Tuesday, June 3, 2008

Fat is a symptom, not a disease, Part Five: Ovarian cysts

When I went to university just after high school, I met a very nice young woman who had a very rounded abdomen that looked like a near-term pregnancy. I lost touch for a while, but a couple years later, I saw her, and her belly was nearly flat. Still young, and not yet introduced to FA, I asked her about her weight loss. She told me that a volleyball-sized ovarian cyst had been removed from her body.

I was absolutely stunned. It was the first I'd heard of such a thing, and it horrified me to know that her cyst had gone undetected for so long--that she had spent so much time and effort trying to lose weight, when it wasn't weight that could be lost without surgical intervention.

Of course, not to be spared any of life's most wonderful experiences, four years ago, my own body decided to produce several cysts, one of them quite large, necessitating the removal of an entire ovary, the fallopian tube next to it, and a chunk of uterus, all of which had been engulfed in the cysts and could not be salvaged. It was an emergency surgery, due to the cysts being previously undiagnosed, and growing to a point where they suddenly caused acute, unceasing abdominal pain that landed me in the ER.

Ovarian cysts often go undetected because the women who have them are blown off as lazy overeaters. Instructed by doctors to "diet and exercise", patients can become frustrated and stop bothering to get medical care. The cysts continue to inflate--they fill with fluid, and can reach some mind-boggling proportions. A Texas woman had a 156-lb cyst removed in 1994. That pales in comparison to the world record, a 328-lb cyst removed from yet another Texas woman (what's in the water there?!) in the early 1900s, but a 156-lb cyst, as well as a 93-pounder and 66-pounder, are still problematic.

A woman carrying around a large ovarian cyst may experience disabling pain, and she may have her activity levels severely curtailed. With a reduction in activity, her metabolism may slow down, causing her to gain weight on top of having the weight of the cyst. By the time she finds a doctor willing to treat her actual problem (instead of berating her for being fat), she may have developed additional health problems related to being sedentary.

No amount of diet and exercise is going to make the cyst disappear. The rest of the body may lose mass, but the cyst will not shrink. There are generally only a couple of options for treatment; one is surgical removal of the cysts, and the other is hormone treatment in the form of birth control pills. Generally, most cysts will go away on their own once a woman starts taking birth control pills. Of course, weight gain is also a symptom of taking oral contraceptives; it would be great if fatophobes would understand that sometimes gaining weight on a medication is better than not having the therapeutic effects of the medication.

So the next time you see a woman that you think is OMGFAT, and you think it's somehow your business to get upset about that, consider the fact that the above is just one of many medical conditions that can make a person appear to be fat, and it is often one that goes untreated far too long because too much attention is paid to making people thin instead of making them healthy. You might also consider that she is on a medication that is keeping her healthy, and being fat is a side effect of that medication. Asking a woman about the status of her reproductive system, though a favorite hobby of aunts and mothers-in-law, is generally considered to be a gauche thing to do, so the best thing to do is assume that her health and reproductive system are private matters between her, her physician, and possibly her significant other, no matter how badly your screwed-up, bigoted aesthetic sense is upset by the sight of her.


Anonymous said...

One of my high school boyfriend's sisters (got that?) had this happen to her, at the age of 14. She was lucky - not only did she not get the stigma of "fat" placed on her because she had previously been already one of the "popular" crowd, but she had parents with good medical insurance and the common sense to realize that if she's only getting bigger in one spot on her body and NOWHERE else, that something HAD to be wrong.

But, like I said, she was one of the lucky ones. You're absolutely right that many women will avoid medical treatment because of the way they're being treated as a person. My great-aunt had one for years, until it was the size of a grapefruit, and only THEN was she taken seriously.

It disgusting to think that the stigma of "fat" is so bad that it blinds even the so-called "medical professionals" to what's REALLY going on. But it DOES happen.

Anonymous said...

This is certainly a minor point and secondary to the discussion in the post and nuckingfutz's comment, but I think a little of the stigma around this particular issue might be related to the fact that ovarian cysts enlarge your belly. An apple shape is not considered "womanly" in the framework of the modern obsession with an hourglass, 36-24-36 pinup shape and flat abs, so the misogynist disgust at the "greed" and other perceived characteristics of women who dare to be fat could also be exacerbated when her "fat" is mostly around the belly. I agree that whatever the reasons, fat hatred very likely causes doctors to be negligent of patients with ovarian cysts, just as it causes fat and "fat" women to receive substandard care in so many other areas.

Anonymous said...

How about PCOS? Which also causes insulin intolerance (do I have that right) which also causes weight gain?

RioIriri said...

PCOS is actually caused BY the insulin resistance, not the other way around. The way it is talked about frequently neglects to mention this, though, I think partly because 1. they probably didn't know the cause of PCOS at first, and 2. the fertility problems it causes tend to be the main focus of treatment, since other symptoms may not be as obvious.

RioIriri said...

You've got a point there. People really do have a thing against bellies!

Yeah, if you happen to be fat in other places (as is frequently the case with PCOS, due to insulin resistance), a cyst can be very easily overlooked. And if you started with the cyst and got fat elsewhere because of the cyst (for whatever reason), you can be really screwed :(

Heather said...

Once again, sweetie, I say "hell yes". I have a big belly (courtesy of my biological father) and so far no one's asked me when the "blessed date" is, but whoever does will get a swift punch somewhere.

Anonymous said...

RioIriri: See... here's the thing. I've known I had PCOS for probably 10 years. I've been told once in a while that sometimes it can be treated with diabetes meds. Nobody ever told me why. It was less than a year ago that I learned that insulin resistance went along with PCOS. Now today I find out it's the resistance that causes the cyts!?!

Not that you guys are doctors or anything, but should I be treating my PCOS with diabetes meds? I always turned it down 'cause it didn't make any sense to me and nobody ever wanted to explain it!! They just kept telling me to lose weight and it would go away! Do any of you have good resources for researching the matter?

RioIriri said...

The diabetes drug Metformin seems to be working fairly well for the problem.

Try here:

Peggy said...

spacedcowgirl: I think you make a good point. The wife of an acquaintance had an ovarian cyst that went untreated a long time because she just thought she was "getting fat" - and she even stopped going out to bars/clubs because she was so self-conscious about her big belly. Fortunately, she was eventually diagnosed correctly and had surgery to remove the cyst which was almost 25 pounds. It must be terribly painful to have a 50 or 100 pound cyst, and it makes me so mad that fat phobia makes it so hard for women to get a proper diagnosis and treatment.

Anonymous said...

I find people who think that fat simply is eating more and not exercising enough, denying the issue that medicines can cause weight gain. As well as certian medical issues.

It's like trying to reason with a stubborn two year old going, "But but but IT'S TWUE!"

Nan said...

I'm a little late jumping into this, but it's not just discomfort and pain -- sometimes the end result is death when the symptoms are ignored. My niece, a woman in her mid-30s, died from ovarian cancer. It can be a tricky cancer to catch early, but I am totally convinced one reason her diagnosis happened so late in the progression of the disease is her primary care physician kept blowing off her complaints about bloating, abdominal pain, etc., was (a) she was a woman, and (b) after having a couple babies she had gained some weight. Ergo, all she had to do was work on her abs, lose a few pounds, and all her problems would be magically solved.

Anonymous said...

I have been meaning to read this whole series and praise it enormously for almost a year and a half now. Today, I am ever so glad I did (finish reading; the praising has only just begun). In short: THANK YOU. I am about to start writing the final paper for my food policy class, advocating health-at-every-size instead of thin-at-any-cost, and these posts are encouraging and inspiring. Again, many, many thanks.