With increasing trends in both cancer diagnosis and survivorship, a growing number of individuals impacted by cancer need high-quality contraceptive counseling. Individuals with cancer and cancer survivors have individualized needs with respect to sexual activity, fertility desires, and contraceptive preferences. Clinicians should provide person-centered contraceptive care that supports individual autonomy in decision-making, is tailored to the individual’s expressed preferences and values, and includes cancer-specific considerations. While pregnancy prevention is generally recommended during cancer treatment, pregnancy may occur before or during treatment and require person-centered counseling. No test reliably rules out pregnancy potential in cancer survivors; clinicians should offer to discuss contraception with individuals who are pregnancy-capable before cancer treatment. Clinicians should counsel individuals about common risks and complications that may impact contraceptive choice, as cancer and chemotherapy can cause (1) vascular injury, which can increase the risk of venous thromboembolism, (2) anemia, and (3) bone loss increasing the risk of fractures. Clinicians should counsel individuals with cancer that it is safe for them to use emergency contraception. Clinicians should be aware that individuals experiencing intimate partner violence and other marginalized populations, including adolescents and young adults and gender-diverse individuals, have unique needs requiring a person-centered approach to contraceptive care complicated by cancer. Access to the full spectrum of contraceptive methods should be prioritized for individuals with cancer and cancer survivors, accommodating individual preferences and health status.

This Clinical Recommendation provides evidence-informed, person-centered, and equity-driven recommendations to facilitate the management of and access to contraceptive care for individuals who are diagnosed with, being actively treated for, or who have previously been treated for breast, ovarian, uterine, or cervical cancer. For individuals with a history of breast cancer, we recommend nonhormonal contraceptives as the first-line option (GRADE 1B); additional guidance is provided for hormonal contraception depending on breast cancer hormone receptor status. For individuals with a history of or active ovarian cancer, we recommend clinicians provide access to all available contraceptive methods utilizing a person-centered approach (GRADE 1B); in individuals diagnosed with hormonally-sensitive ovarian malignancies, such as adult granulosa cell tumors, low-grade serous, and endometrioid adenocarcinomas, who are considering hormonal contraception, we suggest shared decision-making with the individual and their oncologist (GRADE 2C). Estrogen-containing contraceptives should be avoided by individuals treated with estrogen-blocking therapy (Best Practice). For individuals with a history of endometrial cancer, we recommend clinicians provide access to all available contraceptive methods utilizing a person-centered approach (GRADE 1B); in individuals with active endometrial cancer requesting an intrauterine device (IUD), we suggest shared decision-making with the individual and their oncologist (GRADE 1B). Recommendations for individuals with gestational trophoblastic disease are provided based on factors such as evidence of persistent intrauterine disease, human chorionic gonadotropin (hCG) levels, and the individual’s preferred contraceptive method. For individuals with cervical dysplasia or a history of cervical cancer, we suggest clinicians provide access to all available contraceptive methods (GRADE 2B); we suggest against IUD placement in individuals with active cervical malignancy (GRADE 2C).

This Clinical Recommendation provides evidence-informed, person-centered, and equity-driven recommendations to facilitate the management of and access to contraception care for individuals who are diagnosed with, being actively treated for, or who have previously been treated for skin, blood, gastrointestinal, liver, lung, central nervous system, and other cancers. For individuals with a history of nonmelanoma skin cancers, we recommend clinicians provide access to all available contraceptive methods utilizing a person-centered approach (GRADE 1B). Based on expert opinion, for individuals with a history of melanoma who are considering hormonal contraception, we suggest shared decision-making with the individual and their oncologist (GRADE 2C). For individuals with a history of myeloproliferative neoplasms, lymphatic or hematopoietic cancer, and hematopoietic stem cell transplantation, we recommend clinicians provide access to all contraceptive methods (GRADE 1B); we suggest shared decision-making in those with follicular lymphoma subtype of non-Hodgkin lymphoma who are considering hormonal contraception (GRADE 2C). For individuals with a history of colorectal, pancreatic, esophageal, and gastric cancer, we recommend clinicians provide access to all available contraceptive methods (GRADE 1C). We recommend clinicians provide access to all available contraceptive methods in individuals with a history of primary hepatocellular carcinoma with normal liver function (GRADE 1C); with severely altered liver function, we recommend nonhormonal and progestin-only contraceptives as first-line contraceptive methods (Grade 1B). For individuals with a history of glioma, we recommend clinicians provide access to all available contraceptives (GRADE 1B). For individuals with a history of meningioma who request hormonal contraception, we recommend shared decision-making with the individual and their oncologist (GRADE 2B). We recommend clinicians provide access to all available contraceptive options for individuals with a history of or active bladder, kidney, thyroid, head and neck squamous cell, and soft tissue sarcomas (Grade 1B).