IUDs and Ovarian Cysts: Effectiveness and Considerations
Both copper and hormonal IUDs are considered safe for women with benign ovarian tumors including cysts, with the hormonal (levonorgestrel) IUD potentially offering additional benefits in preventing functional ovarian cysts.
IUD Safety with Ovarian Cysts
According to the U.S. Medical Eligibility Criteria for Contraceptive Use, both levonorgestrel-releasing IUDs (LNG-IUD) and copper IUDs are classified as Category 1 for women with benign ovarian tumors, including cysts 1. This means there is no restriction for the use of either type of IUD in women who have ovarian cysts.
Potential Benefits of Hormonal IUDs
The hormonal (levonorgestrel) IUD may offer advantages over the copper IUD for women concerned about ovarian cysts:
Mechanism of action: LNG-IUDs release progestin locally, which can:
Effect on ovarian function: Studies show that LNG-IUDs can affect ovarian function by:
- Altering follicular development and rupture
- Creating subtle disturbances in hypothalamic-pituitary-ovarian function 2
- Potentially reducing the risk of functional ovarian cysts compared to no hormonal contraception
Copper IUDs and Ovarian Cysts
Copper IUDs work primarily by creating a local inflammatory response to prevent fertilization 3. They do not have hormonal effects that would prevent or treat ovarian cysts. However, they remain safe to use in women who have benign ovarian cysts 1.
Comparative Risk of Ovarian Cysts with Different Contraceptives
Research suggests that:
- Women using copper IUDs have a lower prevalence of ovarian cysts (1.2-2.1%) compared to users of hormonal implants (5.2-26.7% for Implanon and 8.0-14.6% for Jadelle) 4
- Oral contraceptives, particularly higher-dose formulations, appear to have a stronger protective effect against functional ovarian cysts than IUDs 5
Important Considerations
When considering an IUD for a woman with ovarian cysts:
- Pre-existing cysts: Both types of IUDs are safe to use with existing benign ovarian cysts 1
- Cancer risk: Evidence suggests both LNG-IUDs and copper IUDs may reduce gynecologic cancer risk, including possibly ovarian cancer 3
- Side effects: Be aware of potential side effects:
Follow-up Recommendations
- Regular follow-up is important, particularly in the first 3-6 months after insertion
- Patients should be informed about normal post-insertion symptoms versus warning signs 7
- Ultrasound monitoring may be warranted if there are concerns about cyst growth or symptoms
In summary, while IUDs are safe for women with ovarian cysts, the hormonal LNG-IUD may offer additional benefits through its effects on ovarian function that could potentially help prevent functional ovarian cysts, though higher-dose hormonal contraceptives like combined oral contraceptives may have stronger protective effects against functional ovarian cysts.