Skip to main content
SpringerLink
Log in

Contraception and Menstrual Suppression for Adolescent and Young Adult Oncology Patients

  • Chapter
  • First Online:
Textbook of Oncofertility Research and Practice

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Abma JC, Martinez GM. Sexual activity and contraceptive use among teenagers in the United States, 2011–2015. Natl Health Stat Report. 2017;104:1–23.

    Google Scholar 

  2. ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives (2010). Obstet Gynecol. 115 (1):206–18. https://doi.org/10.1097/AOG.0b013e3181cb50b5

  3. Akers AY, Steinway C, Sonalkar S, Perriera LK, Schreiber C, Harding J, Garcia-Espana JF. Reducing pain during intrauterine device insertion: a randomized controlled trial in adolescents and young women. Obstet Gynecol. 2017;130(4):795–802. https://doi.org/10.1097/AOG.0000000000002242.

    Article  PubMed  Google Scholar 

  4. American College of O, Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891–6. https://doi.org/10.1097/01.AOG.0000428646.67925.9a.

    Article  CAS  Google Scholar 

  5. Bassuk SS, Manson JE. Oral contraceptives and menopausal hormone therapy: relative and attributable risks of cardiovascular disease, cancer, and other health outcomes. Ann Epidemiol. 2015;25(3):193–200. https://doi.org/10.1016/j.annepidem.2014.11.004.

    Article  PubMed  Google Scholar 

  6. Bednarek PH, Creinin MD, Reeves MF, Cwiak C, Espey E, Jensen JT, Post-Aspiration IUDRSTG. Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial. Contraception. 2015;91(3):193–7. https://doi.org/10.1016/j.contraception.2014.11.012.

    Article  CAS  PubMed  Google Scholar 

  7. Black AFD, Rowe T, Collins J, Miller D, Brown T, David M, Dunn S, Fisher WA, Fleming N, Fortin CA, Guilbert E, Hanvey L, Lalonde A, Miller R, Morris M, O’Grady T, Pymar H, Smith T, Henneberg E, Society of Obstetrics and Gynaecology of Canada. Canadian contraception concensus. J Obstet Gynaecol Can. 2004;26(4):347–87.. 389–436

    Article  PubMed  Google Scholar 

  8. Bonny AE, Lange HL, Rogers LK, Gothard DM, Reed MD. A pilot study of depot medroxyprogesterone acetate pharmacokinetics and weight gain in adolescent females. Contraception. 2014;89(5):357–60. https://doi.org/10.1016/j.contraception.2014.01.017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Bonny AE, Ziegler J, Harvey R, Debanne SM, Secic M, Cromer BA. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med. 2006;160(1):40–5. https://doi.org/10.1001/archpedi.160.1.40.

    Article  PubMed  Google Scholar 

  10. Brener N, Kann L, Shanklin S. Methodology of the youth risk behavior surveillance system – 2013. MMWR Recomm Rep (Morb Mortal Wkly Rep Recomm Rep/Centers Dis Control). 2013;62(RR01):1–20.

    Google Scholar 

  11. Committee on Adolescent Health C, Committee on Gynecologic P. Committee opinion no. 582: addressing health risks of noncoital sexual activity. Obstet Gynecol. 2013;122(6):1378–82. https://doi.org/10.1097/01.AOG.0000438963.23732.80.

    Article  Google Scholar 

  12. Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group TACoO, Gynecologists. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2012;120(4):983–8. https://doi.org/10.1097/AOG.0b013e3182723b7d.

    Article  Google Scholar 

  13. Committee on Health Care for Underserved W. Committee opinion no 707: access to emergency contraception. Obstet Gynecol. 2017;130(1):e48–52. https://doi.org/10.1097/AOG.0000000000002162.

    Article  Google Scholar 

  14. Committee on Practice Bulletins-Gynecology L-ARCWG. Practice bulletin no. 186: long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2017;130(5):e251–69. https://doi.org/10.1097/AOG.0000000000002400.

