Oral contraceptives for functional ovarian cysts

David A Grimes; LaShawn B. Jones; Laureen M Lopez; Kenneth F Schulz

doi:10.1002/14651858.CD006134.pub5

Anticonceptivos orales para los quistes ováricos funcionales

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Referencias

Referencias de los estudios incluidos en esta revisión

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estudios excluidos
otras referencias

Altinkaya SO, Talas BB, Gungor T, Gulerman C. Treatment of clomiphene citrate‐related ovarian cysts in a prospective randomized study. A single center experience. Journal of Obstetrics and Gynaecology Research. 2010/02/13 2009; Vol. 35, issue 5:940‐5.

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Referencias de los estudios excluidos de esta revisión

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estudios incluidos
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Biljan MM, Mahutte NG, Dean N, Hemmings R, Bissonnette F, Tan SL. Pretreatment with an oral contraceptive is effective in reducing the incidence of functional ovarian cyst formation during pituitary suppression by gonadotropin‐releasing hormone analogues. Journal of Assisted Reproduction and Genetics 1998;15:599‐604.

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Ferrero S, Remorgida V, Venturini P L, Leone Roberti Maggiore U. Norethisterone acetate versus norethisterone acetate combined with letrozole for the treatment of ovarian endometriotic cysts: A patient preference study. Fertility and Sterility 2013;100(3):S371‐2.

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Referencias adicionales

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estudios excluidos

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Enlace al artículo

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Altinkaya 2009

Methods	Randomized controlled trial. Report notes women were "randomized into three groups consecutively".
Participants	186 women diagnosed with clomiphene citrate‐related ovarian cyst > 20 mm on third day of menstrual cycle. Diagnosis based on evaluation by transvaginal ultrasonography. No participant had a basal cyst early in cycle prior to clomiphene citrate treatment. No other inclusion or exclusion criteria were mentioned.
Interventions	1) levonorgestrel 100 μg plus EE 20 μg versus 2) desogestrel 150 μg plus EE 30 μg versus 3) placebo Duration: 4 weeks; women with persistent cysts at 4 weeks were called for a second visit 4 weeks later and assessed again at 12 weeks.
Outcomes	Regressed cysts at 4 weeks and 12 weeks; evaluated with transvaginal ultrasonography
Notes	No information on randomization method, blinding, or sample size estimation. Attempted to contact the researcher for more information on methods. Analysis based on all randomized women. Loss to follow up by 12 weeks: 6.5% overall; levonorgestrel group, 2/62; desogestrel group, 4/62; placebo group, 6/62.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	Women were randomized "consecutively. No information on concealment or blinding.

Bayar 2005

Methods	Randomized controlled trial
Participants	141 premenopausal women, < 50 years old, with low serum CA‐125 antigen and ovarian cyst detected by transvaginal ultrasonography in the first 5 days of the menstrual cycle. Simple cysts were defined as unilocular, smooth‐walled, from 3 to 10 cm in diameter, with or without internal echo. No exclusion criteria were reported.
Interventions	Desogestrel 150 μg plus EE 20 μg (daily) versus expectant management; duration 24 months.
Outcomes	Resolution of cyst by 6 months; also mean diameter of cyst at end of study, but laparoscopic intervention was performed if cyst persisted at 6 months
Notes	No information on method of generating randomization, allocation concealment, blinding, or sample size estimation. Attempted to contact author regarding methodology. Losses: none reported; data were apparently included for all 141 women.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	no information

Ben‐Ami 1993

Methods	Randomized controlled trial without blinding
Participants	54 women in Israel found to have ovarian cysts with mean diameter larger than 2.0 cm after ovulation induction. Mean ages of 34 and 33 years in treatment and control groups, respectively. Mean cyst diameters 2.9 and 2.8 cm, respectively
Interventions	Oral contraceptive containing levonorgestrel 125 μg and ethinyl estradiol 50 μg versus expectant management for one cycle, after which ultrasound examination was repeated.
Outcomes	Resolution of cyst, defined as complete disappearance on ultrasound examination.
Notes	Method of randomization and allocation concealment not described. Sample size calculation not provided.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	no information

