Post-menopausal ovarian cysts

Who to refer:

Women with ovarian pathology identified on USS (see flowchart). The ultrasound report will state if urgent or rouitne referral is required.

Women who have cysts which may be causing symptoms, or who have a personal or family history of breast, ovarian or bowel cancer should also be referred to gynaecology.

Who not to refer:

This guideline relates to women in whom ovarian pathology has been identified on USS.  It does not relate to women presenting with acute symptoms in which a diagnosis of an ovarian cyst accident is suspected.  In such cases, patients should be discussed with the on-call gynaecology doctor via switchboard.

How to refer:

Va SCI Gateway.

Please include menopausal status and BMI in referral letter.

The use of sequential or continuous HRT is not thought to affect Ca125, which when indicated, can be checked at any time.

Women are considered to be postmenopausal if it is more than 12 months since their last menstrual period.

For women who are on hormonal medication, or are amenorrheaic due to a hysterectomy or endomtrial ablation, age 50 or over should be taken as postmenopausal.

• RCOG Green-top Guideline No. 34 Ovarian Cysts in Postmenopausal Women https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg34/
• Simple Adnexal Cysts: SRU Consensus Conference Update on Follow up and Reporting. Radiology 2019; 293:359-371.
• Risk of Malignant Ovarian Cancer based upon ultrasonography findings in a large, unselected population. JAMA Internal Medicine 2019; 179:71-78. Smith-Bindman et al.
• Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study. Lancet Oncol 2019 20:448-458. Froyman et al.
• Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2021; 397:2182-2193 Menon et al.