Contraception in Breast Cancer Patients

Introduction to Contraceptive Guidelines

• The European School of Oncology-European Society for Medical Oncology (ESO-ESMO) guidelines state that hormonal contraception is generally contraindicated in breast cancer survivors 1
• The American Society of Clinical Oncology (ASCO) guidelines emphasize that hormone receptor-positive breast cancers represent the majority of breast cancers worldwide and are treated with endocrine therapy 4

Non-Hormonal Contraceptive Options

• Non-hormonal contraception methods are strongly preferred, including copper IUDs, barrier methods such as condoms and diaphragms, and permanent methods like tubal ligation or vasectomy 1
• Copper IUD (non-hormonal) provides effective long-term contraception without hormonal effects 5

Considerations for Hormone Receptor-Positive Breast Cancer

• For patients with hormone receptor-positive breast cancer, endocrine therapy is the preferred treatment option, and adding hormonal contraception could potentially interfere with endocrine therapy or increase recurrence risk 2, 3

Management of Sexual Health

• Sexual dysfunction is a major issue for breast cancer patients, especially those on endocrine therapy, and first-choice treatments for vaginal symptoms include non-hormonal therapies such as vaginal moisturizers, lubricants, and gels 1
• Vaginal dilators for pain or stenosis and pelvic floor physical therapy are also recommended 6

Clinical Decision-Making

• The European School of Oncology-European Society for Medical Oncology (ESO-ESMO) guidelines recommend considering patient-specific factors, such as time since diagnosis and current endocrine therapy, when choosing a contraceptive method 1
• The American Society of Clinical Oncology (ASCO) guidelines suggest that Mirena should only be considered as a last resort after thorough discussion of risks 1