Safety of Estrogen-Type Birth Control in Patients with Ewing Sarcoma
Long-acting reversible contraception (LARC) methods such as intrauterine devices (IUDs) are preferred over estrogen-containing hormonal contraceptives for patients with Ewing sarcoma due to the increased risk of venous thromboembolism (VTE) associated with estrogen-based contraceptives.
Contraception Recommendations for Cancer Patients
- The U.S. Centers for Disease Control and Prevention recommends avoiding combined hormonal contraceptive methods (which contain estrogen) in women with active cancer or who have been treated for cancer in the past 6 months due to the increased risk of venous thromboembolism (VTE) 1
- The Society of Family Planning guidelines recommend the use of IUDs or implantable contraceptives (LARC methods) as first-line contraceptive options for most women receiving cancer treatment 1
- LARC methods have been shown to be superior to short-acting contraceptives with higher 12-month adherence rates (86% vs. 55%) and lower contraceptive failure rates in young women 1
Specific Concerns for Ewing Sarcoma Patients
- Ewing sarcoma patients undergo intensive multiagent chemotherapy regimens that may increase the risk of thrombotic complications 1
- The combination of cancer-related hypercoagulability and estrogen-containing contraceptives could potentially increase VTE risk 1
- While there is no specific evidence showing estrogen receptors in Ewing sarcoma tissue 2, the general recommendation for cancer patients is to avoid estrogen-containing contraceptives during active treatment and for at least 6 months afterward 1
Preferred Contraceptive Options
- Intrauterine devices (IUDs) are considered the preferred first-line contraceptive option for women with a history of cancer 1
- Progestin-only methods (including levonorgestrel-containing IUDs, progestin-only pills, or implants) provide effective contraception without the thrombotic risks associated with estrogen 1
- For patients concerned about fertility preservation, discussions about contraception should be integrated with fertility preservation counseling before starting therapy 1
Special Considerations for Female Ewing Sarcoma Patients
- Fertility preservation options should be discussed with all Ewing sarcoma patients before starting treatment, as chemotherapy and radiation may affect future fertility 1
- Pelvic Ewing sarcoma patients receiving radiation therapy may benefit from ovarian transposition to reduce radiation exposure to the ovaries 1
- Some patients with pelvic Ewing sarcoma may experience permanent ovarian damage from treatment, potentially leading to premature ovarian failure 3
Timing Considerations
- Any method of contraception is generally acceptable for women who have been cancer-free for at least 6 months and have no history of VTE 1
- After 6 months post-treatment with no recurrence, estrogen-containing contraceptives may be reconsidered if there are no other contraindications 1
Follow-up Recommendations
- Regular follow-up with both oncology and gynecology providers is recommended to monitor for any complications and adjust contraceptive methods as needed 1
- Surveillance for Ewing sarcoma recurrence should continue regardless of contraceptive choice, with physical exams and imaging studies every 3 months initially 1
In summary, while there is no direct evidence that estrogen-containing contraceptives specifically affect Ewing sarcoma outcomes, the general oncology guidelines recommend avoiding estrogen-containing contraceptives during active cancer treatment and for 6 months afterward due to VTE risk. LARC methods provide safer and more effective contraception for these patients.