Special Medical Factors

Birth Control Considerations

Low blood counts (anemia or thrombocytopenia)  

Anemia is common in women with cancer, especially lung cancer or female cancers like cervical, uterine, or ovarian cancer. The copper IUD is not a good choice for anemic women because it increases menstrual bleeding. An IUD with levonorgestrel may be a good choice because it reduces bleeding during menstrual periods.  

High risk of osteoporosis   

Many women reach menopause at an unusually early age after cancer treatments that include chemotherapy or pelvic radiation therapy. They lose strength in their bones because of a lack of the hormone estrogen. Bone loss can also occur during a temporary period of menopause. Birth control methods that include estrogen can reduce bone loss and may be a good choice if the cancer was not hormone-sensitive, especially once active treatment is over. Injectable DMPA (Depo) may not be a good choice since it may increase the risk of osteoporosis.  

Heavy menstrual bleeding  

Heavy menstrual bleeding can be a problem, especially for women with leukemia or other cancers of the blood who are on chemotherapy. One solution is to prescribe a GnRH agonist or antagonist, drugs that temporarily turn off the ovaries (for example leuprolide or goserelin). These medications do not always prevent pregnancy, however. A birth control method that also reduces menstrual bleeding is the IUD with levonorgestrel. 

Weak Immune System 

Women on chemotherapy often have weakened immune systems that increase their risk of all kinds of infections. In the past, doctors worried that women with IUDs were more likely to get sexually transmitted infections. Recent research suggests that women with cancer can use IUDs safely while the immune system is weakened, but more data would be reassuring.  

High risk of venous thrombo-embolism (blood clots)

Blood clots are more common during and soon after cancer treatment. Blood clots can travel to the heart or lungs and cause serious illness or death. Women with cancer of the stomach or pancreas have especially high blood clot risk. All women should avoid a birth control method that includes estrogen during active cancer treatment and for at least six months after the end of cancer treatment because estrogen increases the risk of clotting. It is unclear if birth control methods that only use progesterone hormones increase the risk of blood clots, however.  

Scarring in upper vagina 

If you have had surgery or radiation therapy for vaginal, cervical, uterine, bladder, anal, or colorectal cancer, the upper part of your vagina may be scarred or abnormal in shape so that a diaphragm or cervical cap would not fit correctly to provide reliable birth control.  

Colostomy or ileostomy

Birth control pills (oral contraceptives) can be a problem for women who have a colostomy or even more so, an ileostomy, because the hormones pass through the digestive system without getting absorbed into the bloodstream. A patch, injection, implant, or vaginal ring type of hormonal birth control should work well, however.  

Hormone-sensitive cancer (breast, uterine, or ovarian cancer)

Birth control pills or other types of hormonal birth control are usually not recommended, especially in hormone receptor-positive cancers (estrogen or progesterone). A large scale study of US women between the ages of 20 and 44 shows that using the injectable contraceptive, DMPA, is associated with two fold increase in the risk of invasive breast cancer when the contraceptive is used for at least one year. Another option for young breast cancer survivors is the copper IUD which is highly effective and does not contain any hormones. Some cancers of the uterus, fallopian tubes, or ovaries can be sensitive to hormones. Women with these types of cancer should ask their doctors if it is safe to use birth control containing hormones. IUD safety has not been studied for women with ovarian cancer.  

History of radiation therapy to the chest in childhood or teen years  

Women who had radiation therapy to the chest area as children or teens (for example for Hodgkin Lymphoma) have a very high risk of getting breast cancer at an early age. Their safest form of effective, reversible birth control is the copper IUD. It is best to avoid methods that contain estrogen. Progesterone-only types of birth control may be safer, but more research is needed.  

Carriers of BRCA or other genetic mutations that increase the risk of breast and ovarian cancer

Women who have mutations in the BRCA1 or BRCA2 gene have very high lifetime risks of breast and ovarian cancer. They are often advised to use hormonal birth control methods. There is no evidence that modern types of birth control pills, which have lower hormone levels than pills made before the 1980s, increase the risk of breast cancer in BRCA mutation carriers, but more research is needed. When it comes to ovarian cancer, however, each 10 years of using birth control pills cuts a BRCA carrier's risk by about one-third.