An unintended pregnancy during cancer treatments may result in delay in therapy, teratogenic exposure and/or pregnancy termination (1). For many of these patients, unintended pregnancy is associated with an unacceptable health risk. Therefore, an open and early discussion about contraceptive needs and options is essential to the overall care of the adolescent and young adult oncology patient. Choosing a contraceptive method is an important decision with many involved factors for both patients and physicians. We must consider the efficacy and safety profile of each method, as well as the how the method fits into the patient’s lifestyle (technically, socially, religiously, etc…). In the adolescent oncology patient, these issues can compound quickly. Medically, these patients’ present increased challenges due to their underlying diagnoses and the increased risk of thrombotic disease associated with all malignancy. Every social situation is unique and we must remember to ensure confidentiality. An added benefit (or alternative use) of contraceptive medications during cancer treatment has been to elicit menstrual suppression, especially in patients with low blood count, menorrhagia and/or risk of bone marrow suppression. A thorough discussion of indicated contraceptive methods should be undertaken with each patient, with focus placed on efficacy.
The Centers for Disease Control and Prevention adapted the World health organization (WHO) guidance to create the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, (2) for use by health care provider. It can be found in its complete form at www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm , and ranks contraceptive methods based a four point scale (1- no restrictions for use, 4-unacceptable for use) (2) for a large number of medical conditions. The only cancers outlined specifically are ovarian, cervical, breast cancer, gestation trophoblastic neoplasia, and malignant hepatoma. However, there is a special designation under high risk of DVT/PE for active cancer (metastatic, on therapy, or within 6 months of clinical remission, excluding non-melanoma skin cancer) that is also of great importance in our patient population. The WHO also classifies contraception based on efficacy into four tiers (3):
Tier 1 (Most Effective): Sterilization, Implants, Intrauterine devices
Tier 2: DMPA, Combined hormonal methods
Tier 3: Barrier Methods
Tier 4: Behavioral Methods
Through the links below we will outline all available methods of contraception and discuss their efficacy, safety profiles, ease of use and common side effects. We will also note any particular concerns in the oncology population. For more detailed information regarding contraception in cancer patients and survivors go here.
To learn more about the role of contraception in cancer survivors, click here.