It has been shown that, in general, centers caring for AYA oncology patients do not routinely discuss sexual health with their patients and therefore survivors have limited awareness of the contraceptive options available to them.  Even though specific data if not available for unintended pregnancy among cancer survivors, we do know that survivors in the 15-30 year old range are more likely than their peers to terminate a pregnancy. For women who have been cancer –free for at least six months and are without a history of chest wall radiation, hormonally mediated cancers, anemia, osteoporosis or VTE, the use of all of the above noted contraception options are available.  Women with a history of chest wall radiation are at an increased risk of breast cancer and may not be candidates for exogenous hormones, therefore the copper IUD would be first line in these patients.  However, some physician will allow modern hormone formulations, as they no longer show an increased risk of breast cancer in the general population.  In general, the important point to note is that AYA individuals with cancer need to be aware of their sexual health options during all stages of their diagnosis and treatment and all health care providers should become comfortable with at least asking the questions. (3)

Menstrual Lightening/Suppression

In cancer patients, suppression of periods is mainly used to prevent anemia and thrombocytopenia but is also used to provide relief of menstrual symptoms. Patients with thrombocytopenia are at increased risk for hemorrhage, therefore cessation of periods is crucial. The aim is for high efficacy without causing any harm.

Per WHO definitions; amenorrhea is defined as absence of bleeding or spotting within a 90-day time interval.

GnRH agonist

Progestin-only Pills

Depot Medroxyprogesterone Acetane (DMPA)

Combined Hormonal Contraception

Levonorgestrel-IUD

 

References