A practical approach to managing post-menopausal women with ovarian cysts

Ovarian cysts are common among post-menopausal women. Although ovarian cancer is a significant cause of mortality in menopausal women, large population-based studies demonstrate that the majority of adnexal masses are benign. In most cases, a pelvic mass or ovarian cyst is an incidental finding, generally corresponding to a benign cyst and easily diagnosed by conventional ultrasound. However, an ovarian tumour may be malignant and should be treated as early as possible. Several diagnostic modalities exist including ultrasound, blood tumour markers, advanced imaging modalities such as magnetic resonance imaging, and computerized tomography to diagnose and characterize the ovarian masses. Complex ovarian masses with malignant characteristics are then discussed in gynaecology oncology multidisciplinary team meetings to decide on treatment modality and hospital - whether a cancer unit or centre would provide the agreed treatment. Adnexal masses with benign morphological and functional properties may be periodically monitored as an alternative to surgery since malignant transformation is rare.