Traitements médicaux des tumeurs ovariennes présumées bénignes

Medical treatment of functional cysts and endometriomas, and the risk of developing functional ovarian cysts in different therapeutic situations are assessed. The available literature regarding the treatment of functional cysts is limited both by the number of studies and the variability of criteria used to define cysts. There is no evidence to support any efficiency of a medical treatment (LE1). However, oral contraceptive use reduces the risk of development of functional cysts (LE2). Using a second generation combination is recommended as a first-line option in order to reduce thromboembolic risk (LE1). Tamoxifen is significantly associated with an increased risk of developing unilocular cysts before menopause (LE2). For endometriomas, GnRH-agonists are not recommended before cystectomy in order to facilitate surgery (grade C) or to prevent recurrence (grade B). After surgery of endometriomas, the use of an intrauterine device with levonorgestrel or oral contraceptives significantly reduces the volume of the cyst in case of recurrence (LE3); oral contraceptives reduce the recurrence rate of endometriomas (LE2); the use of a low-dose oral contraceptive decreases the frequency and severity of long-term dysmenorrhea (LE1).