CHECK-UP: A physical therapist uses a manual therapy technique on a patient to examine gynaecological disorders.
From a young age, Flora Steyn, 46, has always had irregular and painful periods - so painful that she had to take an average of eight strong pain tablets each day.

“I began to dread that time of the month. I went to my doctor who referred me to a gynae who did an internal scan to see the ovaries.

“All was not well. While ovaries should be one colour or whitish, both mine looked as though they had raisins stuck on them. These spots were actually showing the scars from the multiple small cysts that had formed on the ovaries then withered away,” she said. Steyn also developed excessive hairiness and struggled to lose weight - all symptoms of polycystic ovary syndrome.

While ovarian cysts are quite common for women in their reproductive years, most are harmless and painless; but these benign fluid-filled sacs can become problematic when they don’t disappear on their own, becoming enlarged or causing scarring. In Steyn’s case, some of the cysts popped instead of disappearing.

According to Dr Katrien Dehaeck - a gynaecologist at Vincent Pallotti Hospital in Pinelands, who specialises in gynaecological oncology and paediatrics - while it is normal for ovulating women to develop “functional” ovarian cysts every menstrual cycle, this becomes a problem when the cysts become “non-functional” or grow in size.

“Cysts that develop in women of reproductive age are usually not harmful, provided they get smaller on repeat checking with an ultrasound. However, some women might experience pain and bleeding. If they are causing severe pain, it means there is torsion, leakage or a haemorrhage. A torsion of a cyst often leads to emergency surgery.”

Dehaeck said if cysts continue to grow or are larger than 5cm, they should be investigated to exclude malignancy. They should be monitored for a month or two via ultrasound to determine their nature, as most ovarian cysts don’t cause any symptoms even if they get larger.

She also recommends that a tumour marker test be done, while those at menopausal stage should be observed even closer.

Steyn is at premenopausal stage and needs even closer investigation, but she says her financial circumstances prevent her from seeing a gynaecologist regularly.

Even though she is on medical aid, she says it’s years since she went to a gynae as she is careful of depleting her medical savings. “I don’t know what the state of my womb or ovaries is...”

She says even though many women live with constant pain due to gynaecological disorders, the reality is that financial constraints and work demands prevent these women from seeking medical help.

“Bosses don’t like it when you have to keep going to the state hospital and wait all day in queues, perhaps several times a month.

“You can’t keep on taking time off to see what is happening. We basically have to put up and shut up, even though we may have endometriosis, ovarian cancer, painful fibroids or cervical cancer.

“As women, I feel we don’t have anywhere to run to for help. We feel embarrassed, alone, driven by hormones and ‘dysfunctional’.”

Although Steyn was advised by her doctors to go on a contraceptive pill to ease symptoms, “sadly, my body reacts badly to the pill my blood thickens more than normal”.

Dr Peter de Jong, a gynaecologist at Netcare Chris Barnard Memorial Hospital, said ovarian cysts are not all equal: overweight and obese women are at risk of polycystic ovaries (multiple small cysts causing irregular, heavy periods).

“Treatment begins with a proper diet and plenty of exercise,” he said.

While non-functional ovarian cysts increased the risk of ovarian cancer, De Jong said there is currently no way of screening for ovarian cancer, as is the case with cervical cancer through pap smears.

The best that can be offered is that women attend their health care provider for regular check-ups. Ovarian cancer is quite rare, affecting one in 80 women.

It is more common in older women, and initially causes very few symptoms. When it is advanced, patients complain of abdominal bloating, distention and pain, with bowel symptoms. “Sadly it often presents late, when major surgery and chemotherapy are the only treatment options,” he said.

He advises women with persistent pain in the left or right groin area and painful sex to seek medical care for further investigation, including an ovarian scan.

“The best way to avoid ovarian cysts is to lead a healthy lifestyle with plenty of exercise and normal diet. The combined oral contraceptive can prevent ovarian cysts in women before the menopause. In postmenopausal women, don’t neglect regular check-ups,” he said.