Ovarian Cysts: Options in Management


Q: Dear Dr, i had an ovarian cyst that was so painful and had raptured, so i had a laparascopy done to remove it but the following month, when my periods came, the pain came back exactly as it was before. I've had numerous scans done and one showed a cyst on the very side they operated. I fear taking contraceptives because i want to concieve in the near future. What should i take to reduce the size of the cyst?


A:   Treatment and management of ovarian cysts usually depend on the size of the cysts. There are some studies which show evidence that contraceptive pills can reduce the size of ovarian cysts. I don’t know of any other medication that will have that effect. Oral contraceptive pill is a good option for you if you are planning to conceive. Its effect will last only while you’re taking it that is why the pill should be used perfectly. Most contraceptive pills prevent ovulation (release of an egg by the ovary). This effect usually lasts 24 hrs +/- 2-3 hours. That is why it is always better to take it at the same time every day. If you take it too late, there is always the chance of ovulating. However, the advantage is the effect will immediately subside once you decide to stop and fertility is promptly restored. The contraceptive patch has a similar principle, only that the hormones are being released gradually. However, the depot contraception (depo-provera) has a different mechanism of action. It controls the hormone from the pituitary gland that controls the hormone release from the ovary. Its contraceptive effect is much more prolonged even after discontinuation; some will not conceive after 1-2 years. In very rare circumstances, fertility is never restored at all. You may talk to your OB on what you should do about the new cyst. I think for now, continuous monitoring is preferable. As long as you are ovulating, there will always be a chance for you to form cysts. You may try doing less strenuous exercise or work to prevent cyst rupture. Cystectomy (surgical removal of the cyst) is also an option but the benefits should outweigh the risks. The last resort is oophorectomy (removal of the ovary); this is usually done in women with suspicious ovarian cysts, postmenopausal age, or when the cyst is too large. I hope this helps and I wish you well always.

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