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Meta-Analysis
. 2014 Apr 29;2014(4):CD006134.
doi: 10.1002/14651858.CD006134.pub5.

Oral contraceptives for functional ovarian cysts

David A Grimes  1 , LaShawn B Jones, Laureen M Lopez, Kenneth F Schulz
Affiliations
Meta-Analysis

Oral contraceptives for functional ovarian cysts

David A Grimes et al. Cochrane Database Syst Rev. .

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: In March 2014, we searched the databases of CENTRAL, PubMed, EMBASE, and POPLINE, as well as clinical trials databases (ClinicalTrials.gov and ICTRP). We also examined the reference lists of articles. For the initial review, we wrote to authors of identified trials 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 trials.

Data collection and analysis: Two authors independently abstracted data from the articles. One entered the data into RevMan and a second verified accuracy of data entry. For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio with 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference with 95% CI.

Main results: We identified eight randomized controlled trials from four countries; the studies included a total of 686 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 for two or three cycles is appropriate. Should cysts persist, surgical management is often indicated.

PubMed Disclaimer

Conflict of interest statement

D Grimes has consulted with the pharmaceutical companies Bayer Healthcare Pharmaceuticals and Merck & Co, Inc.

Figures

1.1
1.1. Analysis
Comparison 1 Norethindrone 1 mg plus mestranol 50 μg daily versus expectant management, Outcome 1 Resolution of cyst within nine weeks.
2.1
2.1. Analysis
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).
3.1
3.1. Analysis
Comparison 3 Desogestrel 150 μg plus ethinyl estradiol 20 μg taken daily versus expectant management, Outcome 1 Resolution of cyst by six months.
4.1
4.1. Analysis
Comparison 4 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by 12 weeks.
5.1
5.1. Analysis
Comparison 5 Levonorgestrel 125 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst within one menstrual cycle.
6.1
6.1. Analysis
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).
6.2
6.2. Analysis
Comparison 6 Levonorgestrel 150 μg plus ethinyl estradiol 30 μg taken cyclically versus expectant management, Outcome 2 Cyst volume after third month.
7.1
7.1. Analysis
Comparison 7 Levonorgestrel 250 μg plus ethinyl estradiol 50 μg taken cyclically versus expectant management, Outcome 1 Resolution of cyst by 10 weeks.
8.1
8.1. Analysis
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.
9.1
9.1. Analysis
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.
9.2
9.2. Analysis
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.
10.1
10.1. Analysis
Comparison 10 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo, Outcome 1 Regression of cyst by 4 weeks.
10.2
10.2. Analysis
Comparison 10 Levonorgestrel 100 μg plus ethinyl estradiol 20 μg versus placebo, Outcome 2 Regression of cyst by 12 weeks.
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