It was impossible to ignore it any longer - my belly was bulging. But, unlike excess fat, the bulge didn't disappear when I lay on my back: it just sat there solidly, menacingly, pressing down uncomfortably on my bladder. So I went to see my GP.
When a pregnancy test proved negative, as I knew it would, he looked worried. He assured me that the lump could be one of any of a number of "non-serious" growths but that we needed to make sure, and then he booked me in for an ultrasound scan.
Four weeks later, at University College Hospital in London, the scan revealed a large ovarian cyst. My first reaction was anger. I had spent most of my life eating a balanced diet and exercising regularly, and strongly believed in a preventive, holistic approach to disease. How could my body betray all these years of care and attention by producing an enormous growth in my reproductive system?
Reading up on the subject, I discovered that ovarian cysts are, in fact, extremely common but as they have few symptoms, women often discover them only when examined for another gynaecological condition. Cysts smaller than about four centimetres in diameter are simply monitored, since they may dissolve and be reabsorbed by the body without being treated. My cyst, however, had ballooned to 10cm so discreetly that I'll never know when it first appeared or exactly how quickly it grew.
There are different types of cysts, depending on their cause and make-up. The ultrasound described mine as fluid-filled, thick-walled and "unilocular" - meaning that it has a single cavity; this type is also called a simple cyst. Multichambered cysts containing solid components have more chance of being malignant. The low risk of cancer was comforting, but I was worried that surgery would reveal something other than a simple cyst.
Because the ultrasound scan showed that the cyst had expanded my right ovary to about 10cm in circumference the nurse recommended referral to a gynaecologist. She explained there was a danger that the cyst might burst. The weight of the cyst could also cause either it or my ovary to twist round, causing great pain or haemorrhaging. I became hyper-aware of any unusual pain, expecting the cyst to burst at any minute. In bed, I would struggle to get comfortable as this fluid-filled mass wobbled around inside my abdomen, pressing first on my bladder and then on my intestines.
When I saw the gynaecologist at my local hospital, he confirmed the need for swift surgery and broached the issue of fertility. A scan isn't a precise diagnostic tool, he explained, and they couldn't be sure exactly what was going on inside my abdomen until they opened me up. They might have to remove one or both ovaries. His stark confirmation of my worst fears sent a chill through me and the anxiety I had been suppressing bubbled over into tears. I went home with the date of my operation and cried all morning.
Although I had never felt a strong desire to have children, I had never doubted that, when called on to perform, my reproductive system would acquit itself admirably: I was fit, had never had gynaecological problems and had always opted for alternatives to the contraceptive pill. However, at 37, I was no spring chicken, biologically speaking, and surgery would leave its mark. Ironically, two close friends became pregnant during this period and I was surprised by the strength of my reaction to the announcement. It was a potent mixture of joy for them, jealousy and self-pity - they were carrying babies, I was about to give to give birth to a lump of useless tissue.
The operation itself didn't worry me because I trusted my consultant. A friend had worked on a television programme about the unnecessary removal of female reproductive organs during surgery and a check of his credentials allayed any fears that he would whip out my ovaries at the drop of a hat; he had an excellent reputation. The anaesthetic was a different matter. A strong believer in complementary therapies, I balk at even mild painkillers and was terrified of the effect such a strong drug would have on my system.
The operation was to take place at 9am. As I was wheeled down to the operating theatre on my hospital bed, I felt incredibly vulnerable: total strangers were going to render me unconscious, cut me open and remove part of my insides. Weird.
A friend's hand on my arm woke me from post-operative sleep back on the ward. I opened my eyes to drips, tubes and plastic bags suspended from metal poles - all attached to me.
A nurse explained that the "remote control" next to my hand would give me a shot of morphine at the touch of a button if the pain became too much. More drugs. I don't know if was a subconscious desire to purge my body of medication, or a strong constitution, but I barely touched the morphine admin istrator and asked for it to be removed next day. Doctors told me that the cyst had been about 14cm in circumference (about the size of a large grapefruit on the frequently used but curious fruit and vegetable scale of the internal growth) and was, in fact, attached to my left ovary. The ultrasound scan had recorded the results of it being squashed around the front of my lower abdomen.
