Clinical recommendations	Evidence rating	References
The U.S. Preventive Service Task Force recommends against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination.	A	17
Serum CA 125 levels should not be routinely used during the diagnostic workup of an adnexal mass in a premenopausal patient.	B	20
Serum CA 125 levels should be drawn in postmenopausal patients with adnexal masses to guide treatment options.	B	21
Gray-scale transvaginal ultrasonography is the preferred imaging modality for the evaluation of adnexal masses.	B	20
Adnexal masses coincidental with intrauterine pregnancy have a low risk of becoming symptomatic during pregnancy, and they are most often benign; therefore, they may be observed until the postpartum period.	C	20, 30
Asymptomatic simple cysts 10 cm or less in diameter with a CA 125 level less than 35 U per mL (if drawn) may be managed with close follow-up, regardless of patient's age (if past menarche).	B	20
Oral contraceptives are not effective in the management of ovarian cysts in premenopausal women.	A	32