The biggest ovarian cyst I’ve ever seen was in a young woman and was 24cm across. She was supermodel-slim, and finally went to her GP after spending a fortune on pregnancy tests, because she couldn’t understand why they were all negative, yet she looked seven months pregnant. A big tummy is a slightly unusual way for a cyst to present. More common symptoms include:
abdominal pain – this may be constant, occasional or during sex
constipation – due to pressure on your bowel
wanting to pass urine more often – due to pressure on your bladder
a change in your periods – irregular, heavier or lighter.
The risk of a cyst being cancerous in a pre-menopausal woman is very low, ranging from 1 to 3 in 1000.7 (See Chapter 4 for more about polycystic ovaries.)
Should I be worried about ovarian cancer?
Ovarian cancer is so rare before the menopause and ovarian cysts do not increase your risk.
An estimated 5–15 per cent of ovarian cancers are inherited, most often caused by mutations in the BRCA1 and 2 genes, which are also associated with breast cancers. If you have close family members (e.g. mother, sister, grandmother) affected by ovarian cancer, particularly at a young age, you may be eligible for genetic testing, which should be discussed with a genetic counsellor.
An estimated 21 per cent of cases of ovarian cancer are directly related to lifestyle factors including smoking, poor diet and lack of exercise,8 so keeping active and eating well is one of the best ways to prevent the disease.
There isn’t currently any screening for ovarian cancer, as there isn’t yet a test that is accurate enough. Remember that screening means identifying women who may have a disease but do not have any symptoms.
If you experience any of the following symptoms more than twelve times per month, you should be investigated:
Persistent bloating
Feeling easily full after eating and/or loss of appetite
Pelvic or abdominal pain
Needing to pass urine more often, or as a matter of urgency
Change in bowel habit
THE GYNAE GEEK’S KNOWLEDGE BOMBS
I hope you have found this chapter more fascinating than when you studied female anatomy in that awkward biology lesson at school. These are the key facts that you may not have learned back then that I want you to keep in mind:
Your uterus can face forwards or backwards and contracts during your period to help the blood get out, which is what causes period pain.
It also doesn’t like being poked very much, which is why it can be normal to get a bit of an ache after sex.
Bleeding after sex is rarely caused by the big C.
Your fallopian tubes are pretty flexible guys, flapping around like a Mexican wave, so that they can pick up an egg from either ovary.
Ovarian cysts are very common (often a result of the normal functioning of your ovary) and do not increase your risk of ovarian cancer.
Periods are one of society’s biggest taboos. Over half of the population has had or will have one at some point during their lifetime. Yet we barely talk about them.
I’ve noticed an interesting three-way split in the way women feel about periods. In the first group are women who are ambivalent; they don’t mind either way whether they come or not. The second group hate them and would do anything to make them go away (‘Give me anything you’ve got to make them stop!’). The third group love them and are horrified at the thought of not having their period every month – some, because they see it as a sign that their bodies are working, and many because they feel like it’s ‘cleaning their body from the inside’ (although I’m always quite keen to point out that having a period doesn’t clean your body of germs or toxins; in fact, I think period blood often has a ‘dirty’ connotation, which is probably one of the reasons we’re so reluctant to address the issue).
There are some types of contraception – for example, the hormonal coil – that will stop your periods (see Chapter 7), and if that happens it’s not a bad thing. It doesn’t mean your uterus will become ‘unclean’. The medication is simply preventing the lining from building up, so there’s nothing to shed. I once offered the hormonal coil to a lady whose periods were so heavy that she’d had several blood transfusions. However, for her the possibility of having no period at all was unacceptable and she declined, explaining that she ‘wouldn’t feel like a woman any more’. I really like the fact that some women appreciate their period as a sign that their body is working. This is so true, and I always tell my patients that their period is a reflection of what’s been going on in their bodies for the last month, even slightly longer.
The next three chapters will cover the basics of periods, the menstrual cycle and what can, and commonly does go wrong.
Me: How long is your menstrual cycle?
Patient: Three to four days.
Many people think that the length of a cycle is how long you bleed for, but this is a common misconception. Your cycle is actually the number of days from the start of one period until the start of the next.
Education about periods is pretty mediocre at best. In fact, at my school it was so dire that I genuinely thought a period was the contents of an egg cracking and being released through the vagina, which often makes me laugh when I think of the irony that I now spend my life explaining periods to others. But rest assured, I’ve done my fair share of reading since then.
In this chapter I want to start with the absolute basics, so do bear with me if you’re a period pro, although I hope there will be something to be gained for you geeks too.
If you fall into the ‘I’m-in-need-of-period-101’ group, you are not alone. A recent survey by ActionAid UK revealed that one in four women in the UK does not understand her periods, and that 20 per cent feel embarrassed to talk to their friends about them. If we can’t talk about periods, we will never work out what is normal or abnormal. And this results in so many women suffering unnecessarily because they don’t realise that there are things that can be done to help the problems they experience on a monthly basis.
What is a period?
A period is what happens when the lining of the uterus (the endometrium) falls away. Even though most of us are not trying to get pregnant the majority of the time, the entire reason for having a menstrual cycle is to prepare your uterus for a fertilised egg to implant. When this doesn’t happen, your uterus chucks out the lining it had prepared. But in order to actually have a period there is a lot of work going on behind the scenes throughout the menstrual cycle.
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