Did you know that around 7% of women across the globe will have an ovarian cyst at some point in their lives?
Cysts often occur before menopause, and in many cases, these growths develop on the ovaries and disappear on their own. But ovarian cysts can also appear after menopause, too. In fact, research suggests that 5-17% of post-menopausal women will develop an ovarian cyst.
Often, these cysts are small, and they don’t lead to any long term complications. But for some women, they can cause problems, and may even require surgery and further medical treatment. That’s why it’s so important to recognize the signs and symptoms of ovarian cysts so that you can seek the appropriate advice and care.
In my work as an ER doctor, I’ve seen multiple patients who dismissed the early warning signs of an ovarian cyst only to end up in extreme pain; pain that, with the right knowledge, might have been avoided.
So, what causes ovarian cysts after menopause, what are the signs and symptoms, and how are they treated? In this post, I’ll be covering all of this and more.
Ovarian Cysts After Menopause
Ovarian cysts are fluid-filled or solid sacs that develop inside or on the surface of the ovaries. Most of the time, they’re completely harmless. In fact, many women with smaller cysts don’t even realize they have them.
They can be the size of a grain of rice or as large as a watermelon, but the bigger they are, the more problems they are likely to cause.
There are several types of ovarian cysts. The most common are follicular cysts and corpus luteum cysts. These are known as ‘functional cysts’ and are related to the menstrual cycle. Typically, they go away on their own within a few weeks or months.
However, once a woman passes menopause, she is no longer experiencing menstruation, and her ovaries are much less active. So, she is highly unlikely to develop a functional cyst at this stage in life. For this reason, ovarian cysts are mostly seen in premenopausal women. However, it’s still possible to experience cysts on your ovaries after menopause, too.
Several other types of ovarian cysts can develop after menopause, for example, dermoid cysts, endometriomas, cystadenomas, and, in rarer cases, malignant cysts.
Dermoid cysts are usually asymptomatic. They develop from cells that were present during fetal development.
Endometriomas are a consequence of a condition called endometriosis. This occurs when, tissue similar to the lining of the uterus grows in other areas of the pelvic region. While endometriomas don’t always require medical attention, I have treated several patients in the ER who have presented with extreme pain due to these types of cysts.
Cystadenomas are fluid-filled sacs that grow on the surface of the ovary. They are benign by definition; however, in rare cases, they can become cancerous over time.
Malignant cysts are cancerous cysts; however, they are quite rare. The vast majority of ovarian cysts are not malignant. That being said, when they do occur, they are most often found in post-menopausal women.
What are the Symptoms of Ovarian Cysts After Menopause?
The majority of ovarian cysts don’t cause any symptoms at all. However, if they grow past a certain size, you may begin to notice one or more of the following symptoms:
- A feeling of pain or pressure in the lower abdominal region
- Swelling of the abdomen
- Pain during sex
- Pelvic pain
- Pain while walking or exercising
- Vaginal bleeding
- A feeling of fullness in the bladder
Important note: If an ovarian cyst ruptures or twists (called ovarian torsion), it can cause sudden and intense pain. I have treated several post menopausal women with this condition in my work in the ER, and-more often than not, the pain is accompanied by nausea, vomiting, fever, or fainting. If you have any of these symptoms, seek emergency medical help immediately.
What Causes Ovarian Cysts After Menopause?
As we’ve already discovered, most ovarian cysts occur before menopause and are related to hormonal shifts during the menstrual cycle.
But after menopause, ovarian cysts are more likely to be caused by one of the following conditions:
- An infection in the pelvic region
- Polycystic ovarian syndrome (PCOS)
- Ovarian cancer
How is an Ovarian Cyst Diagnosed?
If you suspect that you have an ovarian cyst, the first course of action is to visit your doctor or healthcare provider. Even though most cysts are benign, the risk of ovarian cancer increases after menopause. So, it’s important to be properly assessed by a medical professional, even if your symptoms aren’t causing too much discomfort.
When a patient presents with a potential ovarian cyst, we start by conducting a pelvic exam and an ultrasound to make an accurate diagnosis.
A manual pelvic exam involves feeling the area where the ovaries sit to check for lumps and bumps, which could indicate a cyst.
An ultrasound uses sound waves to produce an image of the inside of the pelvic region. In some cases, you may be asked to drink plenty of water and keep a full bladder for this procedure to help provide a clearer image of the size and location of the cyst.
You may also be asked to give a blood sample to check your hormone levels and detect the presence of certain tumor markers, known as cancer antigens, in the blood.
What Happens After Diagnosis?
