Functional Ovarian Cysts: Do OCs Hasten Resolution?

Review: the current evidence does not suggest that oral contraceptives hasten resolution of functional ovarian cysts

Grimes DA, Jones LB, Lopez LM, et al. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev 2006;(4):CD006134. [Medline® abstract]

Evidence-Based Medicine 2007;12:76; doi:10.1136/ebm.12.3.76 [Free full-text EBM article pdf] [Medline® abstract]

Commentary
Kathleen Hoeger, MD
University of Rochester,
Rochester, New York, USA

Functional ovarian cysts are one of the most common gynaecological problems diagnosed in reproductive aged women. Grimes et al reviewed RCTs that examined the role of OCs for treatment after a cyst is diagnosed. It is important to be aware that many women have ovarian cysts with few or no symptoms; thus, the studies included in this report represent either symptomatic cysts or cysts identified during routine assessment for fertility treatment. At least 2 RCTs in the review included many women who may not have had symptoms at the time of the ultrasound diagnosis of the cyst, as ultrasonography was done routinely during clomiphene or gonadotropin treatment cycles.

Because functional ovarian cysts often result from dysfunction at the level of the hypothalamic pituitary ovarian (HPO) axis, they occur more frequently in women with irregular menses or in the perimenopausal period.1 Additionally, there is evidence that use of OCs, which suppress the HPO axis, may reduce the development of ovarian cysts,2 making the suppression of the HPO axis a logical choice for treatment of an existing cyst. Despite the benign nature of the majority of functional appearing ovarian cysts, when they are discovered at the time of ultrasonography, patients experience increased anxiety and often request treatment.

The review by Grimes et al revealed that, in most cases, cysts will resolve without treatment and those that persist are often not functional in nature. Although there were too few large RCTs to allow for meta-analysis, the use of OCs neither increased the probability of cyst resolution nor decreased the time to resolution. However, the review did not address the issue of recurrent cyst formation, for which evidence does suggest a role for HPO axis suppression.

In summary, Grimes et al showed that no strong evidence exists for use of OCs in the treatment of ovarian cysts. Reassurance alone is appropriate, with follow up to detect cysts that do not resolve, as persistent cysts are likely to represent pathological conditions.

REFERENCES

1. Parazzini F, Moroni S, Negri E, et al. Risk factors for functional ovarian cysts. Epidemiology 1996;7:547–9. [Medline® abstract]
2. Chiaffarino F, Parazzini F, La Vecchia C, et al. Oral contraceptive use and benign gynecologic conditions. A review. Contraception 1998;57:11–8. [Medline® abstract]