Even though ovarian cysts after the menopause are less common, instances do crop up and may cause difficulties. Post-menopausal women with an ovarian cyst that is not suitable for conservative management may have to have an oophorectomy. This operation is done to take out the ovary within a bag so as not to have the cyst break open in the peritoneal cavity. Post-menopausal women are recommended to take a sonographical CA125 test using transvaginal grayscale. Magnetic resonance imaging (MRI), computed tomography (CT), and Doppler scans are not as good for the detection of post-menopausal cysts. Transvaginal ultrasound is the best way to understand the situation of ovarian cysts because it gives enhanced detail and more sensitivity. Larger cysts nevertheless should be examined transabdominally.



Although it may be advisable to suspect all ovarian cysts of being malignant in a woman after the menopause, to be completely sure requires a full laparotomy and staging procedure. Some seventeen percent of women after menopause contract ovarian cysts. There is no optimal solution to manage the cysts. Most of them will spontaneously be reabsorbed causing no major problem. Ovarian cysts and malignancy do not seem to be very correlated but ovarian cancer is showing a worrying increase in older women. If the cancer spreads beyond the ovary then survival is statistically unlikely. Recent research on ovarian cysts after the menopause from a sample of 226 women suggests that ovarian cysts that are benign are smaller than 50 mm in diameter and can benefit from safe management using constant monitoring of the cyst dimensions and the levels of CA125.

There are two main questions concerning ovarian cysts for women after menopause: what is the best management; and where the treatment should take place. A gynecologist generalist should be able to manage low-risk cases, but intermediate-risk cases should be referred to a cancer unit and those women who represent high-risk cases should go to a cancer center. Management changes should be revised accordingly when used with an index to determine malignancy risk. Measurement of CA 125 which is used in more than four out of every five studies is a typical test here. Usually a cutoff of 30 u/ml is used with test specificity of 75 percent and sensitivity of 81 percent. Using ultrasound has demonstrated 73 percent specificity and 89 percent sensitivity. To usefully evaluate ovarian cysts, Doppler sonography with color flow has also proven its worth. It is less effective in the evaluation of a tumor as benign or malignant to examine the cytological fluid from an ovarian cyst. In this case the sensitivity is only around 25 percent and the danger is greater that the cyst will break open.

In the laparoscopic management of ovarian cysts in post-menopausal women, the recommendation is often for oophorectomy instead of cystectomy. Frequently the error is made in choosing ovarian cyst fluid for a cytological assessment in an effort to identify cyst malignancy. The precision factor is only 25 percent in this case and there is also the risk of the cyst disintegrating. It is the high threat malignancy index that shows all ovarian cysts in post-menopausal women, which are suspected of being malignant. If a laparoscopy indicates suspicious clinical findings, then a full laparotomy and other staging procedures are to be employed. These must be done by a surgeon qualified for this as part of a multidisciplinary team working at a certified cancer center. Therefore one may deduce that aspiration has no real role to play in the post-menopausal management of asymptomatic ovarian cysts. Nevertheless, in conjunction with laparotomy and laparoscopy it might be a step in the preliminary surgical management. The extended midline incision should comprise biopsies from areas and adhesions under suspicion, the cytology in the form of ascites or washings, BSO, TAH and infra-colic omentectomy and laparotomy that is well documented. If the cyst is malignant this may have grave further effects on the probability of the patient surviving.

Post-menopausal ovarian cysts in common with many other chronic health ailments have no simple cause. For this reason, classical medicine that only focuses on a specific symptom will not be successful in remedying ovarian cysts. Several factors will in fact trigger the formation of an ovarian cyst. Some of these factors are directly responsible for ovarian cysts forming, and others act indirectly to play a secondary part to worsen existing cysts. Although classical medicine may be of use in handling a primary cause, these indirect factors will stay around and be the root of further complications. A holistic program is the only way to free yourself from a complaint of post-menopausal ovarian cysts. Because multiple factors are at the root of ovarian cysts, the treatment needs to integrate multiple dimensions. This is the only way for getting to the real, underlying problems and removing cysts forever.