From the Guidelines
For patients with ovarian cysts, a combined oral contraceptive pill (COCP) containing drospirenone or desogestrel is often recommended as the best option, as it can help suppress ovulation and reduce the formation of new cysts 1. The goal of using COCPs in patients with ovarian cysts is to reduce the frequency and severity of cyst formation by suppressing ovulation.
- COCPs work by introducing hormones that prevent the release of an egg from the ovary, thereby reducing the likelihood of new cysts forming.
- The hormonal suppression also reduces the cyclical changes that can lead to cyst development and growth. Some key points to consider when prescribing COCPs for ovarian cysts include:
- The type of progestin used in the COCP, with drospirenone and desogestrel being preferred due to their low androgenic activity 1.
- The dosage and regimen of the COCP, with a typical regimen consisting of 21 days of active pills followed by a 7-day break 1.
- The potential side effects of COCPs, including nausea, breast tenderness, and mood changes, which are usually mild and temporary 1. It's essential to note that while COCPs can be effective in managing ovarian cysts, they may not be suitable for all patients, particularly those with certain medical conditions or contraindications 1.
- Patients should be counseled on the importance of consistent and correct use of COCPs to maximize their effectiveness and minimize the risk of side effects 1.
- Regular follow-up appointments should be scheduled to monitor the patient's response to the COCP and address any concerns or side effects that may arise 1.
From the Research
Best COCP for Ovarian Cysts
The best combined oral contraceptive pill (COCP) for patients with ovarian cysts is not clearly defined, as the effectiveness of COCPs in treating ovarian cysts is still a topic of debate. However, some studies suggest that:
- Low-dose hormonal contraception may protect against the development of functional ovarian cysts 2
- Combined oral contraceptives may reduce the size of cysts in women with polycystic ovary syndrome (PCOS) 3
- However, treatment with combined oral contraceptives did not hasten the resolution of functional ovarian cysts in any trial 4
Types of COCPs
Different types of COCPs have been studied, including:
- Multiphasic pills: may have a protective effect against functional ovarian cysts, but the evidence is limited 5
- Low-dose monophasic pills: may have a protective effect against functional ovarian cysts, but the evidence is limited 5
- High-dose monophasic pills: may have a protective effect against functional ovarian cysts, but the evidence is limited 5
- Levonorgestrel-releasing intrauterine system (LNG-IUS): may not have a significant effect on the presence or persistence of ovarian cysts 6
Key Findings
Some key findings from the studies include:
- Most cysts resolve without treatment within a few cycles 4
- Persistent cysts tend to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological 4
- Watchful waiting for two or three cycles is appropriate for women with functional ovarian cysts 4
- Surgical management is often indicated for persistent cysts 4