Cysts of the ovaries are a common gynecologic problem throughout the world among women in their reproductive years. The majority of these are benign, and often labeled as “functional” or “physiologic”. When ovarian cysts become large or painful, or when they persist, surgical intervention to remove them may be required, at times resulting in removal of that entire ovary. Back in the 1970’s, it was discovered that women who were taking birth control pills had a lower incidence of functional ovarian cysts, therefore many physicians concluded that such birth control pill usage could also be used to actually treat existing ovarian cysts. This has since become a common clinical practice that continues to be used today. However, it has not been proven that this treatment is in fact effective in doing so. Recently, Dr. David Grimes and several of his colleagues performed a review of the literature to assess whether the use of birth control pills can help treat ovarian cysts in such a fashion.
For the purpose of this review, seven randomized controlled trials from four countries throughout the world that included a total of 500 women were identified. The patients received treatment consisting of “combined” (i.e. containing both estrogen and progesterone hormones) oral contraceptives. What the researchers found was that this therapy did not hasten the resolution or disappearance of functional ovarian cysts in any of the trials that were looked at. This finding held true for both cysts that occurred spontaneously, as well as those that resulted from ovulation induction therapy, such as in patients undergoing fertility treatments. Most of the cysts resolved without any treatment within a few menstrual cycles. In fact, those cysts that did not resolve tended to be more of a pathologic nature (e.g. endometriosis cysts or para-ovarian cysts).
From the above findings, the authors of this important review concluded that although widely used for treating functional ovarian cysts, combined oral contraceptives do not appear to be of any benefit in doing so. Simply waiting and observing the patients for 2 or 3 menstrual cycles is the appropriate course, and if the cysts do persist, then surgical intervention is often indicated. These findings should have a far reaching effect on the way we approach this common worldwide condition today in our reproductive age women.