Birth control pills for ovarian cysts
|Generic Name||Brand Name|
|Combination birth control pills with both estrogen and progestin||Alesse, Loestrin, Ortho-Cyclen, Ortho-Novum, Ortho Tri-Cyclen, Triphasil, Yasmin, Zovia|
One tablet is taken daily for 20 to 21 days, followed by 7 to 8 days of no medication, during which time there is a menstrual period.
How It Works
Why It Is Used
Birth control pills can be used to treat women who have recurrent ovarian cysts with their menstrual cycles.
How Well It Works
Women who use high-dose estrogen and progestin birth control pills have a modestly decreased risk of developing functional ovarian cysts. Low-dose birth control pills seem to have a less preventive effect.1
Experts disagree about the use of birth control pills to shrink and eliminate ovarian cysts that have already formed. Some studies show that the cysts shrink at the same rate with or without birth control pill use.2
Combination hormonal pills, skin patches, and vaginal rings have similar possible side effects because they all contain a combination of estrogen and progestin. The pill causes hormone levels to peak and drop each day. Each weekly patch takes 3 days after application to reach a steady hormone level. The ring releases a steady dose every day throughout the day. This may explain why the ring is less likely to cause headaches and nausea than the pill or patch.
Common side effects of combination hormonal methods
The most common side effects are changes in menstrual periods, including:
- Very light or skipped periods.
- Bleeding between periods (spotting), which usually decreases after using a hormonal method for 3 to 4 months.
The contraceptive skin patch may cause skin irritation at the site.
The contraceptive vaginal ring may cause:
- Vaginal discharge.
- Irritation and inflammation of the vagina (vaginitis).
Less common side effects of combination hormonal methods
Less common side effects include:
- Nausea and vomiting, especially during the first month of use. This side effect usually goes away after the first few months of use.
- Frequent or more severe headaches. Migraine headaches may get worse.
- Weight gain.
- Breast tenderness for the first few months.
- Depression or mood changes.
- Darkening of the skin on the upper lip, under the eyes, or on the forehead (chloasma). This may slowly fade after you stop using hormonal methods, but in some cases, it is permanent.
- Less interest in sex.
Rare but serious side effects of combination hormonal methods
The following symptoms, called ACHES, are rare but serious and should be reported to your health professional immediately.
- Abdominal pain that is severe or persists may be a sign of blood clots (thrombophlebitis) in the pelvis, liver blood clots or tumors, or gallbladder disease.
- Chest pain may be a sign of blood clots in the lungs (pulmonary embolism), heart attack, or heart disease. Smoking increases this risk.
- Headaches that are severe may be a sign of stroke, migraine, or hypertension. Smoking increases this risk.
- Eye problems, such as blurred vision or loss of vision, may be a sign of migraine, blood clots in the eye, or a change in the shape of the cornea.
- Severe leg pain or sudden swelling of one leg may be a sign of leg blood clots (thrombophlebitis) or deep vein thrombosis (DVT).
Patch warnings. The patch delivers more estrogen than the low-dose birth control pills do. Some research has found that women using the patch are more likely to get dangerous blood clots in the legs and lungs. The risk may be higher if you smoke or have certain health problems. The U.S. Food and Drug Administration warns that you talk to your doctor about your risks before using the patch.
Direct sunlight or high heat can increase, then lower, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. This increases your risk of pregnancy. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Cancer protection, cancer risk? Recent studies have shown that using the Pill (with estrogen and progestin) for a year or more helps protect against uterine cancer. Long-term Pill use protects against ovarian cancer. However, the research is mixed about breast cancer.3, 4 Breast cancer risk may be slightly increased by the Pill for women with a family history of breast cancer.5 Women who have a personal history of breast cancer should not take the Pill. If you're considering hormonal birth control, let your health professional know if you have any family history of breast cancer.
Combined hormonal contraceptive methods are usually not prescribed for women who:
- Smoke and are older than 35.
- Have diabetes and are older than 35 or have diabetes with complications.
- Have migraines with visual changes (aura).
- Have a risk for blood clots, including a family history of clots or a past clot in the lung (pulmonary embolism) or leg (thrombophlebitis).
- Have coronary artery disease, uncontrolled high blood pressure, or high triglyceride levels.
Other factors to consider include the following:
- Birth control pills may not be as effective when combined with other medications. Be sure to tell your health professional or pharmacist that you are taking birth control pills whenever you get a new prescription. The herbal medication St. John's wort also makes birth control pills less effective. Be sure to tell your health professional about all medications and supplements you are taking when starting hormonal birth control.6
- After stopping high-dose birth control pill use in order to start a planned pregnancy, it may take longer to become pregnant than after stopping use of a low-dose pill, diaphragm, or intrauterine device (IUD).7
- If you are taking birth control pills, take special precautions for backup birth control if you miss or skip pills.
- Birth control pills may not be as effective if you are vomiting or have diarrhea. Use another method of birth control for 7 days after vomiting or diarrhea, even if you have not missed any pills.
- The pill and the patch may not work as well if you are overweight (body mass index greater than 25).8, 9 If you are overweight, ask your doctor about which birth control methods are right for you.
Be sure to use a backup birth control method during the first 7 days of starting hormonal contraception.
Emergency contraception is available if any birth control method fails and you are concerned about unprotected sex.
- Holt VL, et al. (2003). Oral contraceptives, tubal sterilization, and functional ovarian cyst risk. Obstetrics and Gynecology, 102(2): 252–258.
- Smith RP (2002). Ovarian cysts. In Netter's Obstetrics, Gynecology, and Women's Health, pp. 271–272. Teterboro, NJ: Icon Learning Systems.
- Practice Committee of the American Society for Reproductive Medicine (2004). Hormonal contraception: Recent advances and controversies. Fertility and Sterility, 82(Suppl 1): S26–S32.
- Marchbanks PA, et al. (2002). Oral contraceptives and the risk of breast cancer. New England Journal of Medicine, 346(26): 2025–2032.
- Petitti DB (2003). Combination estrogen-progestin oral contraceptives. New England Journal of Medicine, 349(15): 1443–1450.
- Hatcher RA, Nelson A (2004). Combined hormonal contraceptive methods. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 391–460. New York: Ardent Media.
- Speroff L, Fritz MA (2005). Oral contraception. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 861–942. Philadelphia: Lippincott Williams and Wilkins.
- Hatcher RA, et al. (2005). Pocket Guide to Managing Contraception 2005–2007. Tiger, GA: Bridging the Gap Foundation.
- Holt VL, et al. (2005). Body mass index, weight, and oral contraceptive failure risk. Obstetrics and Gynecology, 105(1): 46–52.
Last Updated: November 10, 2008
Author: Sandy Jocoy, RN