Yes, you can still develop ovarian cysts after menopause, although their nature and significance change considerably compared to the reproductive years. An ovarian cyst is a fluid-filled sac that forms either within or on the surface of the ovary. While they are more commonly associated with the menstrual cycle, they can still arise when the ovaries are no longer actively ovulating. Studies suggest that ovarian cysts affect between 5% and 17% of post-menopausal individuals, often being discovered incidentally during routine imaging. While the majority are benign, any mass found in the ovary after the cessation of periods warrants a thorough evaluation because the risk profile shifts.
Why Ovarian Cysts Change After Menopause
The fundamental difference between pre- and post-menopausal ovarian cysts lies in the hormonal environment. Before menopause, most cysts are “functional,” forming directly as a result of the monthly ovulation cycle. These functional cysts, such as follicular and corpus luteum cysts, are tied to hormone production and typically resolve on their own within a few months.
After menopause, the ovaries stop releasing eggs and dramatically decrease the production of estrogen and progesterone. This physiological slowdown means that functional cysts largely cease to form. Therefore, any cyst that develops in the post-menopausal ovary is considered “non-functional,” arising from cellular changes, structural anomalies, or tissue growth rather than the normal reproductive cycle.
Because hormonal activity is minimal, any persistent growth is viewed with more caution. The absence of cycle-related reasons for cyst formation means the evaluation focuses on ruling out abnormal cell growth.
Identifying the Types of Post-Menopausal Cysts
Cysts found after menopause are generally classified as pathological cysts, deriving from different tissues within the ovary.
Simple Cysts
The most common type is a simple cyst, which is a thin-walled, fluid-filled sac with a low risk of malignancy, often identified as a simple serous cystadenoma. Simple cysts are typically benign and, if small and asymptomatic, are often monitored rather than immediately removed.
Complex Cysts
A complex cyst deviates from the simple structure by containing internal walls (septations), solid components, or papillary projections. These features suggest a different growth pattern and increase the need for diagnostic investigation. The statistical likelihood of a malignant or borderline tumor is higher with complex cysts than with simple cysts.
Other Pathological Types
Other types include dermoid cysts, which form from cells present since birth and can contain various tissues like hair or fat. Mucinous cystadenomas are filled with a thick, mucous-like material. While most of these are also benign, characteristics seen on imaging—such as the presence of solid areas or a large size—determine the level of concern and the subsequent management plan.
Detection and Diagnostic Procedures
The investigation for a post-menopausal ovarian cyst typically begins when a person experiences persistent symptoms, such as pelvic discomfort, bloating, pressure, or changes in urinary habits. Cysts can also be found incidentally during unrelated abdominal or pelvic imaging. The primary tool for initial assessment is the transvaginal ultrasound (TVUS), which provides detailed images of the ovaries.
The ultrasound allows the physician to characterize the mass by determining its size, wall thickness, and internal structure—specifically whether it is simple (only fluid) or complex (containing solid areas or septations). Ultrasound findings are often combined with a blood test that measures the level of Cancer Antigen 125 (CA-125). A normal CA-125 level is generally considered to be below 35 units per milliliter.
CA-125 is not a standalone diagnostic test for cancer, as levels can be elevated by various benign conditions. However, in a post-menopausal person with an ovarian mass, a significantly elevated CA-125 level, especially when paired with complex ultrasound findings, raises the clinical suspicion of malignancy. These two pieces of information are frequently integrated into a scoring system, such as the Risk of Malignancy Index (RMI), to guide decisions regarding specialist referral and further management.
Treatment Approaches Based on Risk
The management of a post-menopausal ovarian cyst is determined by assessing its risk profile, combining ultrasound findings and the CA-125 level.
Watchful Waiting
For small, simple cysts, typically less than 5 centimeters in diameter and accompanied by a normal CA-125 level, the standard approach is “watchful waiting.” This involves conservative surveillance with repeat transvaginal ultrasound and CA-125 testing every few months. This strategy is appropriate because many simple cysts will either remain stable or resolve spontaneously, with a very low risk of malignancy. If the cyst remains stable after a year of surveillance, the person may be discharged from routine follow-up.
Surgical Intervention
Surgical intervention becomes necessary if the cyst is large, causes persistent symptoms, or if imaging and blood tests suggest a higher risk of malignancy. Indications for surgery include complex morphology, growth over time, or a raised CA-125 level. Surgery may be performed using minimally invasive laparoscopy or traditional laparotomy. Surgery allows for the definitive removal of the mass and subsequent pathological analysis to confirm whether the growth is benign or malignant.