Phasic contraceptive pills and functional ovarian cysts

Abstract

This seven-case anecdotal report is presented to alert physicians to the possibility of the formation of functional ovarian cysts during use of phasic contraceptive pills. The patients were studied by the combination of history, physical examination, ultrasound examination, and in two cases surgery. The occurrence of functional ovarian cysts during the use of phasic contraceptive pills is well established while not well appreciated by practicing physicians. This seven-case presentation strongly suggests that phasic contraceptive pills may be a threat to patient health and safety. It is suggested that further studies be undertaken to better understand the pathophysiology.

PIP: The 7 cases presented in this article are intended to alert physicians to the possible formation of functional ovarian cysts in conjunction with use of phasic oral contraceptives (OCs). All 7 patients were diagnosed within a 3-month period in a single medical practice. A striking feature of these cases was the short time interval (1-6 OC cycles) between onset of medication and occurrence of the cysts. The patients were placed on Ovral contraceptive pills for suppression of ovarian function following diagnosis of the cyst and have remained free of cyst formation since that time. Many patients have been placed on a phasic OC regimen to reduce the side effects often associated with conventional OCs. However, these case reports suggest that lowering the dose of estrogen and progestogen leads in some patients to incomplete hypothalamic-pituitary-ovarian suppression and the resultant formation of functional ovarian cysts. As a result of these findings, the authors have discontinued the prescription of phasic OCs to their patients.