Ovarian cysts

Pre- and postmenopausal women with cysts demonstrating low suspicion for malignancy may be managed expectantly with monitoring. It is reasonable to perform sonographic follow-up of cysts larger than 5-7 cm in premenopausal women and 3-5 cm in postmenopausal women.

Premenopausal women should be evaluated with transvaginal ultrasound, whereas postmenopausal women should be evaluated with cancer antigen (CA)-125 levels and transvaginal ultrasound. Pelvic exam should be included at each of these visits, with particular attention to the rectovaginal exam findings, but the rising prevalence of obesity often hinders its utility.