Do progesterone-only pills (POPs) help ovarian cysts?

From the Guidelines

Oral contraceptive pills (OCPs) can help manage ovarian cysts by preventing ovulation, which reduces the formation of functional ovarian cysts. For women with recurrent ovarian cysts, doctors often prescribe combination OCPs containing both estrogen and progestin, typically taken daily for 21 days followed by 7 days of placebo pills or no pills. Common brands include Yaz, Ortho Tri-Cyclen, and Sprintec. OCPs may be prescribed for 3-6 months initially to manage cysts, though some women take them longer for ongoing prevention. While OCPs can prevent new cysts from forming and may help existing cysts resolve faster, they cannot immediately eliminate already-formed cysts. OCPs work by suppressing the hormones that trigger ovulation, thereby preventing the formation of follicular cysts that occur during the normal ovulation process. It's essential to note that while OCPs are effective for functional cysts, they don't treat other types like endometriomas or dermoid cysts, which may require different approaches. Side effects can include nausea, breast tenderness, and mood changes, which typically improve after a few months of use 1.

Some key points to consider:

• The risk of malignancy in simple cysts is low, and OCPs can help manage these cysts by preventing new ones from forming 1.
• Unilocular cysts in premenopausal women have a very low risk of malignancy, and OCPs can help reduce the formation of these cysts 1.
• OCPs are not effective for all types of ovarian cysts, such as endometriomas or dermoid cysts, which may require different treatment approaches 1.
• The American College of Radiology recommends that simple cysts up to 10 cm in diameter can be safely monitored with repeat imaging without surgical intervention, even in postmenopausal patients 1.

In terms of specific treatment, combination OCPs containing both estrogen and progestin are often prescribed for 3-6 months initially to manage ovarian cysts. However, the treatment approach may vary depending on the individual patient's needs and the type of cyst present. It's crucial to consult with a healthcare provider to determine the best course of treatment. 1.

Overall, OCPs can be an effective treatment option for managing ovarian cysts, particularly functional cysts, by preventing ovulation and reducing the formation of new cysts. However, it's essential to weigh the benefits and risks of OCPs and consider individual patient factors when making treatment decisions. 1.

From the FDA Drug Label

If follicular development occurs, atresia of the follicle is sometimes delayed, and the follicle may continue to grow beyond the size it would attain in a normal cycle. Generally these enlarged follicles disappear spontaneously. Often they are asymptomatic; in some cases they are associated with mild abdominal pain Rarely they may twist or rupture, requiring surgical intervention.

Progestin-only oral contraceptives (POPs) may be associated with delayed follicular atresia and ovarian cysts. However, the text suggests that these enlarged follicles often disappear spontaneously. It does not provide direct evidence that POPs help ovarian cysts. In fact, it notes that rarely, these follicles may twist or rupture, requiring surgical intervention 2.

From the Research

Ovarian Cysts and Treatment

• Ovarian cysts can be treated with various medical therapies, including estrogen/gestagen-combinations, GnRH-analogues, gestagens, and danazol 3.
• However, the effectiveness of hormonal suppression in treating functional ovarian cysts is still a topic of debate, with some studies showing no significant difference between expectant management and hormonal suppression 4.
• Oral contraceptives, which are often used to treat functional ovarian cysts, have been found to be of no benefit in hastening the resolution of these cysts 5.
• In fact, most cysts resolve without treatment within a few cycles, and persistent cysts tend to be pathological rather than physiological 5.

Management of Ovarian Cysts

• The American College of Obstetricians and Gynecologists (ACOG) recommends that simple cysts found on ultrasound may be safely followed without intervention, even in postmenopausal women 6.
• Ovarian cysts can be managed conservatively, with a CA-125 blood test and transvaginal ultrasonography (TVU) used for follow-up 6.
• The use of a levonorgestrel-releasing intrauterine system (LNG-IUS) has been found to have a low incidence of ovarian cysts, with most cysts being functional in nature and resolving on their own 7.

Persistence of Ovarian Cysts

• The persistence of ovarian cysts has been found to be low, with most cysts resolving within a few months 7.
• The likelihood of cyst persistence increases for cysts larger than 50mm, but even in these cases, the majority of cysts resolve on their own 7.
• The use of hormonal therapies, such as oral contraceptives, does not appear to affect the persistence of ovarian cysts 4, 5.