,” he declared. It was just after 6am by this point and I really couldn’t see making that arduous trip when my GYN’s office would be open in 2 hours.

“Look,” I said. “Get me one of the Vicodin I have left from my ablation. That will give me time until the doctor’s office opens. In the meantime, you’re going to have to get the kids up and out to school.” There were grumbles at the mention of managing the kids solo, but my husband made me comfortable and proceeded to tend to my children.

Not long after I took the Vicodin the pain began to subside. I slowly began to unfold from my fetal position. After 8am I began calling my GYN’s office to see if I could be seen later in the day. The lines were all busy, but I was finally able to leave a message for my doctor’s nurse. By the time I finally talked to my doctor’s nurse, I was feeling better and the pain had subsided considerably. I probably wouldn’t have even scheduled an office visit except that my husband was hovering over me with the look of panic in his eyes (I think he was more concerned that he would have to care for the children alone indefinitely!), so I took the open 3pm appointment for an ultrasound and examination with one of the nurse practitioners.

My ultrasound showed multiple uterine fibroids (no news there!), a couple of ovarian cysts on my left ovary and a lot of fluid around the right ovary. Watching the scan I realized that I had “fluid in the cul-de-sac” meaning fluid in the area surrounding my ovary. I had seen this when I used to work in infertility when the doctors would retrieve the eggs from women after they had been hyperstimulated. The fluid would often spill into the pelvis after the follicles were punctured and the eggs retrieved or after the follicles had spontaneously ruptured. since I had not been hyperstimulated yet was somewhere near the mid-point in my cycle, an ovarian follicle or cyst had likely ruptured. The nurse practitioner confirmed my suspicions and I returned home with orders to take anti-inflammatories.

Ovarian cysts are quite common and frequently occur in women of childbearing age. Each month several follicles develop to mature eggs for ovulation, but ultimately only one will go on to mature an egg which will be ovulated. The body usually reabsorbs the remaining follicles, but not always.  Follicles that aren’t reabsorbed but persist as fluid filled sacs or (Functional) cysts can cause pain and pressure within the abdomen. When they burst, the fluid they contain irritates the tissue in the abdominal cavity causing intense pain. The pain will gradually subside over a few days, and is relieved with anti-inflammatory drugs. In other cases, the follicles don’t rupture but continue to grow and cause pain as well as put pressure on surrounding structures such as the bowels or bladder, sometimes obstructing them. Cysts that don’t go away and continue to cause problems must be surgically emoved.

In women who repeatedly develop ovarian cysts related to ovulation (functional and luteal cysts), birth control pills can reduce the number of cysts they develop because birth control pills prevent the ovaries from developing follicles. Other types of ovarian cysts such as endometriomas (cysts made up of tissue from endometriosis), cystadenomas (cysts that form on the outer surface of the ovaries), and dermoid cysts (cysts formed from a variety of tissue types) are also easily managed conservatively with careful monitoring is they cause no symptoms, with medications (endometriomas) or via surgery if they cause too many problems.

Overall I would say that I am pretty lucky. While having a ruptured ovarian cyst pretty much knocked out my day, it could have been a lot worse.

If you have any of these symptoms, talk to your doctor, you may have an ovarian cyst.

• Pressure, swelling, or pain in the abdomen
• pelvic pain
• dull ache in the lower back and thighs
• problems passing urine completely
• pain during sex
• weight gain
• pain during your period
• abnormal bleeding
• nausea or vomiting

And get help immediately if you experience any of these symptoms:

• pain with fever and vomiting
• sudden, severe abdominal pain
• faintness, dizziness, or weakness
• rapid breathing

Symptom list is from The National Women’s Health Information Center of the US Department of Health and Human Services. www.womenshealth.gov.

Add a comment November 4, 2009