What follow-up is recommended for patients with simple ovarian cysts that are asymptomatic?

For patients with asymptomatic simple ovarian cysts, current UK guidelines recommend a conservative approach with no routine follow-up if the cyst is simple, unilocular, and less than 5 cm in premenopausal women, as these cysts are usually benign and resolve spontaneously. In postmenopausal women, simple cysts less than 5 cm with normal serum CA125 levels generally do not require further follow-up or intervention. If the cyst is larger than 5 cm, or if there are complex features or elevated CA125, further assessment with ultrasound and possible referral to secondary care is advised. Women should be advised to return for review if symptoms develop or become persistent. This approach balances the low risk of malignancy in simple cysts with the need to avoid unnecessary interventions NICE CKS.

Supporting evidence from the literature indicates that asymptomatic simple ovarian cysts, particularly in postmenopausal women, have a very low risk of malignancy and often resolve without treatment, supporting the guideline recommendation for conservative management without routine follow-up unless clinical changes occur Oyelese et al. 2002.