Medical and surgical treatment of functional ovarian cysts]

Most of symptomatic functional ovarian cysts (FOC) are treated by surgery. Oral contraceptives and ultrasound-guided puncture are not more efficient than expectant management for treating asymptomatic FOC in non menopausal women. The probability of a cyst being functional or benign in asymptomatic postmenopausal women is assessed by transvaginal ultrasonography, color Doppler flow imaging and CA 125 serum level measurement. Conservative management of simple cysts (anechoic, diameter < 5 cm with normal Doppler and CA 125 serum level) is more reasonable and safer than surgical treatment. The use of high-dose combination oral contraceptives has a protective effect against FOC, whereas low-dose pills have little or no effect. However, low-dose oral contraceptives or progestogen-only oral contraceptives do not increase the risk of FOC. In the case of recurrent or symptomatic FOC, the advantages of using higher dose formulations have not been proved. Expectant management is as effective as oral contraceptives for the resolution of FOC induced by ovarian stimulation. Tamoxifen treatment in premenopausal breast cancer patients is associated with ovarian overstimulation and FOC formation (> 35%). Co-treatment with Gn-RH agonist may be successful in this indication. Hormone replacement therapy may be associated with an increasing ovarian volume, but not with an increasing rate of FOC. The management of surgical-induced FOC (entrapped ovarian cyst, ovarian transposition) has never been assessed by controlled studies.