Summary
Ovarian cysts are diagnosed with increasing frequency in postmenopausal women as more patients are undergoing imaging in connection with medical care. An ovarian cyst inevitably raises the question of its relevance to the woman’s symptoms and concerns for the possibility of ovarian cancer. The understandable fear of malignancy has driven many patients and their care providers to pursue further testing and surgical investigation.
This guideline aims to clarify when ovarian masses can be managed within a general gynaecological service or when referral to a specialist gynaecological oncology service is appropriate. This should help in determining whether surgical or expectant management is more appropriate, and help to avoid unnecessary surgery or invasive or costly testing in the vast majority of patients in whom simple cysts are benign.
A useful clinical algorithm for the management of postmenopausal women with ovarian cysts can be found on page 6 of this guideline.
The management of confirmed ovarian malignancy is outside the remit of this guideline. Further information can be sought from the National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network.
Update December 2025: This guideline was amended in December 2025 in line with a consensus statement issued on behalf of the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists (RCR), and supported by the British Gynaecological Cancer Society (BGCS), and British Society of Urogenital Radiology (BSUR) regarding follow up of simple ovarian cysts in postmenopausal women:
For postmenopausal women, unilateral, unilocular simple ovarian cysts measuring 3cm or less detected on imaging do not require routine follow up.
The changes were made to the following sections of the guideline:
- Final paragraph, page 4
- Clinical algorithm for the care of postmenopausal women with ovarian cysts, pages 6 and 30 (Appendix II)
- Section 2, page 7
- Section 6.1.1, page 19
- Three references were added (176-178), detailed on page 1.
COVID disclaimer
This guideline developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers (PDF), and prior to the emergence of COVID-19.
Version history
This is the third edition of this guideline; the fourth edition of this guideline is currently in development.
Developer declaration of interests
Dr MK Mehasseb: Dr Mehasseb has received payment for lectures at the University of Leicester for the RCOG Membership examination, and is a member of the Advisory Board for Ethicon Endo-Surgery.
Dr NA Siddiqui: None declared.
Dr F Bryden: None declared.