Kilicdag 2003

Methods	Randomized controlled trial conducted in Turkey.
Participants	62 women referred to university clinic, with ovarian cyst > 20x20 mm on menstrual cycle day 3 via vaginal ultrasound. No other criteria were reported for inclusion or exclusion.
Interventions	Three arms: 1) expectant management; 2) levonorgestrel 100 μg plus ethinyl estradiol 20 μg; 3) desogestrel 150 μg plus ethinyl estradiol 30 μg.
Outcomes	Regression of cyst on vaginal ultrasound during follow‐up examinations at 4, 8, and 12 weeks.
Notes	Abstract only; attempted to contact author regarding full report. No mention of method for randomization or blinding. Two women (levonorgestrel and desogestrel groups) were included in expectant management group due to intolerance of the medication. All 62 women were included in the analysis.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	No information

Sanersak 2006

Methods	Randomized controlled trial; "block randomization"; open label, intent‐to‐treat analysis used. A priori sample size calculation to detect 30% difference in remission between groups (90% OC versus 60% expectant management).
Participants	70 women attending gynecologic clinic and found to have functional ovarian cyst (diameter 2 to 8 cm). Exclusion criteria: premenarche, postmenopause, ovulation induction in past 3 months, current use of OC or other hormonal drug, contraindication to OC use, condition requiring adnexal surgery before study end, history of bilateral oophorectomy, gynecologic malignancy, pelvic inflammatory disease.
Interventions	Oral contraceptive (OC) containing levonorgestrel 150 μg and ethinyl estradiol 30 μg versus expectant management. For OC group, 1 "package" was provided; if no remission at 1 month, the woman continued on same treatment for another month. Cyclical administration was presumed, although the report did not specify.
Outcomes	Remission of cyst by 2 months (ultrasonographic exam unable to detect the cyst or cyst < 2 cm). Cyst was assessed at one‐month follow up and, if no remission at one month, assessed again at two months.
Notes	No mention of block size for randomization or allocation concealment before assignment. Attempted to reach corresponding author regarding methodological issues and data presented in figures. Lost to follow up: 2 in oral contraceptive group and 1 in expectant management.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	no information

Steinkampf 1990

Methods	Randomized controlled trial
Participants	48 women in the U.S. who had an adnexal cyst 1.5 cm in diameter or larger document by vaginal ultrasound examination. All participants were having ovulation induction with clomiphene, human menopausal gonadotropin, or both. Mean ages of 33 and 32 years in treatment and control groups, respectively. Mean cyst diameters 3.0 and 2.9 cm, respectively
Interventions	Oral contraceptive containing norethindrone 1 mg and mestranol 50 μg, taken daily for up to six weeks versus expectant management.
Outcomes	Resolution of cyst on vaginal ultrasound follow‐up examinations at three, six, and nine weeks.
Notes	Method of randomization and allocation concealment not specified. Sample size calculation not provided. One participant excluded from analysis because of noncompliance (treatment group unknown). An additional six women with persistent cysts were deleted from the analysis.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	no information

Taskin 1996

Methods	Randomized controlled trial; table of random numbers used for sequence generation.
Participants	45 women aged 18 to 34 years in Turkey who had newly diagnosed "ovarian cysts" four to six cm in diameter. Exclusion criteria included prior surgery, endometriosis, pregnancy, masses not purely cystic, cysts more than six cm in diameter, and contraindications to oral contraceptives.
Interventions	Oral contraceptive containing levonorgestrel 150 μg plus ethinyl estradiol 30 μg given cyclically for three months versus expectant management.
Outcomes	Resolution of cyst on vaginal ultrasound examination "every four weeks and at the end of the second and third month just after menses." Cyst volumes were also measured, using the prolate ellipsoid formula.
Notes	Allocation concealment not mentioned. Sample size not explained. A parallel trial was done in women without ovarian cysts to study cyst prevention. Those 50 women without cysts were not considered in this review.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	No information