    Article  Google Scholar 

  15. Committee Opinion No. 602. Depot medroxyprogesterone acetate and bone effects. Obstet Gynecol. 2014;123(6):1398–402. https://doi.org/10.1097/01.AOG.0000450758.95422.c8.

    Article  CAS  Google Scholar 

  16. Committee opinion no. 606: Options for prevention and management of heavy menstrual bleeding in adolescent patients undergoing cancer treatment. Obstet Gynecol. 2014;124(2 Pt 1):397–402. https://doi.org/10.1097/01.AOG.0000452745.44206.c3

  17. Committee opinion no. 607: Gynecologic concerns in children and adolescents with cancer. Obstet Gynecol. 2014;124(2 Pt 1):403–8. https://doi.org/10.1097/01.AOG.0000452746.44206.18

  18. Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(3):1–103. https://doi.org/10.15585/mmwr.rr6503a1.

    Article  PubMed  Google Scholar 

  19. Darney P, Patel A, Rosen K, Shapiro LS, Kaunitz AM. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril. 2009;91(5):1646–53. https://doi.org/10.1016/j.fertnstert.2008.02.140.

    Article  PubMed  Google Scholar 

  20. Deans EI, Grimes DA. Intrauterine devices for adolescents: a systematic review. Contraception. 2009;79(6):418–23. https://doi.org/10.1016/j.contraception.2008.12.009.

    Article  PubMed  Google Scholar 

  21. Denford S, Abraham C, Campbell R, Busse H. A comprehensive review of reviews of school-based interventions to improve sexual-health. Health Psychol Rev. 2017;11(1):33–52. https://doi.org/10.1080/17437199.2016.1240625.

    Article  PubMed  Google Scholar 

  22. Diedrich JT, Zhao Q, Madden T, Secura GM, Peipert JF. Three-year continuation of reversible contraception. Am J Obstet Gynecol. 2015;213(5):662 e661–8. https://doi.org/10.1016/j.ajog.2015.08.001.

    Article  Google Scholar 

  23. Divasta AD, Laufer MR, Gordon CM. Bone density in adolescents treated with a GnRH agonist and add-back therapy for endometriosis. J Pediatr Adolesc Gynecol. 2007;20(5):293–7. https://doi.org/10.1016/j.jpag.2007.04.008.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Eisenberg D, McNicholas C, Peipert JF. Cost as a barrier to long-acting reversible contraceptive (LARC) use in adolescents. J Adolesc Health. 2013;52(4 Suppl):S59–63. https://doi.org/10.1016/j.jadohealth.2013.01.012.

    Article  PubMed  Google Scholar 

  25. Eisenberg DL, Schreiber CA, Turok DK, Teal SB, Westhoff CL, Creinin MD, Investigators AI. Three-year efficacy and safety of a new 52-mg levonorgestrel-releasing intrauterine system. Contraception. 2015;92(1):10–6. https://doi.org/10.1016/j.contraception.2015.04.006.

    Article  CAS  PubMed  Google Scholar 

  26. Green DM, Whitton JA, Stovall M, Mertens AC, Donaldson SS, Ruymann FB, Pendergrass TW, Robison LL. Pregnancy outcome of female survivors of childhood cancer: a report from the childhood cancer survivor study. Am J Obstet Gynecol. 2002;187(4):1070–80. https://doi.org/10.1067/mob.2002.126643.

    Article  PubMed  Google Scholar 

  27. Gronich N, Lavi I, Rennert G. Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study. CMAJ. 2011;183(18):E1319–25. https://doi.org/10.1503/cmaj.110463.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hatcher RATJ, Neson AL, Cates W, Kowal D, Policar MS. Contraceptive technology. New York: Ardent Media; 2013.

    Google Scholar 

  29. Heerman WJ, Hotop A, Omlung K, Armstrong S, Mathieu I, Sherwood NE, Barkin SL. A tool kit to enhance the informed consent process for community-engaged pediatric research. IRB: Ethics Hum Res. 2016;38(5):8–14.

