The authors created a nomogram for healthy menopausal ovarian changes. They documented the menopausal ovary decreases in volume from 8.6 cm3 in the first postmenopausal year to 2.2 cm3 after 15 menopausal years. They compared ovarian volume of 85 postmenopausal women diagnosed with ovarian neoplasia with the normal ovarian volume described above. Among the women studied, 70% had adnexal pathology diagnosed at routine sonographic screening prior to starting hormone replacement therapy, whereas 11% were diagnosed following complaints of abdominal pain, and 19% were diagnosed following a difficult bimanual pelvic examination that resulted in the use of ultrasound. The neoplastic ovaries ranged in volume from 98.15 cm3 in the perimenopausal women to 161.81 cm3 in women who were 15 years postmenopausal. The authors found that 86% of ovaries of women with benign ovarian neoplasias were larger than the norm, whereas 100% of ovaries of 21 women with malignant or low malignant potential ovarian tumors were larger than the norm. The authors confirmed that the larger the ovarian neoplasia, the more likely the process to be malignant. They stressed that ovarian volume measurements have less variation than other structural ovarian findings. They propose that ovarian volume be used as a screening criterion for ovarian malignancy.