Post Menopausal Simple Ovarian Cysts

These are for simple cysts or cysts with one thin septation (<3mm).  These are anechoic, with smooth thin walls, posterior acoustic enhancement, no solid component and no internal flow at colour Doppler ultrasound.

Transabdominal and transvaginal scans are recommended.



  • Simple cysts < 3 cm need no follow up
  • One thin septation (<3mm) or small calcification in wall is almost always benign. Treat as simple and follow up according to size of cyst.
  • Cysts >5cm recommend urgent referral to gynae 2WW clinic with CA125
  • Complex ovarian cysts of any size recommend urgent referral to gynae 2WW clinic with CA125. Use colour Doppler to assess solid elements / papillary projections.
  • Symptomatic cysts of any size may need referral to the General Gynae Clinic
  • Always review previous imaging US/CT/MRI if available- if unchanged over one year then no need to follow up.
  • Ask GP to check CA125 and arrange F.U. as above.


  • Levine D et al. Management of Asymptomatic Ovarian and other Adnexal Cysts Imaged at US: Society of Radiologist in Ultrasound Consensus Conference Statement. Radiology 2010;256:943-954
  • Sauders B et al. Risk of malignancy in sonographically confirmed septated cystic ovarian tumors. Gynecologic Oncology 2010;118:278-282
  • Greenlee R et al. Prevalence, incidence, and natural history of simple ovarian cysts among women >55yrs old in a large cancer screen trial. American Journal of Obstetrics and Gynecology. 2010;202:373.e1-9
  • Ovarian Cysts in Postmenopausal women. Royal College of Obstetricians and Gynecologists 2003 Guideline No 34.