Simple ovarian cysts in most postmenopausal women are unlikely to change much during follow-up, suggests a recent study published in the journal Menopause.¹

A team of researchers affiliated with Sichuan University in China conducted a systematic review and meta-analysis to study if simple ovarian cysts in postmenopausal women were premalignant in nature. Twelve studies involving 1672 participants and 1513 ovarian cysts were included in the meta-analysis after a comprehensive search of PubMed, MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and ISRCTN databases up to January 2022. The study included postmenopausal women with simple ovarian cysts and women who did not have ascites and/or other signs of carcinomatosis. Those with complex cysts and/or a high suspicion of malignancy were excluded from the trial.

Postmenopausal women in the conservatively managed group were followed up to 29 to 64 months (average) after the diagnosis. It was observed that 34.17% of the simple ovarian cysts disappeared, 5.5% shrank in size, 1.59% increased in size at follow-up and 1.18% advanced to complex cysts, while 38.9% of the cysts remained unchanged. Around 19.04% of them were managed surgically; 44% of the surgeries were undertaken because the patients desired the procedure, while 27% surgeries were on account of cyst increasing in size or progressing from simple to complex cyst. The malignancy conversion rate was found to be “very low” with only one in 10,000 cysts becoming cancerous.

Based on these findings, the researchers concluded that simple ovarian cysts in postmenopausal women had a high probability of disappearing during follow-up or remaining as such with very low malignant transformation potential. Conservative management may thus be a feasible option in most cases. However, surgery should be put on the table particularly for women at high risk for ovarian cancer such as those with family history of ovarian cancer.

Reference

1. Liu YN, et al. Natural history and malignant potential of simple ovarian cysts in postmenopausal women: a systematic review and meta-analysis. Menopause. 2023 Feb 14. doi: 10.1097/GME.0000000000002163.