Other cysts can be malignant tumours, particularly in older women. Cysts can vary in size from about 3cm to15cm or more, before they are detected.
Endometriosis - In this condition other tissues act as if they are endometrium. The tissue is usually within the pelvis, especially around the ovaries. During each period there is bleeding into the endometriosis tissue. This internal bleeding leads to pain and a local reaction. The local reaction may be a collection of old blood, called a chocolate cyst, or adhesions of the ovaries, which can become stuck to the back of the uterus.
Infections - There may be a general infection in the pelvis. This is called pelvic inflammatory disease, or PID for short. One or both Fallopian tubes can become infected. This is called salpingitis. This may cause pain and adhesions in the lower abdomen.
Other conditions - Some conditions, such as appendicitis or an inflamed lower bowel, may also cause pain and swellings in the pelvis similar to the conditions above.
The main aim of the laparoscopy is to look inside your abdomen to find out what is going on. We can then decide on the best treatment. During the laparoscopy the surgeon can look at the uterus, the Fallopian tubes and the ovaries. All the surrounding tissues and structures can also be examined. We use a special telescope, called a laparoscope, attached to a camera. Sometimes we can do minor surgery as well as looking, for example, drawing fluid from an ovarian cyst. Other procedures, such as ultrasound, x-rays, blood tests and swab tests, may provide further information to help us diagnose your problem.
A laparoscopy gives an excellent view of the pelvis. Once it is clear what the problem is, the best treatment can be started. If the problem is not in the ovaries or uterus, but instead due to an inflamed appendix, for example, another specialist surgeon could be called to deal with this at the time of your laparoscopy.
Are there any alternatives?
You have probably already had other tests to try and find out the cause for your problems. They may have included ultrasound scans, x-rays and CT or MRI scans. These tests can often be used to give us additional information to help in your diagnosis. The direct view through the laparoscope is often the most accurate examination. The laparoscope also allows us to take a biopsy of tissue for examination under the microscope. Unfortunately, a diagnostic laparoscopy requires a keyhole operation with a general anaesthetic. It is for this reason that the other, less stressful tests are usually done first.
Having an open operation with a large wound, called a laparotomy, is not needed unless there are adhesions inside the abdomen from previous infections or operations.
What if you do nothing?
If you do nothing, the cause of your problems will remain in doubt. You may miss out on important treatment. Any problems will usually remain and could seriously affect your future health.
Author: Dr David Hutchon M.R.C.O.G, F.R.C.O.G. Consultant Gynaecologist.
© Dumas Ltd 2006