Turan 1994

Methods	Randomized controlled trial, with randomization stratified by cyst diameter and participant age
Participants	80 women of reproductive age in Turkey with unilateral, mobile, unilocular, thin‐walled ovarian cysts without internal echoes and from three to six cm in diameter on ultrasound examination. Exclusion criteria were ovarian dysfunction, drug use that might interfere with hormone metabolism, and known contraindications to oral contraceptives.
Interventions	1) oral contraceptive containing desogestrel 150 μg plus ethinyl estradiol 30 μg versus 2) oral contraceptive containing levonorgestrel 250 μg plus ethinyl estradiol 50 μg versus 3) multiphasic oral contraceptive containing levonorgestrel 50/75/125 μg plus ethinyl estradiol 30/40/30 μg versus 4) expectant management.
Outcomes	Resolution of cyst on vaginal ultrasound examination after 5 and 10 weeks of therapy.
Notes	Method of randomization not specified, and allocation concealment not described. Sample size justification not provided. Blinding as to therapy not described.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	no information

Characteristics of excluded studies [ordered by study ID]

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estudios incluidos

Study	Reason for exclusion
Biljan 1998	Not a randomized controlled trial; observational study of prevention, not treatment.
Egarter 1995	Not a treatment trial of ovarian cysts.
Ferrero 2014	Treatment allocation was based on the preference of the participants.
Graf 1995	Participants allocated to three treatment groups based on birth dates.
Grimes 1994	Not a treatment trial of ovarian cysts.
MacKenna 2000	Participants allocated to two treatments by alternate weeks of enrollment.
Muzii 2000	Prevention, rather than treatment, trial.
Naz 2011	Participants chose OC or expectant management.
Nezhat 1994	Abstract described 95 participants with cysts, 29 of whom had a history of endometriosis. Potential overlap with participants reported in Nezhat 1996. Corresponding author did not reply to query. Authors have had two published papers retracted by another journal (Carlsen 2001; Editors 2001).
Nezhat 1996	Possible overlap of participants reported in Nezhat 1994. Corresponding author did not reply to query. Authors have had two published papers retracted by another journal (Carlsen 2001; Editors 2001).
Peres 1991	No mention of randomization in article.
Teichmann 1995	Not a treatment trial of ovarian cysts.
Young 1992	Not a treatment trial of ovarian cysts.

Data and analyses

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Comparison 1. Norethindrone 1 mg plus mestranol 50 μg daily versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst within nine weeks Show forest plot	1	41	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 1.1 Comparison 1 Norethindrone 1 mg plus mestranol 50 μg daily versus expectant management, Outcome 1 Resolution of cyst within nine weeks.

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Comparison 2. Desogestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by last follow up (10 or 12 weeks) Show forest plot	2	76	Odds Ratio (M‐H, Fixed, 95% CI)	1.52 [0.46, 5.00]
Open in figure viewer Analysis 2.1 Comparison 2 Desogestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by last follow up (10 or 12 weeks).

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Comparison 3. Desogestrel 150 μg plus ethinyl estradiol 20 μg taken daily versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by six months Show forest plot	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	0.62 [0.27, 1.42]
Open in figure viewer Analysis 3.1 Comparison 3 Desogestrel 150 μg plus ethinyl estradiol 20 μg taken daily versus expectant management, Outcome 1 Resolution of cyst by six months.

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Comparison 4. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by 12 weeks Show forest plot	1	42	Odds Ratio (M‐H, Fixed, 95% CI)	1.71 [0.45, 6.51]
Open in figure viewer Analysis 4.1 Comparison 4 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by 12 weeks.

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Comparison 5. Levonorgestrel 125 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst within one menstrual cycle Show forest plot	1	54	Odds Ratio (M‐H, Fixed, 95% CI)	0.72 [0.14, 3.57]
Open in figure viewer Analysis 5.1 Comparison 5 Levonorgestrel 125 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst within one menstrual cycle.

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Comparison 6. Levonorgestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by last follow up (second or third month) Show forest plot	2	112	Odds Ratio (M‐H, Fixed, 95% CI)	1.19 [0.54, 2.60]
Open in figure viewer Analysis 6.1 Comparison 6 Levonorgestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by last follow up (second or third month).
2 Cyst volume after third month Show forest plot	1	45	Mean Difference (IV, Fixed, 95% CI)	3.20 [‐0.87, 7.27]
Open in figure viewer Analysis 6.2 Comparison 6 Levonorgestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management, Outcome 2 Cyst volume after third month.