Endometriosis is an often painful condition in which bits of the womb's lining, the endometrium, migrate to other areas of the body and become inflamed. Ovarian cysts and endometriosis are often spoken of in the same breath, partly because the latter condition can give rise to "chocolate" cysts, so called because they contain old, thick blood. I was surprised when my consultant told me he had also removed one of these chocolate cysts.
I had never had the pain or any other symptom connected with endometriosis, and how much room is there on one ovary anyway, for heaven's sake? It's only the size of a walnut. My surgeon painstakingly removed both cysts and then sewed the ovary back together. Another doctor, present during the operation, even stayed behind after the usual morning doctors' round to tell me the procedure had been "amazingly intricate and beautiful to watch".
After that, the influx of drugs was relentless. As well as the daily painful injection into my thigh of a blood-thinning agent to reduce the risk of thrombosis, there were oral painkillers and anti-inflammatories dished out by the night nurse. The final - and biggest - drug hurdle was the hormone medication commonly used to suppress ovulation in order to give the reproductive system time to recover from surgery. I found it annoying to be asked every morning by an intimidating gaggle of medics whether I had made up my mind about taking it while still decidedly non compos mentis.
On one occasion my insistence that I didn't like taking drugs was met with the assertion that, in that case, I could be given a one-off injection that would last three months.
These drugs prompt a "mini-menopause" and possible side effects include loss of bone density, hot flushes, vaginal dryness, headaches. A doctor agreed with my observation that whatever benefits this drug brought were purely temporary and that if my body was determined to produce another cyst it would do so as soon as the medication stopped. I declined to take it. Other doctors I spoke to said they doubted the benefits of medication that deactivated the ovaries, and one told me that some women can develop simple cysts while taking the pill.
This settled, I just wanted to get well enough to go home. For the first few days of my week in hospital, visits to the loo were nerve-racking. I felt any "straining" would split my belly open like a ripe watermelon, even though the suture holding together my hip-to-hip wound made me think of a piece of cable from San Fransisco's Golden Gate Bridge, and a nurse assured me that more layers of stitching secured me inside.
My stomach ached constantly and I didn't sleep for three days. Finally, one of the night nurses gently ordered me to swallow a sleeping pill to give my body a chance to rest and heal. Seven days after the operation my brother arrived to take me home.
Six months on, I'm still angry at how my body has "let me down". And angrier still at a GP who told me, when I queried sharp pains in my ovary, that I'd "never be the same again".
Still, the ovaries are intact and what I thought would be a scar for life across my stomach has all but disappeared. I'm amazed at how the human body can bounce back from physical trauma. I just hope I'm not one of the unlucky few for whom ovarian cysts recur. I don't want to have to bounce back twice.
Ovarian cysts: the facts
Simple or "functional" ovarian cysts are fluid-filled blister-like growths on an ovary. Few are cancerous and doctors tend to take a "watch and see" approach to treatment.
Functional cysts tend to appear if the ovary produces too much oestrogen. Although common, especially in young women, they are usually small and disappear on their own in about three months. Most will cause no symptoms: you will feel nothing and probably never know you have a cyst.
But some functional cysts do grow large enough to cause problems. Symptoms may include a dull ache, bloating, pain during sex and irregular or painful periods.
If a large cyst breaks open, it can cause severe pain and swelling in the lower belly. The pill may help, but in extreme cases, when the cyst has grown larger than a tennis ball, surgery may be necessary.
Functional cysts are different from those associated with polycystic ovary syndrome (PCOS), a hormonal condition thought to affect up to one in 10 women. Polycystic ovaries have a string of cysts around them (in what is often described as "a pearl necklace effect"). PCOS often goes undiagnosed because the symptoms are similar to those of premenstrual tension: weight gain, spots, tiredness, breast pain and depression.
But the condition can also cause excess body hair and infertility. The treatment - generally involving hormone pills - will depend on whether or not you are trying to get pregnant.
