Does a history of endometrial cancer contraindicate the use of Oral Contraceptive Pills (OCPs)?

From the Guidelines

Endometrial cancer does not necessarily disqualify you from using oral contraceptive pills (OCPs), but the decision requires careful consideration with your healthcare provider. The use of combined oral contraceptives has been shown to decrease the risk of endometrial neoplasia, reducing its incidence in pre-menopausal and peri-menopausal women 1. However, if you have active endometrial cancer, hormonal contraceptives are typically not recommended as first-line treatment since treatment would focus on addressing the cancer itself through surgery, radiation, or other cancer-specific therapies.

For survivors of endometrial cancer who have completed treatment and are in remission, combined oral contraceptives may be considered on a case-by-case basis. The estrogen and progesterone in combined OCPs can actually provide some protection against endometrial cancer recurrence in certain cases, as progesterone helps counteract estrogen's proliferative effects on the endometrium 1. Some key points to consider include:

• The specific cancer type and stage
• Hormone receptor status
• Time since treatment
• Risk of recurrence
• Other individual health factors

Progestin-only pills might be a safer alternative for some endometrial cancer survivors. Your oncologist and gynecologist should make this decision together, taking into account the above factors. Regular monitoring would be essential if OCPs are prescribed after endometrial cancer. It's also worth noting that estrogen replacement therapy for patients with endometrial cancer who are at low risk for tumor recurrence may be a reasonable option, but this should be individualized and discussed in detail with the patient 1.

From the Research

Endometrial Cancer and Oral Contraceptive Pills

• Endometrial cancer does not necessarily disqualify someone from using oral contraceptive pills (OCPs), but the decision to use OCPs should be made on a case-by-case basis, considering the individual's specific situation and medical history 2, 3, 4.
• Studies have shown that OCPs can reduce the risk of endometrial cancer by about 50%, with the protective effect persisting for more than 10-15 years after cessation of use 2, 3.
• The use of OCPs in women with a history of endometrial cancer is generally not recommended, except in exceptional cases, due to the potential risk of systemic side effects 2.
• For women at high risk of endometrial cancer, the use of OCPs may be considered as a form of chemoprevention, but the potential increase in breast cancer risk must also be taken into account 4.

Factors to Consider

• The type and dosage of OCPs used can affect the risk of endometrial cancer, with combined oral contraceptives (COCs) containing higher progestogen potency appearing to be more effective in reducing the risk 2, 3.
• The duration of OCP use is also an important factor, with longer duration of use associated with a greater protective effect 2, 3.
• Other forms of hormonal contraception, such as the levonorgestrel-releasing intrauterine system (LNG-IUS), may also be effective in reducing the risk of endometrial cancer, but more research is needed to fully understand their effects 2, 5.

Special Considerations

• Women with a family history of female cancer, including endometrial cancer, may need to consider the potential risks and benefits of OCP use more carefully, and alternative forms of contraception may be recommended 4.
• For women with early-stage endometrial cancer who desire to preserve fertility, oral progestins and LNG-IUS may be considered as treatment options, with the goal of achieving a complete response within 1 year 5.