Can a patient with a history of nasopharyngeal cancer treated with chemotherapy use oral contraception (birth control pills) for polycystic ovary syndrome (PCOS) to regulate her menstrual cycles?

Oral Contraception for PCOS in a Patient with History of Nasopharyngeal Cancer

Oral contraceptives can be safely used for PCOS management in a patient with a history of nasopharyngeal cancer treated with chemotherapy, as there are no contraindications between these treatments.

Rationale for Safety of Oral Contraceptives

The clinical practice guidelines for nasopharyngeal carcinoma (NPC) treatment focus primarily on the optimal chemotherapy and radiotherapy protocols for cancer management 1. None of these guidelines mention any contraindications between NPC treatments and subsequent use of oral contraceptives.

The treatment of NPC typically involves:

• Radiotherapy as the primary treatment modality
• Concurrent chemotherapy (typically platinum-based)
• Possible induction or adjuvant chemotherapy depending on disease stage

After completion of cancer treatment, there are no specific restrictions on the use of hormonal contraceptives for managing other conditions such as PCOS.

PCOS Management After Cancer Treatment

For patients with PCOS who have completed cancer treatment:

1. Oral contraceptives are the first-line therapy for managing menstrual irregularities in PCOS
2. Combined hormonal contraceptives help regulate menstrual cycles by:
   • Suppressing ovarian androgen production
   • Increasing sex hormone-binding globulin
   • Reducing free testosterone levels
   • Providing endometrial protection

Important Considerations

Fertility Concerns

• If the patient has fertility concerns, this should be discussed, as both cancer treatments and PCOS can affect fertility
• According to ESMO guidelines on cancer and fertility, fertility preservation methods should be discussed before initiating cancer treatment 1
• For patients who have already completed cancer treatment, fertility assessment may be warranted before starting hormonal contraceptives

Monitoring Recommendations

• Regular follow-up appointments to assess:
  • Effectiveness of PCOS symptom control
  • Any side effects from oral contraceptives
  • Ongoing cancer surveillance as per oncology guidelines

Contraindications to Consider

• Standard contraindications to combined hormonal contraceptives still apply:
  • History of thromboembolic events
  • Uncontrolled hypertension
  • Migraine with aura
  • Active liver disease
  • Estrogen-dependent malignancies

Conclusion

There is no evidence in current clinical practice guidelines suggesting that oral contraceptives are contraindicated in patients with a history of treated nasopharyngeal carcinoma. The focus of NPC treatment guidelines is on optimal cancer therapy protocols 1, 2, with no mention of restrictions on subsequent hormonal treatments for non-cancer conditions.

The patient can safely use oral contraceptives to manage her PCOS symptoms and regulate her menstrual cycles after completing chemotherapy for nasopharyngeal cancer.