The incidence of epithelial ovarian cancer reaches a peak between the ages of 50 and 59 years. Therefore any ovarian enlargement in the postmenopause has been treated up to now with prompt surgical exploration. Recently the reliability of ultrasound has allowed a conservative management of small unilocular ovarian cysts even in the postmenopause. The Authors report here their experience on benign masses in postmenopausal women, and discuss the feasibility of ultrasound-guided aspiration of small, anechoic adnexal cysts.