Functional ovarian cysts associated with the levonorgestrel releasing intrauterine device.

Of the 50 clients at the Margaret Pyke Center (London) fitted with a levonorgestrel-releasing IUD 6 (12%) have developed functional ovarian cysts between 6 weeks and 1 year postinsertion. The cysts all of which were confirmed by ultrasound examination varied in size between 3-7 cm diameter. The IUD in question released 20 mcg of levonorgestrel daily. In 4 cases the women were asymptomatic and the cysts resolved spontaneously within 6 weeks. Laparoscopy was undertaken in the 2 cases in which symptoms (dyspareunia and abdominal pain) were reported. 5 of the 6 women continued use of the IUD; the 1 device that was removed was for personal reasons unrelated to the ovarian cyst. It appears that progestagen-only contraceptive methods that disturb (rather than inhibit) ovulation are associated with an increased incidence of functional ovarian cysts. It would also seem that the levonorgestrel IUD although principally active at the uterine level also has an effect on ovarian function.