Paradoxically,  it is believed that lowering the steroid dose in modern hormonal contraceptives (HCs)  has been connected with a higher incidence of large ovarian follicles and cysts formation;  nevertheless,  the women with functional cysts have been treated with hormonal contraceptives to obtain the resolution of these cysts⁽¹⁾.

A previous study evaluated two groups of users randomized to receive either 20 mcg ethinylestradiol (EE)/150mcg desogestrel or 35 mcg ethinylestradiol (EE) / 250mcg norgestimate. At baseline, 39% of women in the first group and 31%  in the second group reported at least one follicle <35mm.

At the end of second cycle of treatment, the frequency of these follicle decreased to 14% in each group Only one subject, in the higher dose EE- group developed an ovarian cyst > 35mm in diameter(46mm) that appeared during the pill-free week, after the first cycle, and during the second cycle of treatment showed a progressive reduction ⁽²⁾. While, in other investigation no differences were found between women who had hormonal treatment and those who had not.

So,  prospective studies revealed that functional ovarian cysts spontaneously appear and resolve equally well within 12 weeks independent of combined hormonal contraceptive or gestagen used ⁽³⁾.

Particularly, in the 1993, the Fertility and Maternal Health Drugs Advisory Committee of the US Food and Drug Administration (FDA) reported that the diameter of the maximum follicular structures were around 7.5 mm in the higher dose, monophasic HC group, compared to less than 15 mm in the lower-dose,monophasic HC group and about 13.5 mm for the nonuser group.

Same results for multiphasic HCs.  So,  the Committee concluded that neither monophasic nor multiphasic HC increase the risk of ovarian cyst development ⁽⁴⁾.

However, recently a study which compared effectiveness of low-dose monophasic pills with expectant management for functional ovarian cysts reported , after one month a remission, a rate of 63.6%  in low-dose group and 52.9%  in expectant group and after two months 72.7%  and 67.6%,respectively. There was no statistically significant difference between the two groups.  Therefore,  low-dose monophasic contraceptives were no more effective than expectant management in the treatment of ovarian functional cysts⁽⁵⁾.

On the contrary, it was reported that sometimes, transitory hyperprolattinemia, excessive production of the lutheinizing hormone,  deficit of progesterone production may hamper the folliculorexis and induce the development of the follicular cysts ⁽⁶⁾. Therefore, in their production the major role belongs to the hypothalamic-pituitary disregulation.  In this light, the hormonal contraceptive management may be appropriate as conservative and effective treatment of functional ovarian cysts.

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Rosa Sabatini and Raffele Cagiano
Department of Obstetrics and Gynecology
Department of Pharmacology General Hospital Policlinico-University of Bari, Italy
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REFERENCES

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3.   Graf,  M.,  Krussel,  J.S.,  Conrad,  M.,  Bielfeld,  P.,  Rudolf,  K. (1995). Regression of functional cysts:high dosage ovulation inhibitor and gestagen therapy has no added effect.  Geburtshilfe Frauenheilkd,  55(7), 387-92.
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