SummaryEndovaginal ultrasound has been used more and more frequently for the diagnosis of gynecological tumors because it is easy and quick in connection with routine gynecological examinations. This has led to the detection of more unilocular, simple ovarian cysts in postmenopausal women than earlier known and to major surgery of these women. This report discusses the available evidence of the likelihood of a unilocular ovarian cyst not being malignant when found in a postmenopausal woman. We conclude that endovaginal ultrasound-guided puncture of unilocular ovarian cysts should be considered a good therapeutic alternative also in postmenopausal women.