Although ovarian cysts after the menopause are a less frequent occurrence, instances do occur and may cause complications. Women after the menopause are recommended to take a CA125 test with a sonography using transvaginal grayscale. Magnetic resonance imaging (MRI), computed tomography (CT), and Doppler scans are less effective for the detection of cysts after menopause. Transvaginal ultrasound is the best solution to evaluate the situation of ovarian cysts because it makes for more detail and increased sensitivity. Larger cysts however should be assessed transabdominally. Women after the menopause with an ovarian cyst that is not adapted to conservative management may require an oophorectomy. This operation is performed to remove the ovary within a bag so as to prevent the cyst from breaking open in the peritoneal cavity.

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.

For a post-menopausal woman, ovarian cysts spark two questions, the first about the best management and the second on where the treatment should be done. A general gynecologist will be able to handle women with low risk, but for women at an intermediate risk level referral should be made to a cancer unit and if the level of risk is high, they should be accompanied to a cancer center. When used with an index to register the risk of malignancy, the revision of management changes should be done accordingly. A typical test is the check on CA125 that is practiced in over four out of five cases. A cutoff of 30 u/ml is used most often and the test sensitivity is 81 percent with specificity of 75 percent. The use of ultrasound has been registered at 89 percent sensitivity and 73 percent specificity. Doppler sonography with color flow has in addition been found to correctly assess ovarian cysts. Examining the fluid cytologically from an ovarian cyst gives less precise results in order to find out if a tumor is benign or not. The sensitivity is only approximately 25 percent with a greater menace of the cyst rupturing.

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.

A holistic approach is the only way to liberate yourself from a situation of ovarian cysts after the menopause. Ovarian cysts after the menopause like many other chronic health complaints have no unique cause. For this reason, conventional medicine that only targets a specific symptom will not succeed in remedying ovarian cysts. Several factors will in fact provoke the formation of an ovarian cyst. Some of these factors directly trigger the development of ovarian cysts, and others act indirectly to play a secondary role to aggravate existing cysts. Although conventional medicine may be of use in dealing with a primary cause, these indirect factors will linger and provoke further complications. Because multiple factors cause ovarian cysts, the treatment should also be multi-dimensional. This is the only solution for getting to the root of the problem and removing cysts for good.