    Google Scholar 

  30. Heinemann K, Reed S, Moehner S, Minh TD. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contraception. 2015;91(4):274–9. https://doi.org/10.1016/j.contraception.2015.01.007.

    Article  CAS  PubMed  Google Scholar 

  31. Hickman LC, Llarena NC, Valentine LN, Liu X, Falcone T. Preservation of gonadal function in women undergoing chemotherapy: a systematic review and meta-analysis of the potential role for gonadotropin-releasing hormone agonists. J Assist Reprod Genet. 2018. https://doi.org/10.1007/s10815-018-1128-2

  32. Hubacher D, Lopez L, Steiner MJ, Dorflinger L. Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons. Contraception. 2009;80(2):113–8. https://doi.org/10.1016/j.contraception.2009.02.008.

    Article  CAS  PubMed  Google Scholar 

  33. Jacob MS, Kulie P, Benedict C, Ordoobadi AJ, Sikka N, Steinmetz E, McCarthy ML. Use of a midstream clean catch mobile application did not lower urine contamination rates in an emergency department. Am J Emerg Med. 2017. https://doi.org/10.1016/j.ajem.2017.07.016

  34. Jatlaoui TC, Riley HE, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception. 2017;95(1):17–39. https://doi.org/10.1016/j.contraception.2016.10.006.

    Article  PubMed  Google Scholar 

  35. Kaunitz AM. Emergency contraception. 2018. http://www.uptodate.com/contents/emergency-contraception?source=search_result&search=Emergency+contraception&selectedTitle=1%7E137. Accessed 26 Feb 2018 2018.

  36. Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Health. 2008;42(4):344–51. https://doi.org/10.1016/j.jadohealth.2007.08.026.

    Article  PubMed  Google Scholar 

  37. Lopez LM, Ramesh S, Chen M, Edelman A, Otterness C, Trussell J, Helmerhorst FM. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev. 2016;8:CD008815. https://doi.org/10.1002/14651858.CD008815.pub4.

    Article  Google Scholar 

  38. Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K, American Society of Clinical O. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(19):2500–10. https://doi.org/10.1200/JCO.2013.49.2678.

    Article  PubMed  PubMed Central  Google Scholar 

  39. McNicholas C, Maddipati R, Zhao Q, Swor E, Peipert JF. Use of the etonogestrel implant and levonorgestrel intrauterine device beyond the U.S. Food and Drug Administration-approved duration. Obstet Gynecol. 2015;125(3):599–604. https://doi.org/10.1097/AOG.0000000000000690.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. McNicholas C, Peipert JF. Long-acting reversible contraception for adolescents. Curr Opin Obstet Gynecol. 2012;24(5):293–8. https://doi.org/10.1097/GCO.0b013e32835686d5.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Meirow D, Rabinovici J, Katz D, Or R, Shufaro Y, Ben-Yehuda D. Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer. 2006;107(7):1634–41. https://doi.org/10.1002/cncr.22199.

    Article  CAS  PubMed  Google Scholar 

  42. Mestad R, Secura G, Allsworth JE, Madden T, Zhao Q, Peipert JF. Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. Contraception. 2011;84(5):493–8. https://doi.org/10.1016/j.contraception.2011.03.001.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Milbourne A. Heavy or irregular uterine bleeding during chemotherapy. 2018. https://www.uptodate.com/contents/heavy-or-irregular-uterine-bleeding-during-chemotherapy?search=chemoterapy%20menstrual%20bleeding&source=search_result&selectedTitle=8~150&usage_type=default&display_rank=8.

  44. Miller L, Hughes JP. Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial. Obstet Gynecol. 2003;101(4):653–61.

    CAS  PubMed  Google Scholar 

  45. Morch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard O. Contemporary hormonal contraception and the risk of breast cancer. N Engl J Med. 2017;377(23):2228–39. https://doi.org/10.1056/NEJMoa1700732.

