IUDs and Ovarian Cysts: Risk Assessment
IUDs do not increase the risk of ovarian cyst formation, as both copper and levonorgestrel IUDs are classified as category 1 (no restriction) for women with benign ovarian tumors, including cysts. 1
Types of IUDs and Their Effects on Ovaries
Copper IUDs
- Copper IUDs have no hormonal effects and do not influence ovarian function or cyst formation 1
- The U.S. Medical Eligibility Criteria for Contraceptive Use classifies copper IUDs as category 1 (no restriction) for women with benign ovarian tumors including cysts 1
Levonorgestrel IUDs (Hormonal)
- LNG-IUDs are also classified as category 1 (no restriction) for women with benign ovarian tumors including cysts 1
- While LNG-IUDs can affect ovarian function, they are not associated with an increased risk of pathological ovarian cysts 1
Research Evidence on IUDs and Ovarian Cysts
Prevalence of Ovarian Cysts
- In a study of 644 asymptomatic women aged 20-39, ovarian lesions were found in only 3.7% of women, with functional cysts (that resolved within 3-5 months) accounting for just 0.9% 2
- The same study found that women using hormonal contraception, including gestagen IUDs, had a lower prevalence of persistent ovarian lesions (0% in IUD users vs. 4.4% in women with spontaneous menstrual cycles) 2
Physiological Effects of LNG-IUDs
- LNG-IUDs may cause subtle disturbances in ovarian function, with some studies showing follicular cysts in users, but these typically disappear spontaneously 3
- In a study of women using LNG-IUDs for more than seven years, some developed follicular cysts that disappeared spontaneously within 45 days 3
Clinical Implications
Monitoring and Management
- No special monitoring is required for IUD users specifically for ovarian cysts 1
- Regular gynecological check-ups are sufficient for IUD users, as would be recommended for all women regardless of contraceptive method 4
Side Effects to Be Aware Of
- Copper IUDs may cause increased menstrual bleeding and pain 4, 5
- LNG-IUDs may cause hormonal side effects such as headaches, nausea, hair loss, breast tenderness, depression, decreased libido, and amenorrhea 4
- While functional ovarian cysts may occur with LNG-IUDs, they are typically transient and resolve spontaneously 3
Rare Complications
- IUD migration is a rare complication, with extremely rare cases of IUDs found within ovarian tumors 6
- The correlation between ovarian pathology and IUD translocation is unclear and requires further investigation 6
In summary, both copper and hormonal IUDs are safe options for women concerned about ovarian cysts, as they do not increase the risk of pathological cyst formation. In fact, hormonal IUDs may actually be associated with a lower prevalence of persistent ovarian lesions compared to women not using hormonal contraception.