Oral contraceptives for functional ovarian cysts

 

Abstract

Background

Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early oral contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s.

Objectives

This review examined all randomized controlled trials that studied oral contraceptives as therapy for functional ovarian cysts.

Search methods

We searched the databases of CENTRAL, MEDLINE, POPLINE, and EMBASE, as well as clinical trials databases (ClinicalTrials.gov and ICTRP). We also examined the reference lists of articles and wrote to authors of identified trials to seek articles we had missed.

Selection criteria

We included randomized controlled trials in any language that included oral contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of trials.

Data collection and analysis

Two authors independently abstracted data from the articles. One entered the data into RevMan and a second verified accuracy of data entry. For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio with 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference with 95% CI.

Main results

We identified eight randomized controlled trials from four countries; the studies included a total of 686 women. Treatment with combined oral contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological.

Authors' conclusions

Although widely used for treating functional ovarian cysts, combined oral contraceptives appear to be of no benefit. Watchful waiting for two or three cycles is appropriate. Should cysts persist, surgical management is often indicated.

 

Plain language summary

Oral contraceptives to treat cysts of the ovary

Women of reproductive age usually release an egg about once a month. The ovary gets an egg from the inside of the ovary to its surface by creating a blister or fluid-filled space around the developing egg. When the blister (or cyst) reaches the surface of the ovary, it bursts and releases the egg into the abdominal cavity. After this occurs, the blister can develop into another type of cyst, which makes a hormone (progesterone) that helps the pregnancy to grow. Most of these cysts come and go without problems. Sometimes, however, the cysts get large or painful; others may remain for months. Several decades ago, health care providers learned that women taking birth control pills had fewer cysts, since the pills usually kept an egg from being released. Based on this fact, many clinicians started treating these cysts with birth control pills to make them go away faster.

We did a computer search for all randomized controlled trials that studied use of birth control pills to treat these benign (also called functional) cysts. We wrote to researchers to find other trials. We found eight trials from four countries; they included 686 women. Three trials included women receiving drugs to help them get pregnant. The other five included women who developed cysts without fertility treatment. In none of these trials did oral contraceptives help the cysts go away faster. Thus, birth control pills should not be used for this purpose. A better approach is waiting two or three months for the cysts to go away on their own.

 

摘要

背景

針對功能性卵巢囊腫的口服避孕藥

功能性卵巢囊腫在全世界於生育年齡婦女中是一種常見的婦科問題。當增大、持續存在或疼痛時，這些囊腫可能需要開刀。有時須切除卵巢。自從早期知道口服避孕藥和減少功能性卵巢囊腫發病率有相關以來，許多臨床醫師推斷，避孕藥可以用來治療囊腫。在上個世紀七十年代初期，這成為一個普遍的臨床措施。

目標

本篇評論文章細查了所有研究口服避孕藥作為治療功能性卵巢囊腫的隨機對照試驗。

搜尋策略

我們針對隨機對照試驗搜尋了CENTRAL、PubMed、POPLINE與EMBASE的電腦數據資料庫。 我們還細查了文章的參考文獻和寫信給所有研究的作者，尋求我們漏掉的文章

選擇標準

我們納入任何語言的隨機對照試驗，包括口服避孕藥用於治療而不是預防功能性卵巢囊腫。囊腫的診斷標準為研究作者所使用的標準。

資料收集與分析

兩位作者獨立地由相關的試驗抽取數據，而我們輸入數據於RevMan 4.2版進行分析。 對於二分的結果，我們使用Peto勝算比加上95 ％的信賴區間。對於連續的結果，我們計算平均差加上95 ％的信賴區間。

主要結論

我們確定了來自四個國家的7個隨機對照試驗;這些研究共包括500位婦女。在任何試驗中，以混合型口服避孕藥的治療並無法加速功能性卵巢囊腫的消除。這事實存在於那些自發性發生的囊腫以及那些誘導排卵後發展的囊腫。大部分囊腫在沒有接受治療下於數個週期內消除;持久性的囊腫往往是病理性的(例如，子宮內膜異位或卵巢旁囊腫)，而不是生理性的。

作者結論

雖然被廣泛用於治療功能性卵巢囊腫，混合型口服避孕藥似乎是毫無益處的。觀察的等待幾個週期是適當的做法。囊腫若持續存在，手術的處理往往是必要的。

翻譯人

本摘要由臺灣大學附設醫院張致遠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

口服避孕藥治療卵巢囊腫。 生育年齡的婦女通常是每月一次排一個卵。藉由產生一個水泡或者是充滿液體空間而環繞著發展中的卵，卵巢因而得到一個由卵巢內部到表面的卵。當水泡(或囊腫)達到卵巢的表面，它破裂並釋放卵子進入腹腔。這種情況發生之後，水泡可以發展成為另一種類型的囊腫，這使得一激素(黃體酮)可以幫助懷孕的增長。大部分囊腫的來來去去是沒有問題的。但是，有時囊腫會變大或造成疼痛;其他囊腫可能維持幾個月。幾十年前，臨床醫生據悉正在服用口服避孕藥(生育控制藥)的婦女有較少的囊腫，因為這些藥丸通常讓卵保持不被排掉。根據此一事實，許多臨床醫生開始使用口服避孕藥治療這些囊腫而為了使它們早些不見。這篇檢視搜尋了世界上所有研究使用避孕藥治療這些良性的(也稱為功能性)囊腫的隨機對照試驗。我們找到來自三個國家的四個試驗，包括了227名婦女。其中兩篇試驗包括了為了幫助她們懷孕而接受藥物的婦女。其它兩篇包括了非為了生育治療而有囊腫的婦女。在所有這些試驗中，口服避孕藥無法幫助加速囊腫的消失。因此，避孕藥不應被用於此一目的。等待數個月讓囊腫自動消失是一個更好的辦法。