From the Guidelines
When considering the use of oral contraceptives ("the pill") during chemotherapy for leukemia while also on goserelin, it's generally not recommended to use hormonal contraceptives. Patients undergoing chemotherapy for leukemia should use non-hormonal contraception methods such as barrier methods (condoms, diaphragms) or copper IUDs instead. This recommendation stems from several concerns: chemotherapy can reduce the effectiveness of hormonal contraceptives, potentially leading to unplanned pregnancy; hormonal contraceptives might interfere with chemotherapy efficacy; and the combination could increase thrombosis (blood clot) risk, which is already elevated in cancer patients. Additionally, goserelin (a GnRH agonist that suppresses ovarian function) is often used to protect fertility during chemotherapy, and combining it with hormonal contraceptives is contradictory since goserelin creates a temporary menopausal state, as noted in the study by 1. Important questions to discuss with your oncologist and gynecologist include:
- how long to continue non-hormonal contraception after completing treatment
- whether your specific chemotherapy regimen has unique contraindications
- how goserelin affects your contraceptive needs
- potential side effects from the combination of treatments
- fertility preservation options, such as embryo or oocyte cryopreservation, which is the main method to preserve female fertility, as recommended by 1. These healthcare providers can offer personalized guidance based on your specific leukemia type, treatment protocol, and individual health factors. It is also crucial to consider the current state of evidence on GnRHa, which suggests that it should not be considered a proven fertility preservation method, and patients should always be counseled to rely on methods with proven effectiveness in fertility preservation, as stated in the study by 1.
From the Research
Clinical Questions to Ask About Being on the Pill During Chemotherapy for Leukemia and Also on Goserelin
- What are the potential interactions between the pill and chemotherapy medications, such as cytarabine and daunorubicin, used to treat leukemia 2?
- How may the use of goserelin, a gonadotropin-releasing hormone agonist, affect the risk of thromboembolic events during chemotherapy 3, 4, 5?
- Are there any specific risk factors for thromboembolic events that should be considered in patients with leukemia undergoing chemotherapy, such as liver metastases or the administration of high doses of corticosteroids 3, 4, 5?
- What are the current guidelines for preventing venous thromboembolism in cancer patients undergoing chemotherapy, and how may these apply to patients with leukemia 4?
- Are there any alternative treatments or therapies that may be considered for patients with leukemia who are at high risk of thromboembolic events or who are experiencing adverse effects from chemotherapy 6, 4?
- How may the pill affect the efficacy or toxicity of chemotherapy medications, and what monitoring or adjustments may be necessary to minimize potential interactions 2, 4?