Adnexal Masses in Postmenopausal Women

Types of Adnexal Masses

The American College of Radiology reports that simple cysts are common in postmenopausal women, with a frequency of 17-24% 1, 2
The American College of Radiology states that these cysts are typically benign, with US identification of a simple cyst establishing a benign process in 100% of postmenopausal women 3
The natural history of simple adnexal cysts shows that 53% disappear completely, 28% remain constant in size, and only a small percentage show changes in size over time 2
The American College of Radiology notes that simple cysts are not related to hormonal therapy or time since onset of menopause 1
Pedunculated leiomyomas (fibroids) are the most common solid adnexal masses in postmenopausal women, present in approximately 20-30% of postmenopausal women 1, 2, 3

The American College of Radiology recommends transvaginal ultrasound as the essential initial imaging modality for evaluating adnexal masses 3
Ultrasound can triage the majority of adnexal masses into benign or malignant categories, according to the American College of Radiology 1
For indeterminate masses, MRI with intravenous contrast becomes the modality of choice, as stated by the American College of Radiology 3
The American College of Radiology suggests that color or power Doppler should be included in the ultrasound examination to help differentiate between benign and malignant masses 4, 5

For postmenopausal women, simple cysts <3 cm require no follow-up due to extremely low risk of malignancy, with a risk of malignancy in benign-appearing lesions on ultrasound of only 0.3% to 0.4% 6
The risk of acute complications such as torsion or cyst rupture is similarly low at 0.2% to 0.4%, according to Praxis Medical Insights 6

Mistaking pedunculated fibroids for ovarian masses can be avoided by always looking for normal ovaries and identifying the blood supply from uterine vessels, as recommended by the American College of Radiology 2
Failing to use color Doppler in the evaluation can lead to incorrect diagnosis, as it is essential for differentiating true solid components from solid-appearing debris within a cyst, according to the American College of Radiology 5
Relying solely on CA-125 can be misleading, as this marker performs worse than ultrasound in distinguishing benign from malignant lesions and may be low with borderline and low-grade malignant tumors, as noted by the American College of Radiology 5