In most cases, ovarian cysts after menopause are benign and do not require treatment.
If your doctor is satisfied this is the case, you should continue to monitor your symptoms at home and report any changes. Often, the cyst will disappear on its own over a matter of weeks or months.
However, sometimes, benign cysts need to be removed, even though they show no signs of cancer. I often advise this course of treatment to patients who have a very large or painful cyst, or a cyst that could potentially bust or twist (ovarian torsion).
If you are at a higher risk of developing cancer, your doctor may advise removing the cyst to prevent it from becoming malignant further down the line.
The majority of ovarian cysts, both before and after menopause, are benign. However, once a woman enters the post-menopausal phase of her life, she is at a higher risk of developing ovarian cancer.
So, if blood tests show elevated tumor markers or cancer antigens, surgery may be recommended.
Once the cyst has been surgically removed, sample tissue from the cyst and, in some cases, the lymph nodes and organs surrounding the cyst will be tested in the lab to check for the presence of cancer.
Remember, the risk of an ovarian cyst being cancerous is relatively low, even after menopause. Statistics show that at least 80%  of surgically removed ovarian cysts are benign.
How are Ovarian Cysts Treated After Menopause?
If you’re a post-menopausal woman and suspect you have an ovarian cyst, it’s essential to seek medical advice as soon as possible.
The treatment will depend on the type of cyst, your symptoms, and your medical history.
1. Watch and Wait
If your doctor doesn’t suspect your ovarian cyst is cancerous and it isn’t causing you significant pain or discomfort, you may be advised to watch and wait.
Continue to monitor your symptoms at home. If anything changes, e.g., increased pain or abdominal swelling, contact your doctor as soon as possible.
Surgery can be performed to remove the cyst or, in many cases, the entire ovary. If a woman has gone through menopause, it is likely the entire ovary will be removed to screen for cancer and eliminate the risk of cysts recurring.
3. Regular Checkups
If you have existing ovarian cysts, your doctor may ask you to come in for regular checkups to assess any changes. Routine imaging, such as ultrasounds, may be performed, as well as regular blood tests to monitor tumor markers and cancer antigens.
How can I Eliminate the Pain and Discomfort of Postmenopausal Ovarian Cysts?
While it may not be possible to get rid of ovarian cysts without surgery, several home remedies can help treat discomfort and pain. Options include:
1. Over-the-Counter (OTC) Pain Medication
Examples include ibuprofen, naproxen, or acetaminophen. While these shouldn’t be used long-term, they can alleviate discomfort temporarily.
2. Heat Therapy
Applying heat to the area of pain or discomfort can help open the blood vessels and deliver more oxygen and vital nutrients to the affected area. To utilize heat therapy, place a warm water bottle, electric heat pad, or microwaveable rice bag in the region of your lower abdomen.
3. Transcutaneous electrical nerve stimulation (TENS machine)
A TENS machine, which is designed to emit very mild electrical pulses into the muscles, is sometimes used to alleviate pain. While it is employed by some women during childbirth and is also used to address menstrual cramps and symptoms associated with postmenopausal ovarian cysts, it is not considered highly effective for these purposes.
4. Mindfulness Practices
Deep breathing, meditation, and yoga can all help to reduce pain and inflammation in the body, and these practices can be particularly useful in alleviating discomfort caused by ovarian cysts.
After menopause, the risk of developing ovarian cancer increases, and benign cysts can become cancerous. This is why it’s so important to visit your doctor if you suspect you have a cyst and ensure you have regular checkups to monitor existing ones.
Large cysts, whether benign or cancerous, are also at risk of rupturing or twisting (torsion) which is a medical emergency. This is one of the more common conditions I see in post menopausal women in the ER.
While HRT has been linked to an increased risk of certain cancers, ovarian cancer is not one of them. There is also currently no scientific evidence to suggest that HRT can cause ovarian cysts.
Quite possibly. It’s quite common for ovarian cysts to disappear slowly over a few weeks or months. However, if you have already gone through menopause, it’s important to get your symptoms checked by a medical professional before you decide to take a watch-and-wait approach.
Ovarian cysts are common throughout all stages of a woman’s life, and usually, they are nothing to worry about. In fact, I have personally experienced them myself.
However, in some cases, an untreated ovarian cyst can rupture or twist (torsion), causing extreme pain that requires emergency treatment. Plus, the risk of developing ovarian cancer increases after menopause.
So, if you’re a postmenopausal woman and you suspect you may have an ovarian cyst, speak to your doctor as soon as possible. They can assess your symptoms, make an accurate diagnosis, and recommend the right treatment plan for you.