Post
menopausal ovarian cysts are quite
rare, but there have been instances when they did occur
and causing complications. Postmenopausal women are
advised to take a CA125 test along with a
transvaginal grey scale sonography. Computed tomography
(CT), magnetic resonance imaging (MRI) and Doppler scans
are found to be not quite effective in detecting
postmenopausal cysts.
Transvaginal ultrasound is the best bet to assess
ovarian cyst as it allows the greater detailing and
hence increased sensitivity. However, the larger cysts
are better off being assessed transabdominally.
Postmenopausal women with an ovarian cyst that is not
suitable for conservative management is oophorectomy. In
this case the ovary is removed intact within a bag
without letting the cyst to rupture in the peritoneal
cavity.
Almost all
ovarian cysts in a postmenopausal woman carry the
suspicion of malignancy, however, a full laparotomy and
staging procedure is required to ascertain the case for
sure. Ovarian cysts occur in about 17% of postmenopausal
woman; however the optimal management remains unknown.
Most of the cysts tend to spontaneously involutes
causing no major distress. The evidence linking ovarian
cyst and malignancy is pretty low but ovarian cancer is
becomingly alarmingly common in older woman. The survival
rates are bleak if the cancer spreads beyond the ovary.
A recent study conducted on postmenopausal ovarian cysts
from 226 woman conclude that ovarian cysts smaller than
50 mm in diameter tend to be benign and can be safely
managed by constant monitoring of cyst size and CA 125
levels.
Ovarian
cysts in a postmenopausal woman focuses on two
questions, one is the figuring out the best management
and second is where the management should take place.
CA125 measurement is well established test and is used
in more than 80% of the cases. Usually a cut-off of 30
u/ml is used and the test sensitivity is a81% with
specificity of 75%. Ultrasound has been proven to have a
sensitivity of 89% and a specificity of 73%. Color-flow
Doppler sonography is also known to have benefited in
assessing ovarian cysts. The cytological
examination of the fluid from an ovarian cyst is a weak
at determining whether a tumor is malignant or not. The
sensitivity is only around 25%, besides there is a
greater risk of rupturing the cyst. When used along
with an index is used as the risk for malignancy
increases, the management changes should be revised
accordingly. A general gynecologist will be able to
manage women with low risk, women with intermediate risk
should be referred to a cancer unit and those with a
high risk should be taken to a cancer
center.
All ovarian cysts
which are suspected of being malign in a postmenopausal
woman are to be indicated by a high risk malignancy
index. Any suspicious clinical findings at laparoscopy
are to be subjected to full laparotomy and other staging
procedures. These are to be done by a qualified surgeon
who is a part of a multidisciplinary team in a certified
cancer center. The extended midline incision should
include the cytology in the form of ascites or washings,
biopsies from suspicious areas and adhesions, laparotomy
with clearly indicated documentations, TAH, BSO and
infra-colic omentectomy. It is usually
recommend to include oophorectomy that too bilateral
rather than cystecomy in the laparoscopic management of
ovarian cysts in postmenopausal women. Many make the
mistake of choosing the ovarian cyst fluid for the
cytological examination to ascertain whether a cyst is
malign or not.
The accuracy factor is only 25% in this case and
besides there is also the risk of a cyst rupture and in
the event the cyst is malign then it could have deadly
repercussions which may even impact the survival chances
of the individual. Therefore it is safe to say that
Aspiration has no specific role in managing of
asymptomatic ovarian cysts in postmenopausal women.
However, it could be included as the initial surgical
management along with laparotomy and laparoscopy.
The only
way to free yourself from the clutches of
postmenopausal ovarian cysts is through a
holistic approach. Like most other chronic health
conditions, post menopausal ovarian cysts have no single
cause. This is the reason why conventional medications
which target only a specific symptom fail to cure
ovarian cysts. There are actually several factors which
trigger the formation of an ovarian cyst. Apart from
factors which directly trigger the formation of ovarian
cysts there are several other indirect entities which
play a secondary role and aggravates an already
developed cyst. Even though traditional medicines may be
capable of tackling the primary cause, these secondary
factors will still linger on and will most definitely
cause complications. Since the
ovarian cyst is caused by multiple factors, the
treatment should also be multi-pronged. This is the only
way you can hack at the root of the trouble and decimate
the cysts once and for all.
