Oral contraceptives for functional ovarian cysts.
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.


OBJECTIVE
This review examined all randomized controlled trials that studied oral contraceptives as therapy for functional ovarian cysts.


METHODS
We searched the computer databases of CENTRAL, PubMed, POPLINE, and EMBASE for randomized controlled trials. We also examined the reference lists of articles and wrote to authors of all studies identified to seek articles we had missed.


METHODS
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 studies.


METHODS
Two authors independently abstracted data from the articles and entered them into RevMan 4.2. We used Peto odds ratios with 95% confidence intervals for dichotomous outcomes.


RESULTS
We identified four randomized controlled trials from three countries; the studies included a total of 227 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.


CONCLUSIONS
Although widely used for treating functional ovarian cysts, combined oral contraceptives appear to be of no benefit. Watchful waiting over several cycles is appropriate. Should cysts persist, surgical management is often indicated.
Grimes
D A
DA
Family Health International, Clinical Research Department, PO Box 13950, Research Triangle Park, Durham, NC 27709, USA. dgrimes@fhi.org
Jones
L B
LB
Lopez
L M
LM
Schulz
K F
KF
D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D010048:Ovarian Cysts / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012075:Remission, Spontaneous
D003277:Contraceptives, Oral, Combined