Cancer and Contraceptive

Cancer And Contraceptive

Contraception in individuals with current or past cancer requires special considerations due to potential hormonal sensitivity, thrombotic risk, and interactions with ongoing treatments.

Why is special consideration needed?

1. Hormone-sensitive cancers (e.g., breast, endometrial): Estrogen and sometimes progestin may stimulate cancer growth. Hence knowing the type of cancer and its sensitivity to hormones has to be checked.

2. Thrombogenic risk: Cancer and certain cancer treatments elevate the risk of venous thromboembolism (VTE), contraindicating estrogen use.

3. Drug interactions: Chemotherapy or enzyme-inducing agents may affect contraceptive efficacy.

4. Fertility concerns: Contraceptive counseling is crucial for spacing pregnancy and managing fertility preservation before treatment.

Cancer type	Combined Hormonal Contraceptive (CHCs)	Progesterone only methods	IUD (Cu and LNG
Breast cancer - present or within 5 yrs	Cat 4	Cat 4	Cu-IUD: Cat 2, LNC -IUD -Cat 3/4
Breast cancer -past ,> 5yrs and presently no evidence	Cat 3	Cat 3	Cu-IUD :Cat 1
Cervical cancer	Cat 3	Cat 2	Ca-IUD: cat 4 if distorted anatomy
Liver cancer, cervical cancer	Cat 4	Cat 3	Cu IUD -cat 1
Leukemia, lymphoma	Cat 2-3	Cat 2	Cu IUD: caution if immunosuppressed
Endometrial or ovarian cancer	Cat 3-4	Cat 2	Cu-IUD :Cat 2-3

PREFERRED CONTRACEPTIVE OPTIONS

1. Non-hormonal

Copper IUD: Most suitable for hormone-sensitive cancers; long-acting and reversible.

Barrier methods: Condoms or diaphragms; safe but with higher failure rates.

Permanent methods: Tubectomy or vasectomy – for completed families.

1. Hormonal – only if no contraindication

Progestin-only pills, injectables, LNG-IUD: Caution in hormone-sensitive cancers; suitable for others.

Avoid CHCs (pills, patch, ring) in estrogen-sensitive cancers or with high thrombotic risk.

Additional Considerations

1. Post-treatment: Re-evaluate contraceptive options based on cancer status and recurrence risk.

2. Adolescents and young adults (AYA): Discuss fertility preservation before initiating cancer therapy.

3. Palliative care: Tailored to patient’s comfort and priorities; low-dose or barrier methods preferred.

References:

1. WHO Medical Eligibility Criteria for Contraceptive use ,5th edition (2015,updated 2022)

1. FSRH (UK)-Guidance on cancer and contraception