Contraception after cancer treatment
Does the use of hormonal contraception by women after cancer treatment result in cancer recurrence?
There is very little evidence to guide the selection of contraception for women after cancer treatment. This includes studies of the use of hormonal contraception and the likelihood of cancer recurrence. There are two clinical practice guidelines available, one from the Society of Family Planning and the other by the Society of Gynecologic Oncologists of Canada and two expert reviews that may help guide clinical practice. The rigour employed in these systematic reviews is unclear from the published methodology. However, the following is a summary of the relevant recommendations from these guidelines:
- Caution should be exercised regarding the use of combined hormonal contraceptive methods (containing estrogen and progestin) for women undergoing cancer treatment and in the immediate post-treatment phase due to the risk of venous thromboembolism (VTE).
- There is a theoretical risk of breast cancer recurrence with hormonal contraception after cancer treatment. Non-hormonal methods of contraception (including the copper IUD) are recommended for women with a history of breast cancer (McNaught 2005, Patel 2012).
- Patel A, Schwarz EB, Society of Family Planning. Cancer and contraception. Release date May 2012. SFP Guideline #20121. Contraception 2012 Sep;86(3):191-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22682881.
- McNaught J, Reid RL, SOGC/GOC JOINT AD HOC COMMITTEE ON BREAST CANCER.. Progesterone-only and non-hormonal contraception in the breast cancer survivor: Joint Review and Committee Opinion of the Society of Obstetricians and Gynaecologists of Canada and the Society of Gynecologic Oncologists of Canada. J Obstet Gynaecol Can 2006 Jul;28(7):616-626 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16924781.
- Gompel A, Ramirez I, Bitzer J, European Society of Contraception Expert Group on Hormonal Contraception.. Contraception in cancer survivors - an expert review Part I. Breast and gynaecological cancers. Eur J Contracept Reprod Health Care 2019 Jun;24(3):167-174 Available from: http://www.ncbi.nlm.nih.gov/pubmed/31033361.
- Cagnacci A, Ramirez I, Bitzer J, Gompel A. Contraception in cancer survivors - an expert review Part II. Skin, gastrointestinal, haematological and endocrine cancers. Eur J Contracept Reprod Health Care 2019 Aug;24(4):299-304 Available from: http://www.ncbi.nlm.nih.gov/pubmed/31066294.