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.

Some seventeen percent of post-menopausal women contract ovarian cysts. There is no optimal solution for cyst management. Most of them will disappear spontaneously without any major impact. Ovarian cysts and malignancy do not seem to be correlated, but there is a concerning rise in ovarian cancer in older women. If the cancer invades beyond the ovary then survival is probably unlikely. Although it may be recommended to suspect all ovarian cysts of malignancy in a woman following the menopause, to be entirely certain means a full laparotomy and staging procedure. Studies done recently on post-menopausal ovarian cysts from a group of 226 women indicates that ovarian cysts that are smaller than 50 mm in diameter are benign and can be handled using safe management using regular examination of the dimensions of the cyst and the concentration 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.

The recommendation for women after the menopause when laparoscopic management of ovarian cysts is done is frequently not for cystectomy but in fact for oophorectomy. Trying to use ovarian cyst fluid for a cytological assessment is a common error when trying to evaluate system malignancy. The accuracy factor is only 25 percent with an increased risk of cyst rupture. The higher risk malignancy index indicates all ovarian cysts suspected of malignancy in post-menopausal women. If laparoscopy indicates suspicious clinical evidence, then a full laparotomy and subsequent staging procedures are to be employed. A certified surgeon within a cancer center team that is multidisciplinary is required. For this reason, it may be said that aspiration does not have a role to play after menopause for asymptomatic ovarian cysts management. Notwithstanding, it might still form a part of the pre-surgical management together with laparoscopy and laparotomy. The incision under extension of the midline should include the cytology in the form of ascite washings, laparotomy that is well documented, and biopsies from adhesion and areas that are suspect. It should also include infra-colic omentectomy as well as BSO and TAH. In the case of a malignant cyst, this may have grave repercussions on the probability of survival of the patient.

Similar to a number of other chronic complaints, ovarian cysts after menopause are not caused by one factor only. Conventional medicine that only acts on a particular symptom will therefore not be successful in curing ovarian cysts. Several factors need to be treated in the formation of an ovarian cyst. Some of these are directly responsible for the generation of such cysts, whereas others will act to worsen cysts that already exist. A primary cause might perhaps be dealt with by conventional medicine, but the indirect factors will remain and cause complications. A holistic program is the only possibility to fully relieve yourself from ovarian cysts after menopause. The treatment needs to be multi-dimensional because of the multiple factors involved in ovarian cysts. This is the only way of getting to the underlying problems and eliminating cysts forever.