Which Birth Control Pill is the Best for Ovarian Cysts? A Comprehensive Guide

Duly Care
Jun 20
9 min read

Ovarian cysts are a common concern for many women, often causing discomfort, irregular periods, or even fertility issues. While most cysts are harmless and resolve on their own, some may require medical intervention.

If you are considering starting birth control pills and suffer from ovarian cysts, this blog post will help break down how different types of pills work for ovarian cysts, their benefits, and what to consider when discussing options with your doctor.

Key Takeaways:

Birth control pills can help regulate hormones and prevent the formation of new ovarian cysts.
Combined oral contraceptive pills (COCPs) and progestin-only pills (POPs) are two types of birth control pills commonly used for cyst management.
Birth control pills do not treat existing cysts but may help reduce symptoms like irregular periods and pelvic pain.
Always consult a doctor to determine the best option based on your medical history and needs.

What are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that develop on or within the ovaries. They are a common occurrence, especially during a woman's reproductive years, and are often linked to hormonal fluctuations during the menstrual cycle.

While most ovarian cysts are harmless and resolve on their own, some can cause discomfort or lead to complications. Understanding the different types of ovarian cysts can help you better manage your reproductive health.

Types of Ovarian Cysts

Ovarian cysts are broadly categorised into two types: functional cysts and pathological cysts. Each type has distinct characteristics, causes, and implications for treatment.

Functional Cysts

Functional cysts are the most common type of ovarian cysts and are directly related to the menstrual cycle. They typically form as a result of normal ovarian function and often resolve without treatment. There are two main types of functional cysts:

Follicular Cysts: During a normal menstrual cycle, an egg grows inside a tiny sac called a follicle in the ovary. When the follicle fails to rupture and release the egg during ovulation, it can continue to grow and form a follicular cyst. Most follicular cysts are asymptomatic, but some women may experience mild pelvic pain or discomfort. These cysts usually disappear on their own within one to three menstrual cycles.
Corpus Luteum Cysts: After the follicle releases the egg, it transforms into a structure called the corpus luteum, which produces hormones to support a potential pregnancy. If the corpus luteum fills with fluid or blood, it can form a cyst. These cysts may cause pelvic pain, bloating, or, in rare cases, twisting of the ovary, called ovarian torsion. Corpus luteum cysts typically resolve within a few weeks but may occasionally rupture, causing sudden, sharp pain.

Pathological Cysts

Pathological cysts are less common and are not related to the normal menstrual cycle. They can develop due to abnormal cell growth and may require medical intervention. There are three main types of pathological cysts:

Dermoid Cysts (Mature Cystic Teratomas): Dermoid cysts are benign tumours that can contain tissues like hair, skin, or even teeth. They develop from embryonic cells and are often present from birth, but grow during the reproductive years. These cysts are usually asymptomatic but can cause pain if they grow large or twist the ovary. Surgical removal is often recommended to prevent complications.
Cystadenoma: Cystadenomas are cysts that develop from the outer surface of the ovary. They can be filled with a watery fluid (serous cystadenomas) or a thick, gel-like substance (mucinous cystadenomas). These cysts can grow quite large, causing abdominal bloating, pelvic pressure, or pain. Surgical removal is typically required, especially if the cyst is large or causes symptoms.
Endometriomas (Chocolate Cysts): Endometriomas are cysts that form as a result of endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus. These cysts are filled with dark, old blood, giving them a "chocolate" appearance. They can cause severe pelvic pain, especially during menstruation, and may affect fertility. Treatment options include hormonal therapy, pain management, or surgery to remove the cyst.

What are Birth Control Pills?

Birth control pills are an oral method of preventing pregnancy that contains synthetic versions of the hormones estrogen and/or progestin. These hormones mimic the natural hormones produced by the ovaries and help regulate the menstrual cycle. By doing so, they can prevent ovulation, thicken cervical mucus to block sperm, and thin the uterine lining, to prevent a pregnancy from occurring.

