Management of ovarian cysts in postmenopausal women

ABSTRACT

Ovarian cysts in postmenopausal women are not uncommon and the majorities are asymptomatic. The primary goal in case of an ovarian cyst in a postmenopausal woman is to exclude malignant disease. Evidence is emerging that most of these ovarian cysts in postmenopausal women are benign, and many of these cysts resolved spontaneously. Therefore, surgical exploration of these cysts in postmenopausal women, who might have multiple co-morbidities, can be avoided in a large proportion of these patients. The aim of this review was to provide an evidence-based guideline about the management of ovarian cysts in postmeopausal women according to clinical, ultrasonographic, and biochemical features. Articles concerning ovarian cysts in postmenopausal women from a Medline literature search for the past 10 years were included. Using different imaging tools and serum marker CA125 are used. Size and consistency of the cyst found on benign appearing criteria on ultrasound and Doppler in addition to normal CA125, can be managed conservatively by repeated ultrasound and CA125, majority of cyst in postmenopausal women are benign and disappear spontaneously. Operative laparoscopy can be safely used to remove persistent cyst with normal CA125. Suspicious cyst by imaging and elevated CA125 should be manage in the traditional way as ovarian cancer. Discrimination between benign and malignant ovarian cyst is challenging. No single test can achieve this, for this reason multiple diagnostic modalities can be used together to optimize the accuracy of prediction of malignancy in a cyst. More work is needed on Doppler and three-dimensional ultrasound hoping to improve the sensitivity to discriminate between benign and malignant cysts in the future