Ovarian Cysts in Post-Menopausal Women: What to Look For and What to Ask
National Institutes of Health.
Ovarian cysts in post-menopausal women are now known to be very common and most are not cancerous. However, because the greatest risk factor for ovarian cancer is age, any cysts in a postmenopausal woman should be taken seriously. Before ultrasound was readily available for physicians to use as a tool to evaluate the ovaries, any ovary which a physician was able to palpate (feel) on a physical examination in a post menopausal woman was recommended to be removed. After the advent of the use of ultrasound in pelvic imagining, any cysts noted in post-menopausal women were generally removed. Now, after years of widespread use and experience in ultrasound imaging, the criteria for how to manage an ovarian cyst has radically changed, and generally cysts that do not demonstrate well-defined malignant characteristics and do not grow may simply be observed for change.
In one study of 7,700 healthy women, 450 were found to have ovarian cysts, and many of these resolved with time. Ovarian cysts may be detected on physical examination by your healthcare provider, because your physician has performed or ordered a pelvic ultrasound, or they may be found when imaging studies such as a CT scan, MRI, or ultrasound have been performed for another reason. Cysts may be associated with pelvic pressure or pain. When they twist, they may be associated with severe pain.
In general, all post-menopausal women with ovarian cysts should be evaluated by a physician and an expert in pelvic sonography. A CA125 blood test should also be performed. Simple cysts (those which only contain liquid) are generally benign and may be followed through serial ultrasounds for a period of time. Cysts should be considered for removal if they are associated with pain or an elevated CA125. Complex cysts (those which have potentially malignant characteristics) should thoroughly be evaluated by an expert sonographer in pelvic imaging, and careful consideration about their removal should be made.
Removal of an ovarian cyst can many times be performed with minimally invasive surgery, such as laparoscopy (referred to as belly button or keyhole surgery). However, occasionally an open procedure (referred to as a laparotomy) will be required. It is important that the gynecologist, if not a gynecologic oncologist, have a gynecologic oncologist on standby if the cyst has potential malignant characteristics or if the CA125 is elevated. Your gynecologist may also pre-operatively order a new blood test called OVA1 to help determine if the cyst is malignant.
Important questions to consider when surgery is recommended are: Do I remove just the cyst, or the entire ovary? Do I remove both ovaries? These points should be thoroughly reviewed pre-operatively with your physician. If you have an elevated risk of ovarian or breast cancer, then careful consideration about removal of both ovaries should be made. If you are not at elevated risk for ovarian cancer, then you should discuss with your healthcare provider the fact that the ovaries, even after menopause, help protect women against cardiac disease, which remains the leading cause of death in women.
The take-home message:
- Benign cysts are common in post-menopausal women.
- If a woman has a small, simple ovarian cyst with a normal CA125 and no symptoms, she may be followed closely by a physician with serial ultrasound imaging, CA125 testing, and physical examinations.
- Cysts which are growing significantly, have potentially malignant characteristics, are associated with an elevated CA125, or associated with symptoms should be removed.
- Careful consideration should be given to surgical approach with minimally invasive surgery, and to whether the cyst, one, or both ovaries should be removed. A gynecologic oncologist should be on standby or perform the operation if there is a significant chance that the cyst could be malignant.
Current models suggest that there is a potential 5-year pre-clinical phase (a time where a cancer is developing and is not detectable or associated with symptoms) to ovarian cancer. So no cyst or ovarian abnormality should be ignored and forgotten about. All need some form of follow-up.
I am a 52 year old woman who has been in post menopause for 5 years. My gynecologist at the time couldn’t understand why I wasn’t having my monthly menstrual cycle anymore and did not think it was due to menopause since I was only in my mid 40s at the time. She ran a test to see if I was in menopause and it came back positive. I have had ongoing pain in the area of my left ovary for several years now. At one time the pain was so severe, I had to go to the emergency room. Morphine did not even help. When I told the emergency room doctor I was post menopause he totally dismissed any issue of a ruptured cyst on my ovary, telling me it was not possible. I know now it was a ruptured cyst because there was so much bleeding once the pain had subsided. However, I had already been released from the emergency room with a diagnosis of constipation. Again, a few days ago,I had quite a bit a pain down in the area of my left ovary,and I had vaginal bleeding once the pain subsided. The pain was not as excruciating this time,but it was fairly uncomfortable. I have had several doctors tell me that
post menopausal cysts on ovaries are not common at all. My comment is this, why are so many Gynecologist and GPs in the dark when it comes to post menopausal ovarian cysts. The last Gynecologist I saw was more interested in marketing hormone replacement junk, and pills that are supposed to to make you feel more younger. I love being in my 50s. So what if my hormones don’t make me want to have sex every hour of the day right now. Why does society constantly want to make women feel like they are not good enough if they are not having tons of sex.
Hope this information helps another woman if your Gynecologist looks at you if you present with the same symptoms i had.
Great info. I’ve had similar experiences over the years. Cysts, pre menopausal, now post menopausal and having pain right now, the reason I’m reading your comment, Dr. Appt soon we shall see…
What are the symptoms of an ovarian cyst? I am a 67-year-old woman and would like to know. I have an appointment with a gynecologist because I am experiencing low back pain and some subtle abdominal discomfort. I did have a urinary track infection at the beginning of September. Want to know if there’s a connection with that. Have had no problem with constipation my body is functioning normal and there is no blood.
Just want to know if there’s any women out there who experience the symptoms I’m having before they were diagnosed with an ovarian cyst. My last period was when I was 57
Thank you for writing this article. It seems like this is something I am currently experiencing. The pain is incredible and has been there since I fell and broke my ankle in June this year. I thought it was from the fall but its just getting more and more painful. I’m making an appointment tomorrow to see what the heck is going on.