There are two main types of birth control pills:

Combined Oral Contraceptive Pills (COCPs): These contain both estrogen and progestin. They are the most commonly prescribed type and are additionally effective in regulating menstrual cycles.
Progestin-Only Pills (POPs): Also known as mini-pills, these contain only progestin. They are often recommended for women who cannot take estrogen due to medical conditions like hypertension, a history of blood clots, or breastfeeding.

Types of Progestins

Progestins, the synthetic form of progesterone used in birth control pills, are categorised into generations based on when they were developed and their specific properties. Each generation has unique characteristics that influence their effectiveness, side effects, and suitability for different individuals.

Here’s a detailed look at the different types of progestins:

First Generation Progestins: Examples include Norethindrone and Norethynodrel. These progestins have mild androgenic effects, meaning they may slightly mimic male hormones (called androgens), which can lead to side effects like acne or excess hair growth in some women. They are among the earliest developed progestins and are still used in certain birth control formulations.
Second Generation Progestins: Examples include Levonorgestrel and Norgestrel. These progestins have more potent androgenic effects compared to the first-generation progestins. While they are highly effective at preventing ovulation, they may cause stronger androgenic side effects, such as acne or weight gain, in some women. They are commonly used in both regular birth control pills and emergency contraceptives.
Third Generation Progestins: Examples include Desogestrel, Gestodene, and Norgestimate. These progestins were developed to reduce any androgenic side effects caused by earlier progestins. They have lower androgenic activity, making them less likely to cause acne or excess hair growth. They are often preferred by women who are sensitive to androgenic side effects or have concerns about skin issues.
Fourth Generation Progestins: Examples include Drospirenone and Dienogest. These progestins have anti-androgenic properties. This makes them particularly beneficial for women with hormonal acne, oily skin, or polycystic ovary syndrome (PCOS).
Drospirenone, for instance, has a chemical structure similar to spironolactone, a medication used to treat hormonal acne and excess hair growth. Additionally, fourth-generation progestins often have mild diuretic effects, which can help reduce bloating and water retention.

Dosage of estrogen

The estrogen in COCPs is usually ethinyl estradiol, and the dose can vary:

Low Dose (10-20 mcg): Suitable for women sensitive to estrogen or at risk of side effects.
Standard Dose (30-35 mcg): Most commonly prescribed, it balances effectiveness and side effects.
High Dose (50 mcg or more): Rarely used, it is prescribed for specific medical conditions.

Which Birth Control Pill is Best for Ovarian Cysts?

When it comes to managing ovarian cysts, birth control pills can be a helpful tool. However, not all pills are the same, and the type of pill - whether it is a combined oral contraceptive pill (COCP) or a progestin-only pill (POP) - as well as the specific progestin and estrogen used, can influence how effective they are for this purpose.

Here’s a breakdown of which types of birth control pills may be beneficial for ovarian cysts and why.

Combined Oral Contraceptive Pills (COCPs)

COCPs contain both estrogen (usually ethinyl estradiol) and progestin. They are often the first choice for managing ovarian cysts because they work by suppressing ovulation, which prevents the formation of new functional cysts.

Suitable Progestins in COCPs for Ovarian Cysts:
- Third-Generation Progestins (e.g., Desogestrel, Norgestimate): These progestins have lower androgenic effects, making them a good choice for women who are prone to acne or other androgenic side effects. They are effective at preventing ovulation and regulating menstrual cycles.
- Fourth-Generation Progestins (e.g., Drospirenone): Drospirenone has anti-androgenic properties, making it particularly beneficial for women with hormonal acne, bloating, or polycystic ovary syndrome (PCOS). It also helps regulate hormones and prevent new cysts.

COCPs are particularly beneficial for women with functional ovarian cysts (e.g., follicular or corpus luteum cysts) because they prevent ovulation, which is the root cause of these cysts.

