Contraception and Menstrual Suppression for Adolescent and Young Adult Oncology Patients

According to the 2013 National Youth Risk Behavior Survey (YRBS) (Abma and Martinez. Natl Health Stat Report 104:1–23, 2017), 47% of high school students in the United States (USA) admitted to previous sexual intercourse, and of those, 14% did not use any method of pregnancy prevention (Brener et al. MMWR Recomm Rep (Morb Mortal Wkly Rep Recomm Rep/Centers Dis Control) 62:1–20, 2013). An unintended pregnancy during cancer treatments may result in a delay in therapy or teratogenic exposure (Committee opinion no. 607 Obstet Gynecol 124:403–408, 2014). These complications, in addition to several other psychosocial and healthcare considerations, may warrant recommendation for abortion, which can be difficult to access, further delaying important care. For many of these patients, unintended pregnancy may also be associated with an unacceptable increase in general health risk. Therefore, an open and early discussion about contraceptive needs and options is essential to the overall care of the adolescent and young adult oncology patient. Choosing a contraceptive method is an important decision with many involved factors for both patients and physicians. We must consider the efficacy and safety profile of each method, as well as how the method fits into each patient’s lifestyle, including technical, social, and religious factors, among others. In the adolescent oncology patient, these issues can compound quickly. Medically, these patients present increased challenges due to their underlying diagnoses and the increased thromboembolic risk associated with malignancy. A thorough discussion of indicated contraceptive methods should be undertaken with each patient, with focus placed on efficacy and safety. An added benefit (or alternative use) of contraceptive medications during cancer treatment has been to elicit menstrual lightening and suppression, especially in patients with low blood count, menorrhagia, and/or risk of bone marrow suppression. Additionally, every social situation is unique, and we must remember to ensure confidentiality in our adolescent patients.