Preoperative hormonal therapy of cystic adnexal masses

Two hundred and eighty-six patients between the ages of 16 and 48 with a cystic adnexal mass were treated with estrogen and progesterone for 6 weeks. Persistence of the adnexal mass occurred in 81 patients and surgical exploration was done. All patients explored with an ovarian enlargement had an ovarian neoplasm causing the enlargement. There were 7 patients with normal-sized ovaries but an associated paraovarian cyst or unilateral hydrosalpinx was found. No patient was subjected to surgical exploration with the finding of a physiologic cyst causing the adnexal mass. In this series suppression of the pituitary gonadotropins for 6 weeks was long enough to cause all significant physiologic cysts to regress. It would seem that menstruating women with a cystic adnexal mass and a differential diagnosis that includes a physiologic cyst should not be subjected to operation without a trial of pituitary suppression. Also, the use of pituitary suppression with estrogen and progestogen removes the indecision as to how long a physiologic cyst will remain before undergoing regression.