Does progestin‑only contraception increase cervical cancer risk in reproductive‑age women?

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Last updated: February 18, 2026 • View editorial policy

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Does Progestin Increase Cervical Cancer Risk?

Progestin-only contraception does not appear to increase cervical cancer risk, while combined estrogen-progestin contraceptives modestly increase risk only with prolonged use (≥5 years) in women with persistent HPV infection. 1, 2

Key Distinction: Progestin-Only vs. Combined Contraceptives

The critical factor is whether the contraceptive contains estrogen in addition to progestin:

Progestin-Only Contraception

  • Current or recent users of progestin-only contraception show NO increased cervical cancer risk (RR 0.91,95% CI 0.78-1.07) in the most recent large cohort study of over 20 million person-years. 2
  • This finding is particularly important because it demonstrates that progestin alone does not drive cervical carcinogenesis. 2
  • The systematic review examining studies that controlled for HPV infection found insufficient evidence to conclude that progestin-only methods increase risk. 3

Combined Estrogen-Progestin Contraceptives

  • Current or recent users of combined contraceptives have a modestly increased risk (RR 1.40,95% CI 1.28-1.53) compared to never users. 2
  • The risk increases with duration of use: no increased risk for <5 years of use (OR 0.73), but OR 2.82 for 5-9 years and OR 4.03 for ≥10 years of use in HPV-positive women. 4
  • This translates to approximately 1 extra cervical cancer per 14,700 women using combined contraceptives for 1 year. 2
  • The risk applies to both adenocarcinoma (RR 1.29) and squamous cell carcinoma (RR 1.31). 2

Clinical Context: HPV as the Primary Driver

Persistent HPV infection is the essential causative factor for cervical cancer, not hormonal contraception. 5

  • HPV types 16 and 18 account for approximately 70% of cervical cancers. 5
  • Combined contraceptives appear to act as a cofactor that increases risk up to four-fold only in women already positive for cervical HPV DNA. 4
  • The mechanism may involve hormonal promotion of HPV-DNA integration into the host genome and modulation of cell apoptosis. 6

Risk Patterns and Reversibility

The increased risk with combined contraceptives shows important temporal patterns:

  • Risk declines after discontinuation and returns to baseline after >10 years since last use. 6, 4
  • The risk pattern increases with longer duration of use and declines after stopping, possibly taking longer to disappear among prolonged users. 2
  • Ten-year combined oral contraceptive use from age 20 increases cumulative incidence of invasive cervical cancer at age 50 by approximately 1 case per 1,000 women. 6

FDA Drug Label Perspective

The FDA label for medroxyprogesterone acetate (a progestin-only injectable) states that long-term surveillance found no overall increased risk of cervical cancer and notes only a statistically insignificant increase in invasive squamous-cell cervical cancer in women first exposed before age 35 (RR 1.22-1.28,95% CI 0.93-1.70). 7

Guideline Recommendations

The CDC indicates that long-term use (≥5 years) of combined hormonal contraceptives may increase cervical carcinoma risk among women with persistent HPV infection. 1

However, the American College of Obstetricians and Gynecologists recommends that women with cervical intraepithelial neoplasia can use hormonal contraceptives (Category 2, benefits generally outweigh risks). 1

Critical Prevention Strategies

Given the modest risk with combined contraceptives and no risk with progestin-only methods:

  • Systematic cervical cancer screening remains the cornerstone of prevention, as screening and treatment of precancerous lesions lead to reductions in cervical cancer incidence, morbidity, and mortality. 5
  • HPV vaccination is essential, particularly for users of combined contraceptives who were not vaccinated. 5, 2
  • Long-term users of combined oral contraceptives should receive extra effort to include them in cervical screening programs. 4

Important Caveats

  • Most studies do not adequately differentiate between combined oral contraceptives and progestin-only pills by recency or duration of use, which clouds interpretation. 3
  • The absolute increase in cervical cancer risk from combined contraceptives is very small compared to the substantial protective effects against ovarian (40-60% reduction) and endometrial cancer (50% reduction). 1
  • Injectable progestin-only contraception (DMPA) showed increased CIN3 incidence in one study (aOR 1.6), but this finding requires confirmation. 3

References

1
Guideline

Risk of Cancer with Hormonal Birth Control

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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