The natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination in postmenopausal women

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Abstract
Objective: To determine the natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination and judged to be benign in postmenopausal women.Methods: One hundred and thirty‐four postmenopausal women referred for ultrasound examination and found to have an adnexal cyst judged to be benign and not causing any symptoms were followed with transvaginal ultrasound at 3, 6 and 12 months, and then every 12 months. The referring physician treated the patient at his/her own discretion.Results: One hundred and sixty cysts were found, 121 (76%) being unilocular and 39 more complicated. Seventy‐two cysts (45%) had a largest diameter of 3–19 mm and 88 (55%) had a largest diameter of 20–80 mm. Median follow‐up time was 3 (range, 0.3–8) years. In twelve women (9%) the cysts were removed during follow‐up, all their cysts (n = 14) being benign. The indication to operate was a change in cyst morphology or increased cyst size in five (4%) women. In 39 (29%) women, the cysts disappeared; in 18 (13%), new cysts developed; and, in 65 (49%), the number of cysts and their location remained unchanged. Regression of cysts was observed in 54% (33/61) of women < 60 years vs. in 8% (6/73) of those ≥ 60 years (P = 0.0001). Ultrasound findings remained unchanged in 34% (21/61) of women < 60 years vs. in 77% (56/73) of those ≥ 60 years (P = 0.0001).Conclusions: The results support conservative management of adnexal cysts incidentally detected at transvaginal ultrasound examination and judged to be benign in postmenopausal women. Whether such cysts need to be followed‐up at all and, if they do, how often and for how long, remains an open question.