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.
For a woman after menopause, ovarian cysts generate two questions, the first concerning the best management and the second concerning where the treatment should take place. A typical test is the measurement of CA125 that is used in more than four out of five cases. A cutoff of 30 u/ml is used typically and the test sensitivity is 81 percent with specificity of 75 percent. The use of ultrasound has been shown to have 89 percent sensitivity and 73 percent specificity. Doppler sonography with color flow has also been demonstrated to usefully assess ovarian cysts. Examining the fluid cytologically from an ovarian cyst is less effective in deciding if a tumor is benign or malignant. The sensitivity is only about 25 percent with a greater danger of breaking open a cyst. When used with an index to measure the risk of malignancy, management changes should be revised accordingly. A general gynecologist will be able to manage women with low risk, but women at an intermediate risk level should be referred to a cancer unit and those with a high risk level should be accompanied to a cancer center.
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.
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.