Contraception and trophoblastic tumours

Contraception and hormone replacement therapy:

• the combined oral contraceptive pill and hormone replacement therapy are safe to use after hCG levels have reverted to normal
• the combined oral contraceptive pill, if taken while hCG levels are raised, may increase the need for treatment. However, it can be used safely after the hCG levels have returned to normal
• other forms of hormonal contraception do not appear to be linked to an increased need for treatment (1). However the primary care clinician should seek expert guidance on when other forms of hormonal contraception should be used
  • the guidance from a specialist centre is that ALL forms of hormonal contraception should be avoided until hCG levels have returned to normal (2)
• the small potential risk of using emergency hormonal contraception, in women with raised hCG levels, is outweighed by the potential risk of pregnancy to the woman
• hormone replacement therapy may be used safely once hCG levels have returned to normal.

Reference:

1. Royal College of Obstetricians and Gynaecologists (February 2004). Guideline No. 38 - The Management of gestational trophoblastic neoplasia.
2. Personal email communication (9/10/06). Delia Short, Service Manager / Co-ordinator, Trophoblastic Tumour Screening & Treatment Centre, Department of Medical Oncology, Charing Cross Hospital, Hammersmith