Oral contraceptives for functional ovarian cysts
Abstract
Background
Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early oral contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s.
Objectives
This review examined all randomized controlled trials that studied oral contraceptives as therapy for functional ovarian cysts.
Search methods
We searched the computer databases of CENTRAL, PubMed, POPLINE, and EMBASE for randomized controlled trials. We also examined the reference lists of articles and wrote to authors of all studies identified to seek articles we had missed.
Selection criteria
We included randomized controlled trials in any language that included oral contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of studies.
Data collection and analysis
Two authors independently abstracted data from the articles and entered them into RevMan 4.2. We used Peto odds ratios with 95% confidence intervals for dichotomous outcomes.
Main results
We identified four randomized controlled trials from three countries; the studies included a total of 227 women. Treatment with combined oral contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para‐ovarian cyst) and not physiological.
Authors' conclusions
Although widely used for treating functional ovarian cysts, combined oral contraceptives appear to be of no benefit. Watchful waiting over several cycles is appropriate. Should cysts persist, surgical management is often indicated.
PICOs
Plain language summary
Oral contraceptives to treat cysts of the ovary
Women of reproductive age usually release an egg about once a month. The ovary gets an egg from the inside of the ovary to its surface by creating a blister or fluid‐filled space around the developing egg. When the blister (or cyst) reaches the surface of the ovary, it bursts and releases the egg into the abdominal cavity. After this occurs, the blister can develop into another type of cyst, which makes a hormone (progesterone) that helps the pregnancy to grow. Most of these cysts come and go without problems. Sometimes, however, the cysts get large or painful; others may remain for months. Several decades ago, clinicians learned that women who were taking oral contraceptives (birth control pills) had fewer cysts, since the pills usually kept an egg from being released. Based on this fact, many clinicians started treating these cysts with oral contraceptives to make them go away faster.
This review searched for all the randomized controlled trials in the world that studied use of birth control pills to treat these benign (also called functional) cysts. We found four trials from three countries; they included 227 women. Two trials included women receiving drugs to help them get pregnant. The other two included women who developed cysts without fertility treatment. In none of these trials did oral contraceptives help the cysts go away faster. Thus, birth control pills should not be used for this purpose. Waiting several months for the cysts to go away on their own is a better approach.