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Comparison 7. Levonorgestrel 250 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by 10 weeks Show forest plot	1	34	Odds Ratio (M‐H, Fixed, 95% CI)	3.18 [0.12, 83.76]
Open in figure viewer Analysis 7.1 Comparison 7 Levonorgestrel 250 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by 10 weeks.

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Comparison 8. Levonorgestrel 50/75/125 μg plus ethinyl estradiol 30/40/30 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by 10 weeks Show forest plot	1	35	Odds Ratio (M‐H, Fixed, 95% CI)	3.36 [0.13, 88.39]
Open in figure viewer Analysis 8.1 Comparison 8 Levonorgestrel 50/75/125 μg plus ethinyl estradiol 30/40/30 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by 10 weeks.

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Comparison 9. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus desogestrel 150 μg plus ethinyl estradiol 30 μg

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Regression of cyst by 4 weeks Show forest plot	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	1.15 [0.55, 2.38]
Open in figure viewer Analysis 9.1 Comparison 9 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus desogestrel 150 μg plus ethinyl estradiol 30 μg, Outcome 1 Regression of cyst by 4 weeks.
2 Regression of cyst by 12 weeks Show forest plot	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	1.41 [0.55, 3.64]
Open in figure viewer Analysis 9.2 Comparison 9 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus desogestrel 150 μg plus ethinyl estradiol 30 μg, Outcome 2 Regression of cyst by 12 weeks.

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Comparison 10. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Regression of cyst by 4 weeks Show forest plot	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	0.93 [0.44, 1.95]
Open in figure viewer Analysis 10.1 Comparison 10 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo, Outcome 1 Regression of cyst by 4 weeks.
2 Regression of cyst by 12 weeks Show forest plot	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	1.27 [0.49, 3.32]
Open in figure viewer Analysis 10.2 Comparison 10 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo, Outcome 2 Regression of cyst by 12 weeks.

Analysis 1.1

Comparison 1 Norethindrone 1 mg plus mestranol 50 μg daily versus expectant management, Outcome 1 Resolution of cyst within nine weeks.

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Analysis 2.1

Comparison 2 Desogestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by last follow up (10 or 12 weeks).

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Analysis 3.1

Comparison 3 Desogestrel 150 μg plus ethinyl estradiol 20 μg taken daily versus expectant management, Outcome 1 Resolution of cyst by six months.

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Analysis 4.1

Comparison 4 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by 12 weeks.

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Analysis 5.1

Comparison 5 Levonorgestrel 125 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst within one menstrual cycle.

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Analysis 6.1

Comparison 6 Levonorgestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by last follow up (second or third month).

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Analysis 6.2

Comparison 6 Levonorgestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management, Outcome 2 Cyst volume after third month.

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Analysis 7.1

Comparison 7 Levonorgestrel 250 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by 10 weeks.

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Analysis 8.1

Comparison 8 Levonorgestrel 50/75/125 μg plus ethinyl estradiol 30/40/30 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by 10 weeks.

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Analysis 9.1

Comparison 9 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus desogestrel 150 μg plus ethinyl estradiol 30 μg, Outcome 1 Regression of cyst by 4 weeks.

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Analysis 9.2

Comparison 9 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus desogestrel 150 μg plus ethinyl estradiol 30 μg, Outcome 2 Regression of cyst by 12 weeks.

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Analysis 10.1

Comparison 10 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo, Outcome 1 Regression of cyst by 4 weeks.

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Analysis 10.2

Comparison 10 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo, Outcome 2 Regression of cyst by 12 weeks.

