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Ovarian cysts are more common before menopause than after. But as long as you have ovaries, you can develop an ovarian cyst.

In this article, we’ll look at ovarian cysts that develop after menopause, what the symptoms are, and how they’re treated.

Ovarian cysts are fluid-filled sacs that form in or on the ovaries.

Most are harmless. Also, they’re more likely to develop before menopause when the ovaries are more active. For example, the two most common types are follicular cysts and corpus luteum cysts, both of which are associated with the menstrual cycle.

After menopause, the ovaries no longer release eggs. They also stop making estrogen and progesterone, though they’re not completely inactive. And they can still develop cysts such as:

  • dermoids, which develop from cells you’ve had since birth
  • cystadenomas, which grow on the surface of the ovary

Although cancerous ovarian cysts are rare, they’re more common in older women.

Research from 2014 found that worldwide, 7 percent of women develop an ovarian cyst in their lifetime. In the United States, post-menopausal women have an ovarian cyst incidence of 18 percent over a 15-year period.

It is estimated that by age 65, 4 percent of women will be admitted to a hospital for ovarian cysts.

Symptoms may start out rather mild and vague. As the cyst grows, symptoms may include:

  • dull ache in the lower back or thighs
  • pressure, bloating, swelling
  • pain in the lower abdomen
  • pain during intercourse
  • bladder or bowel problems
  • spotting or bleeding
  • weight gain

Before menopause, other symptoms may include:

  • spotting or bleeding between periods
  • pain during your period
  • breast tenderness

Ruptured cysts or ovarian torsion

Cysts can rupture or cause twisting of the ovary (ovarian torsion). When that happens, symptoms can include:

  • sudden, acute pain
  • heavy bleeding
  • nausea, vomiting
  • dizziness, fainting
  • fever
  • rapid breathing

Seek immediate medical care

A ruptured cyst can cause internal bleeding. If you have sudden severe pain, vomiting, or fever, seek immediate medical care.

Healthline

Some causes and risk factors for ovarian cysts are:

Women with post-menopausal ovarian cysts may be at higher risk of ovarian cancer.

Your doctor will probably start with a pelvic examination to feel for cysts and other abnormalities.

Other conditions with similar symptoms should be ruled out. Some of these are:

Discuss your health history, particularly factors that may increase your risk of ovarian cancer, such as:

  • close family members (mother, sister, aunt, grandmother) have had ovarian cancer
  • a personal history of cancer of the breast, uterus, colon, or endometrium
  • testing positive for BRCA1 or BRCA2 gene mutations or one associated with Lynch syndrome

Pregnancy and hormone testing are usually ordered for those who haven’t reached menopause.

Imaging tests

If your symptoms and physical exam point toward an ovarian cyst, the next step may be an imaging test. Ultrasound can help reveal the size, shape, and exact location of a mass. It can also show whether the cyst appears to be filled with fluid (simple cyst) or solid (complex cyst).

There are two types of ultrasound used to examine the ovaries and reproductive system:

  • abdominal: In this procedure, the doctor runs the wand over the lower abdomen to view the pelvic area.
  • transvaginal: An ultrasound probe is inserted into the vagina to view the ovaries.

Other testing methods

A solid or partially solid cyst may require further testing, especially if you are at high risk of ovarian cancer.

It’s important to find out whether a cyst is benign or potentially cancerous (malignant). One way to determine this is with a blood test that measures a protein called cancer-antigen 125 (CA-125).

Before menopause, there are other conditions that can cause high CA-125 in the blood. After menopause, a higher-than-normal level could be a sign of ovarian cancer.

Cysts don’t always need treatment, though monitoring for changes is important.

Benign

If the cyst looks benign and your CA-125 level is normal, your doctor may take a waiting approach. That would include:

  • regular physical exams
  • imaging tests
  • follow-up CA-125 testing to detect any changes

In the meantime, pain medication may help.

A benign cyst may need to be surgically removed (cystectomy) if:

  • it grows too large
  • it’s too painful or continues to cause other unpleasant symptoms
  • it looks like it may burst or cause twisting of the ovary
  • it does not resolve after repeated follow-ups
  • you’re at high risk of ovarian cancer

In many cases, this surgery can be performed laparoscopically. This involves very small incisions and may be a good choice when the cyst is small and doesn’t appear cancerous.

Malignant

Although most ovarian cysts are benign, the risk of ovarian cancer is higher after menopause. So, if your CA-125 test is high, your doctor may recommend surgery. Once the cyst removed, it can be tested for cancer.

If you have ovarian cancer, your doctor may refer you to a gynecologic oncologist. Ovarian cancer treatment may include:

  • removal of both ovaries (oophorectomy)
  • removal of ovaries, fallopian tubes, and uterus (total hysterectomy)
  • chemotherapy
  • radiation
  • targeted therapies
  • supportive care

An ovarian cyst is a fluid-filled sac in or on an ovary. Cysts can form at any time throughout a woman’s life. Although many are associated with the menstrual cycle, cysts can also develop after menopause.

Ovarian cysts may be asymptomatic, benign, and go away on their own. But they can cause pain and other symptoms if they grow too large. Ovarian cysts that cause pain or other symptoms can be surgically removed.

The risk of ovarian cancer is greater after menopause. Discuss your symptoms with a doctor and don’t delay diagnosis.