The effect of oral contraceptive pill cessation on hepatocellular adenoma diameter: A retrospective cohort study

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BACKGROUND & AIMS: Hepatocellular Adenomas (HCA) are rare, hormone driven, benign liver tumors. HCA >50mm are associated with hemorrhage and malignant transformation. Guidelines recommend cessation of oral contraceptive pills (OCP) for size reduction, however, it is currently unknown how HCA respond to cessation of OCP. We sought to investigate the effect of OCP cessation on HCA size.

METHODS: A retrospective cohort study was performed including HCA patients who stopped OCP intake within six months of imaging between 2005-2018. Biometrics and hormonal medication use were evaluated with self-designed questionnaires. Response of the largest HCA was evaluated according to Response Evaluation Criteria in Solid Tumors (RECISTv1.1). Cox regression was performed for analysis of factors influencing HCA regression.

RESULTS: Seventy-eight HCA patients were included, diagnosed at a median (IQR) age of 32 (26-41) years. Follow-up was 1.6 (0.4-2.9) years. HCA size at diagnosis ranged 10-167mm. After a median time of 1.3 (0.6 - 2.6) years after OCP cessation, 37.2% of HCA showed >30% regression, 5.1% complete regression, 56.4% stability, and 1.3% progression. No HCA induced complications were observed during follow-up. Cox regression analysis demonstrated a significant association of HCA size with rate of regression; 50≤HCA<100mm (HR 2.4, 95% CI 1.1-5.3; p<0.05), HCA>100mm (HR 8.3, 95% CI 3.3-21.6; p<0.001).

CONCLUSIONS: Ninety-eight percent of HCA remained stable or regressed after OCP cessation. A longer wait-and-see period was associated with a larger proportion of regressing HCA, without HCA related complications during follow-up. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)905-913
Number of pages9
JournalLiver International
Issue number5
Publication statusPublished - May-2019


  • hepatocellular adenoma
  • oral contraceptive pill
  • regression
  • treatment algorithm
  • SEX

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