Ovarian cysts can still occur after menopause even though this is less frequent than before. Women after menopause with an ovarian cyst that does not respond to conservative management may need to undergo an oophorectomy. In this case the ovaries are removed within a clinical bag so that the system cannot rupture inside the cavity of the peritonea. The recommendation for women after menopause is to take a sonography test for CA 125 using a transvaginal grayscale. Doppler scans, computed tomography (CT) and magnetic resonance imaging (MRI) are all less useful for system detection after menopause. The best solution to understand the situation with ovarian cysts is transvaginal ultrasound because of the increased sensitivity and detail with this method. Nonetheless, transabdominal assessment should be used for larger cysts.
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.
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.
It is the high-risk malignancy index that indicates all ovarian cysts in women after menopause that are suspected of being malignant. If there are suspicious clinical findings using laparoscopy then a full laparotomy and other staging procedures are to be used. These must be done by a qualified surgeon within a multidisciplinary team in a cancer center that is certified. The extended midline incision should comprise the cytology in the form of ascites or washings, biopsies from areas and adhesions under suspicion, and laparotomy that is well documented, BSO, TAH and infra-colic omentectomy. In the laparoscopic management of ovarian cysts in women after the menopause the recommendation is often for oophorectomy rather than cystectomy. It is a common mistake to select the ovarian cyst fluid for a cytological assessment in an attempt to ascertain cyst malignancy. The accuracy factor is only 25 percent in this instance and there is also the danger of the cyst breaking. If the cyst is malignant this could then have severe repercussions impacting the chances of survival of the individual. Therefore one may conclude that aspiration has no specific part to play in the management of asymptomatic ovarian cysts after the menopause. Nonetheless, together with laparotomy and laparoscopy it might be part of the preliminary surgical management.
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.