Should OCs be prescribed to prevent adnexal masses?

A 23 year old woman with recurring functional ovarian cysts has heard that oral contraceptives (OC) may be used to influence regression of the cysts, but she is hesitant to use them since she smokes 10 cigarettes a day. The patient, at age 16, was diagnosed as having a 4x4 cm mass, thought to be an ovarian cyst, in the right adnexa. It resolved shortly but returned when the patient was 20, and that mass also resolved spontaneously. The patient experienced lower right quadrant pain with both masses. At age 23 the patient experiences pain in her lower abdomen on the left side. She is due to start her menstrual period on the next day. She and her partner are using foam and condoms consistently for birth control. The patient is in no acute distress. Positive findings were limited to the pelvic examination. A 4x5 cm cystic, moderately tender, mobile mass was found in the left adnexa. The treatment plan was to initiate use of combined OCs after the next period begins, starting with a 50 mcg or a sub 50 mcg pill and to encourage the patient to decrease her smoking. The smoking of 10 cigarettes daily was not regarded as a contraindication to OC use. OCs appear to have an influence on the development of functional ovarian cysts. In a study of almost 1000 hospitalized women, the Boston Collaborative Drug Surveillance Program found 1 of 60 women with functional ovarian cysts using OCs (1.7%). Among the 842 controls, 170 or 20% were using OCs. On the basis of those figures, the estimated incidence rate of functional cysts among women aged 20-44 years who do not use OCs is 38/100,000 per year. For women using OCs, it is 3/100,000 per year. The protective effect of OCs came to 35 hospitalizations for functional ovarian cysts prevented per 100,000 OC users per year. Others have demonstrated that functional ovarian cysts regress more quickly when OCs are provided to women. Many clinicians have used OCs to suppress functional ovarian cysts with good success. OCs are known to suppress follicle stimulating hormone and luteinizing hormone, the pituitary gonadotrophins. The Boston Collaborative Drug Surveillance Program reported no protective effect of OCs against nonfunctional ovarian cysts. Most clinicians agree that women who are moderate or even heavy smokers can use OCs if they are under 30 years of age and do not have other contraindications to pills.