Progestin-Only Pills (POPs)

POPs can also help prevent ovulation in some cases. While they may not be as effective as COCPs at suppressing ovulation, they are an option for women who cannot take estrogen.

The best types of progestins in POPs for the prevention of new ovarian cysts are the same as the progestins in COCPs - third generation progestins such as desogestrel, norgestimate and, fourth generation progestins such as drospirenone.

Summary

For Most Women: COCPs with third-generation progestins (e.g., Desogestrel, Norgestimate) or fourth-generation progestins (e.g., Drospirenone) are often the most often suitable choice. They effectively prevent ovulation, regulate hormones, and reduce the risk of new cysts.
For Women Who Cannot Take Estrogen: POPs containing the third generation or fourth generation progestins are a suitable alternative. While they may not suppress ovulation as strongly as COCPs, they still help manage symptoms and reduce the risk of new cysts.

Can Birth Control Pills Treat Ovarian Cysts?

Birth control pills do not treat ovarian cysts, but they can play a role in preventing certain types from forming. Functional ovarian cysts, such as follicular cysts and corpus luteum cysts, often develop due to the normal hormonal fluctuations of the menstrual cycle.

Since COCPs, and in some cases progestin-only pills (POPs), suppress ovulation, they reduce the likelihood of these functional cysts forming in the first place. However, if a cyst has already developed, birth control pills do not make it shrink or disappear.

Treatment for Ovarian Cysts

Treatment for ovarian cysts depends on their type, size, and whether they cause symptoms. Many functional cysts resolve on their own within a few weeks or months without medical intervention. If a cyst is large, persists over multiple menstrual cycles, or causes pain, a doctor may recommend options such as:

Watchful waiting – Regular ultrasound monitoring to check if the cyst resolves naturally.
Pain management – Over-the-counter pain relievers like ibuprofen or acetaminophen may be used for symptomatic relief.
Surgical intervention – In cases where the cyst is large, growing, causing severe pain, or suspected to be non-functional (such as dermoid cysts or endometriomas), procedures like laparoscopic cystectomy (minimally invasive removal) or, in rare cases, oophorectomy (removal of the ovary) may be necessary.

While birth control pills do not actively treat existing ovarian cysts, they are commonly prescribed for individuals with a history of recurring functional cysts as a preventive measure. However, they do not prevent all types of ovarian cysts, particularly those caused by conditions like polycystic ovary syndrome (PCOS) or endometriosis. If you experience frequent or problematic cysts, a doctor may suggest alternative treatments depending on the underlying cause.

Conclusion

Managing ovarian cysts can be challenging, but birth control pills offer a practical solution for many women. Whether you opt for combined oral contraceptive pills or progestin-only pills, the key is to work closely with your doctor to find the best option for your unique needs.

Remember, birth control pills are not just about preventing pregnancy -they can also play a vital role in managing ovarian cysts.

Frequently Asked Questions (FAQs)

Can birth control pills cure ovarian cysts?
No, birth control pills cannot cure existing ovarian cysts. However, they can help prevent new cysts from forming and manage symptoms like irregular periods and pelvic pain.
How long does it take for birth control pills to work on ovarian cysts?
It may take a few months for birth control pills to regulate your menstrual cycle and reduce the risk of new cysts.
Can I take birth control pills if I have a history of blood clots?
If you have a history of blood clots, your doctor may recommend progestin-only pills, as they do not contain estrogen, which can increase risk of blood clots.
How to treat ovarian cysts?
Treatment for ovarian cysts depends on their type and size, ranging from observation and pain management to surgical removal via laparoscopy or, in some cases, oophorectomy.

Important

This blog, including its text, images, and infographics, is for educational purposes only and not a substitute for professional medical advice. For personalized advice, always consult a doctor.

References

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American College of Obstetricians and Gynecologists (ACOG). Birth Control. Accessed on 7 February 2025. https://www.acog.org/womens-health/faqs/birth-control
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