Expectant management of functional ovarian cysts: an alternative to hormonal therapy. Comparison of low-dose monophasic oral contraceptive pills and expectant management in treatment of functional ovarian cysts. Hormonal treatment of functional ovarian cysts: a randomized, prospective study. Treatment of clomiphene citrate-related ovarian cysts in a prospective randomized study. A single center experience. Management of functional ovarian cysts after induction of ovulation. A randomized prospective study. Ovarian endometrial cysts: the role of gonadotropin-releasing hormone agonist and/or drainage.
We studied whether the administration of oral contraceptives facilitates the disappearance of spontaneously formed functional ovarian cysts.
                Eighty patients in whom ultrasonography revealed unilateral, mobile, unilocular, thin-walled ovarian cysts without internal echoes and greater than 30 mm but not exceeding 60 mm in diameter were enrolled into the study. Patients were randomized by stratification to receive a low-dose monophasic pill, a high-dose monophasic pill, a multiphasic pill or no therapy. Patients were re-evaluated after 5 weeks of therapy and at the end of therapy (10 weeks).
                The mean ages and the mean cyst diameters of the patients for each group were not significantly different. We did not find a significant effect of oral contraceptive administration on the disappearance rate of functional ovarian cysts over that of expectant management.
                We conclude that oral contraceptive therapy even with multiphasic pills is very effective in the management of functional ovarian cysts but expectant management achieves similar success rates and may be a good alternative to oral contraceptive therapy. To compare the effectiveness of low-dose monophasic oral contraceptive pills in the treatment of spontaneously occurring functional ovarian cyst detected by ultrasonography compared with expectant management.
                A total of 70 women in their reproductive period with functional ovarian cysts detected by means of ultrasonography were randomized to low-dose monophasic Oral Contraceptive pills (OC) or to expectant management and followed up at one month with a second ultrasonography. If the ovarian cysts were still present, the women were followed for another month while on the same treatment.
                At the first month, the remission rates of ovarian cyst were 63.6% in low-dose monophasic OC and 52.9% in expectant groups. At the second month, the cumulative remission rates increased up to 72.7% in low-dose monophasic OC and 67.6% in expectant groups. There was no statistically significant difference between the two groups at both the first and second month of treatment. The most common side effect in women using OC was acne (18%).
                Low-dose monophasic OC were no more effective than expectant management in the treatment of spontaneously occurring functional ovarian cysts. Estrogen (E)/progestin therapy for functional ovarian cysts is widely used in clinical practice, but the efficacy of this treatment has not been determined in controlled trials. In this study, we examined the effect of E/progestin administration in a group of infertility patients enrolled in a program of ovulation induction who had cysts identified by transvaginal sonography. Patients were randomized to receive either norethindrone 1 mg/mestranol 0.05 mg/d (group A, n = 24) or no treatment (group B, n = 24) for up to 6 weeks. Patients were re-evaluated by sonography at 3, 6, and 9 weeks after entry into the protocol. The ages, mean cyst diameters, and proportions of patients having received gonadotropins in the previous menstrual cycle were not significantly different among the two groups. All patients who had a sonographic abnormality persisting for 9 weeks were surgically explored and found to have pathological cysts. The rate of disappearance of functional ovarian cysts was not affected by E/progestin treatment. The present study aims to compare the effectiveness of placebo, low dose and very low dose oral contraceptives (OC) in the treatment of clomiphene citrate (CC)-related ovarian cysts.
                A prospective randomized placebo controlled study was undertaken at the Infertility Department of Dr. Zekai Tahir Burak Women's Health Education and Research Hospital. A total of 3250 primary infertile patients were administered CC for ovulation induction because of ovulatory dysfunction and/or unexplained infertility. One hundred and eighty-six women who were diagnosed with CC-related ovarian cysts greater than 20 mm on the third day of the following menstrual cycle, were eligible for the study. Group 1 (n = 62) was treated with very low dose OC (100 microg levonorgestrel + 20 microg ethinyl estradiol [EE]), group 2 (n = 62) with low dose OC (150 microg desogestrel + 30 microg EE) and group 3 (n = 62) with a placebo. The first control was 4 weeks later. Women with persistent cysts (n = 57) were called in 4 weeks later to continue the same treatment.
                Demographic data were similar among the groups. At the first month, the regression rates of ovarian cysts were 64.5, 61.3 and 66.1% in groups 1, 2 and 3, respectively (P = 0.849). Among the 57 women (20, 19 and 18 from groups 1, 2 and 3, respectively) with persistent cysts, the regression rates were 65.0, 63.2 and 55.6%, respectively at the second month (P = 0.821). Persistence of ovarian cysts was significantly higher in women with a longer duration of CC treatment than in women with a shorter duration (P < 0.001).
                Any treatment might be appropriate for patients with a CC-related ovarian cyst. However, there is no evidence to administer OC for treating CC-related ovarian cysts. Expectant management may also achieve similar success rates. To investigate the need for hormonal treatment in patients with functional ovarian cysts after induction of ovulation, a randomized prospective study was performed. Fifty-four patients who were found to have ovarian cysts after induction of ovulation were randomly assigned to two groups: a) Treatment with estrogen/progesterone. b) Expectant management. The main outcome measure was resolution of ovarian cysts. There was no significant difference between the groups. We conclude that hormonal treatment is not necessary in cases with functional ovarian cysts after induction of ovulation. To evaluate the role of GnRH agonist (GnRH-a) and/or drainage in the management of large endometriomas.
                This prospective clinical study was conducted in a parallel and randomized design.
                Department of Gynecology, Cliniques Universitaires St. Luc, Brussels, Belgium.
                Eight infertile women with laparoscopically confirmed ovarian endometriotic cysts. After laparoscopic drainage of the ovarian cyst, patients were randomized. Patients in group I (n = 40) received no therapy. Patients in group II (n = 40) received GnRH-a therapy for 12 weeks. A second-look laparoscopy was performed after 12 weeks in each woman.
                After drainage, a quick recurrence of the endometrial cyst was observed in only group I. Indeed, the score and the cyst size were similar to the values observed before the first laparoscopy. In group II, a significant decrease in score and cyst diameter was observed. Ovarian biopsies revealed significant reduction in the stromal vascularization and a significant reduction in the mitotic activity in the group of women treated with GnRH-a.
                The quick recurrence of the ovarian cyst after drainage proved that drainage alone is ineffective. Drainage followed by GnRH-a was effective in the reduction of cyst size and the glandular mitotic activity.
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.