Is there an increased risk of cancer with the use of hormonal birth control, progesterone (progestin) implant, or hormonal intrauterine device (IUD)?

From the Guidelines

There is a slightly increased risk of certain cancers associated with hormonal birth control methods, but the overall cancer risk from hormonal contraceptives is very small for most women, and for many, the benefits outweigh these risks. The cancer risk profile varies depending on the type of hormonal contraceptive used. Combined hormonal contraceptives (containing estrogen and progestin) are associated with a small increased risk of breast cancer while currently using them, which returns to baseline within about 5-10 years after stopping, as suggested by a pooled analysis by the Collaborative Group on Hormonal Factors and Breast Cancer in 1996 1. They also slightly increase the risk of cervical cancer with long-term use. However, these same methods significantly reduce the risk of endometrial and ovarian cancers, with protection lasting for many years after discontinuation, as reported in a meta-analysis of 29 good-quality observational studies of endometrial cancer 1. For progestin-only methods like the hormonal IUD (such as Mirena) and the implant (Nexplanon), the cancer risk profile is generally more favorable. The hormonal IUD may reduce endometrial cancer risk, while the implant has not been clearly linked to increased cancer risks. Some key points to consider include:

• The risk of breast cancer associated with combined hormonal contraceptives is small and returns to baseline after stopping use 1.
• The risk of endometrial and ovarian cancers is significantly reduced with the use of combined hormonal contraceptives, with long-lasting protection 1.
• Progestin-only methods have a more favorable cancer risk profile, with the hormonal IUD potentially reducing endometrial cancer risk and the implant not being clearly linked to increased cancer risks.
• Women with a strong family history of breast cancer or other risk factors should discuss their specific situation with their healthcare provider to make an informed decision about contraceptive options, as recommended by the Society of Family Planning guidelines 1. It's essential to weigh the benefits and risks of hormonal contraceptives and consider individual circumstances, such as family history and other risk factors, when making decisions about contraceptive options.

From the FDA Drug Label

Various studies give conflicting reports on the relationship between breast cancer and oral contraceptive use. Oral contraceptive use may slightly increase your chance of having breast cancer diagnosed, particularly if you started using hormonal contraceptives at a younger age. After you stop using hormonal contraceptives, the chances of having breast cancer diagnosed begin to go down and disappear 10 years after stopping use of the pill. Some studies have found an increase in the incidence of cancer of the cervix in women who use oral contraceptives. However, this finding may be related to factors other than the use of oral contraceptives. The risk of having breast cancer diagnosed may be slightly increased among current and recent users of combination oral contraceptives However, this excess risk appears to decrease over time after combination oral contraceptive discontinuation and by 10 years after cessation the increased risk disappears.

Cancer Risk with Hormonal Birth Control:

• There may be a slight increase in the risk of breast cancer with the use of hormonal birth control, particularly when started at a younger age.
• The risk of breast cancer appears to decrease over time after stopping hormonal birth control and disappears 10 years after cessation.
• There is also a possible increase in the risk of cervical cancer, but this may be related to other factors.
• The overall risk of cancer with hormonal birth control is still being studied and debated, and more research is needed to fully understand the relationship between hormonal birth control and cancer risk. 2, 2, 2

From the Research

Cancer Risk Associated with Hormonal Birth Control

• The use of combined oral contraceptives (COCs) has been associated with a temporary and limited increase in breast cancer risk, with some studies suggesting a 20%-30% elevation in risk 3, 4.
• However, the overall cancer odds do not change with the use of COCs, and the risk seems to be temporary, limited to recent or current regular COC use 3.
• COCs may provide a diminished risk for endometrial, colorectal, and ovarian cancers, with some studies suggesting a 50% reduction in risk for endometrial and epithelial ovarian cancer 3, 5, 4.
• The relationship between COC use and liver malignancy risk assessments has provided conflicting findings, with some studies suggesting an increased risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma 3, 5.
• Progestogen-only contraceptives (POCs), such as implants and vaginal rings, may also increase the risk of breast cancer and cervical cancer 6.

Specific Cancer Risks

• Breast Cancer: The risk of breast cancer may be slightly elevated in current and recent young oral contraceptives users, but the absolute number of additional breast cancer cases will be very small 3, 7, 4.
• Cervical Cancer: Current and recent oral contraceptive users may have an increased risk of cervical cancer, which declines after discontinuation of the application of medication 3, 6, 4.
• Endometrial Cancer: Oral contraceptives may reduce the risk of endometrial cancer, with a protective effect that exists many years after the discontinuation of medication 3, 5, 4.
• Ovarian Cancer: Oral contraceptive use may cause protective anovulation and reduce the risk of ovarian cancer, with a powerful reduction that persists for many years after the discontinuation of medication 5, 4.
• Liver Cancer: The relationship between COC use and liver malignancy risk assessments has provided conflicting findings, with some studies suggesting an increased risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma 3, 5.