I found out I had uterine and ovarian cysts this week at my, of all places, rheumatology appointment! She ordered an x-ray because of my knee pain complaint, showed me the results, and in addition to the new diagnosis of hip osteoarthritis, in addition to the rheumatoid, showed me the cysts. Last year I had a Gyn biopsy because of spotting (I’m 70), the results were benign, so I didn’t think much of it. Now my rheumatologist wants me to see the oncologist Gyn again, and I will.
My question to a male doctor the next time they recommend removal of both ovaries when there is a cyst on one will be “If you had a cyst on one of your testicles, would you remove both?” Unfortunately, doctors do not inform women of the heart health benefits the ovaries provide in menopause. These organs are in the body for a reason!!!
This article and comments really helped me. I am a 53 year old female, post menopausal, and my left ovary has always been some type of problem. Last year, due to elevated HCG levels, a doctor tried to tell me I was pregnant! I had no idea these levels could elevate due to a possible tumor; obviously neither did she because I was not tested. Now my GYN has found a lump, one I can feel myself inside. The Ultrasounds were inconclusive, so they are scheduling an MRI ASAP. Thank you for the very valid information about ovaries and heart disease. I was not informed of this either!
Exactly the type of information I am searching for! At 57, I have just been diagnosed with a 16x12x15 cm. fibroid. An ovarian cyst was mentioned in passing.
My initial reaction was to wait and watch.
After reading this article, I will certainly be seeking further details on both findings. I have not have a regular menstrual period for a number of years and have assumed I was postmenopausal. I have found little information on these conditions in postmenopausal women. My health care provider, a NP, did not mention that these conditions could be anything that might require urgent treatment. In fact, she reassured me that the lack of an endometrial stripe on the MRI was evidence of benign conditions.
Thank you all for this very helpful information. I had no idea our ovaries were still useful post menopause. In fact, my neighbour just had both of hers removed because of cysts and, as her doctor put it “they aren’t useful anymore anyways”.
I am researching ovarian cysts because I just had my annual physical and because of a uterine fibroid we are watching I had a trans vaginal ultrasound. When my doctors asst. called with results she said ” you’ll be glad to know your fibroid and ovarian cysts are smaller than last time”. Great news, except I didn’t even know I had ovarian cysts. I will be taking a lot of the above information with me to my follow up appt.
It is a difficult decison for sure. At 63, I have a 10 cm growth in one ovary but my mother had uterine cancer, my aunt (my mom’s sister) died of Breast Cancer and my first cousin died of ovarian cancer. Because of my history, I am opting for a complete hysterectomy. I think this is the right thing for me after a long discussion with my doctor. It is so important to be as ibformed as possible.
Jannan,
Good for you! So glad you stood up for yourself and taught the doctors something. Being treated the way you were is absolutely unacceptable and shows such arrogance and ignorance on the part of those docs. I see it more and more. And the ovaries do still produce Estrogen, albeit in small amounts even after menopause. I didn’t know about the Androgens until reading your post. Thank you, because I am post menopausal as well, and have painful cysts on both ovaries. So, unless, as you said, it truly is risky to leave them, they’re staying put.
Google: ‘do i need my ovaries after the memopause?’
Just to say I had my operation with just one ovary, cyst and bit of follopeon tube taken away and recovering nicely. I was also advised that all was clear; what better news for Christmas! So if I had given in to pressure from doctors, then the rest would have been taken away unnessarily.
If you are unsure and want to know more about keeping your ‘bits’ {if possible}after the menopause, then just type ‘do your need your ovaries after the Menopause’ and you can take a balanced view of the situation.
Age 67,I have been diagnosed with ovarian cyst. I came under tremendous pressure from three gynocologists to have a full hysterectomy and removal of both ovaries. I was told this is Standard Management Precedures with post menapausal woman.
Several times I said I do not want a full hysterectomy and the other ovary removed if there is no need. Each time I was told at my age I do not need these parts anymore.
Thank goodness, I read both this article and others, including the NHS own site, which said if there was no history of ovarian or breast cancer in the family, then it would be advisable to keep at least one ovary, and discuss it with your gynocologist. Plus my blood test CA 125 was clear. (All three did not want to discuss it, and passed on to the next Surgeon that full hysterectomy and removal of both ovaries recommended.
After questioning the surgeon again, at my last appointment before the operation, I asked him about heart disease, then adrogens that are still produced by the ovary in post menapausal women. These are important for protecting your heart and lungs.
A 24 year study called the Parker review,proved that more than 30% of women having both ovaries out stood a higher degree of heart disease than of having ovarian cancer.
Eventually my consultant agreed to take just one ovary.
I do understand that if it is absolutley necessary to take both ovaries, etc. due to cancerous cells this is different. But just because of your age, to take everything as STANDARD MANAGEMENT PROCEDURE, as put to me in a letter, is just not right. To carry out preventative surgery, just because you are post menapausal surely cannot be acceptable.
I agree with you point but if another had to be removed. Would you want to do it again? If a person had a history of cancer take them out!
Thank you for a concise and enlightening post. I didn’t know that post-menopause the ovaries protect against cardiac disease.
I was just informed by my gyn of a cyst 3.1 by 2.0 on my left ovary. Ultrasound revealed it was benign but I also had it checked out by a gyn oncologist my gyn recommended. He agreed it was benign and he he did not recommend removal. Checking it out every 6 months is the plan. He stated they are common in post menopausal woman. I’m 66 years old.