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Comparison 1. Norethindrone 1 mg plus mestranol 50 μg daily versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst within nine weeks Show forest plot	1	41	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Norethindrone 1 mg plus mestranol 50 μg daily versus expectant management

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Comparison 2. Desogestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by last follow up (10 or 12 weeks) Show forest plot	2	76	Odds Ratio (M‐H, Fixed, 95% CI)	1.52 [0.46, 5.00]

Comparison 2. Desogestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management

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Comparison 3. Desogestrel 150 μg plus ethinyl estradiol 20 μg taken daily versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by six months Show forest plot	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	0.62 [0.27, 1.42]

Comparison 3. Desogestrel 150 μg plus ethinyl estradiol 20 μg taken daily versus expectant management

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Comparison 4. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by 12 weeks Show forest plot	1	42	Odds Ratio (M‐H, Fixed, 95% CI)	1.71 [0.45, 6.51]

Comparison 4. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg taken cyclically versus expectant management

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Comparison 5. Levonorgestrel 125 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst within one menstrual cycle Show forest plot	1	54	Odds Ratio (M‐H, Fixed, 95% CI)	0.72 [0.14, 3.57]

Comparison 5. Levonorgestrel 125 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management

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Comparison 6. Levonorgestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by last follow up (second or third month) Show forest plot	2	112	Odds Ratio (M‐H, Fixed, 95% CI)	1.19 [0.54, 2.60]

2 Cyst volume after third month Show forest plot	1	45	Mean Difference (IV, Fixed, 95% CI)	3.20 [‐0.87, 7.27]

Comparison 6. Levonorgestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management

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Comparison 7. Levonorgestrel 250 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by 10 weeks Show forest plot	1	34	Odds Ratio (M‐H, Fixed, 95% CI)	3.18 [0.12, 83.76]

Comparison 7. Levonorgestrel 250 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management

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Comparison 8. Levonorgestrel 50/75/125 μg plus ethinyl estradiol 30/40/30 μg taken cyclically versus expectant management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Resolution of cyst by 10 weeks Show forest plot	1	35	Odds Ratio (M‐H, Fixed, 95% CI)	3.36 [0.13, 88.39]

Comparison 8. Levonorgestrel 50/75/125 μg plus ethinyl estradiol 30/40/30 μg taken cyclically versus expectant management

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Comparison 9. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus desogestrel 150 μg plus ethinyl estradiol 30 μg

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Regression of cyst by 4 weeks Show forest plot	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	1.15 [0.55, 2.38]

2 Regression of cyst by 12 weeks Show forest plot	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	1.41 [0.55, 3.64]

Comparison 9. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus desogestrel 150 μg plus ethinyl estradiol 30 μg

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Comparison 10. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Regression of cyst by 4 weeks Show forest plot	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	0.93 [0.44, 1.95]

2 Regression of cyst by 12 weeks Show forest plot	1	124	Odds Ratio (M‐H, Fixed, 95% CI)	1.27 [0.49, 3.32]

Comparison 10. Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo

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Referencias

Referencias de los estudios incluidos en esta revisión

Altinkaya 2009 {published data only}

Bayar 2005 {published data only}

Ben‐Ami 1993 {published data only}

Kilicdag 2003 {published data only (unpublished sought but not used)}

Sanersak 2006 {published data only}

Steinkampf 1990 {published data only}

Taskin 1996 {published data only}

Turan 1994 {published data only}

Referencias de los estudios excluidos de esta revisión

Biljan 1998 {published data only}

Egarter 1995 {published data only}

Ferrero 2014 {published data only}

Graf 1995 {published data only}

Grimes 1994 {published data only}

MacKenna 2000 {published data only}

Muzii 2000 {published data only}

Naz 2011 {published data only}

Nezhat 1994 {published data only}

Nezhat 1996 {published data only}

Peres 1991 {published data only}

Teichmann 1995 {published data only}

Young 1992 {published data only}

Referencias adicionales

Anderson 1990

Booth 1992

Carlsen 2001

Chiaffarino 1998

Christensen 2002

ContracTech 1982

Editors 2001

ESHRE 2001

Higgins 2008

Higgins 2011

Holt 1992

Kozak 2005

Lanes 1992

Muram 1990

Ory 1974

Parazzini 1996

Ramcharan 1981

Schulz 1995

Schulz 2002a

Schulz 2002b

Spanos 1973

Starks 1984

Stein 1990

Vessey 1987

Westhoff 1992

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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