Postmenopausal adnexal cysts: how clinical management has evolved

It has been 25 years since the introduction of the palpable postmenopausal ovary syndrome. As diagnostic imaging techniques have improved, small findings imaged in the adnexa were often handled as if they had been palpated. Clinical management was not made on any scientific basis. New endovaginal probes afford a degree of image magnification that is as if we are doing ultrasonography through a low-power microscope ("sonomicroscopy"). More recent additions of CA 125 measurement, color flow Doppler, and advanced endoscopic surgical techniques have come into the picture. This report attempts to describe an approach to postmenopausal cystic adnexal masses that synthesizes available information and techniques. It is designed to prevent unnecessary surgery and to prevent undue anxiety but not to miss or, at the least, unduly delay the diagnosis of ovarian cancer when it is, in fact, present.