    Article  PubMed  Google Scholar 

  46. Mueller TE, Gavin LE, Kulkarni A. The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. J Adolesc Health. 2008;42(1):89–96. https://doi.org/10.1016/j.jadohealth.2007.08.002.

    Article  PubMed  Google Scholar 

  47. Ngo LL, Braaten KP, Eichen E, Fortin J, Maurer R, Goldberg AB. Naproxen sodium for pain control with intrauterine device insertion: a randomized controlled trial. Obstet Gynecol. 2016;128(6):1306–13. https://doi.org/10.1097/AOG.0000000000001746.

    Article  CAS  PubMed  Google Scholar 

  48. Ngo LL, Ward KK, Mody SK. Ketorolac for pain control with intrauterine device placement: a randomized controlled trial. Obstet Gynecol. 2015;126(1):29–36. https://doi.org/10.1097/AOG.0000000000000912.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Patel A, Schwarz EB, Society of Family P. Cancer and contraception. Release date May 2012. SFP guideline #20121. Contraception. 2012;86(3):191–8. https://doi.org/10.1016/j.contraception.2012.05.008.

    Article  CAS  PubMed  Google Scholar 

  50. Pierce SJ, Gazvani MR, Farquharson RG. Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: a randomized trial with a 6-year follow-up. Fertil Steril. 2000;74(5):964–8. https://doi.org/10.1016/s0015-0282(00)01537-5.

    Article  CAS  PubMed  Google Scholar 

  51. Practice Bulletin No. 152: emergency contraception. Obstet Gynecol. 2015;126 (3):e1–11. https://doi.org/10.1097/AOG.0000000000001047

  52. Quaas AM, Ginsburg ES. Prevention and treatment of uterine bleeding in hematologic malignancy. Eur J Obstet Gynecol Reprod Biol. 2007;134(1):3–8. https://doi.org/10.1016/j.ejogrb.2007.03.012.

    Article  PubMed  Google Scholar 

  53. Rosenstock JR, Peipert JF, Madden T, Zhao Q, Secura GM. Continuation of reversible contraception in teenagers and young women. Obstet Gynecol. 2012;120(6):1298–305. https://doi.org/10.1097/AOG.0b013e31827499bd.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Rowe P, Farley T, Peregoudov A, Piaggio G, Boccard S, Landoulsi S, Meirik O, Research IUDRGotUUWWBSPo, Development, Research Training in Human R. Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A. Contraception. 2016;93(6):498–506. https://doi.org/10.1016/j.contraception.2016.02.024.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Secura GM, Madden T, McNicholas C, Mullersman J, Buckel CM, Zhao Q, Peipert JF. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014;371(14):1316–23. https://doi.org/10.1056/NEJMoa1400506.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Simmons KB, Edelman AB. Hormonal contraception and obesity. Fertil Steril. 2016;106(6):1282–8. https://doi.org/10.1016/j.fertnstert.2016.07.1094.

    Article  CAS  PubMed  Google Scholar 

  57. Society for Adolescent H, Medicine. Abstinence-only-until-marriage policies and programs: an updated position paper of the Society for Adolescent Health and Medicine. J Adolesc Health. 2017;61(3):400–3. https://doi.org/10.1016/j.jadohealth.2017.06.001.

    Article  Google Scholar 

  58. Tepper NK, Dragoman MV, Gaffield ME, Curtis KM. Nonoral combined hormonal contraceptives and thromboembolism: a systematic review. Contraception. 2017;95(2):130–9. https://doi.org/10.1016/j.contraception.2016.10.005.

    Article  CAS  PubMed  Google Scholar 

  59. Waimey KE, Duncan FE, Su HI, Smith K, Wallach H, Jona K, Coutifaris C, Gracia CR, Shea LD, Brannigan RE, Chang RJ, Zelinski MB, Stouffer RL, Taylor RL, Woodruff TK. Future directions in oncofertility and fertility preservation: a report from the 2011 Oncofertility consortium conference. J Adolesc Young Adult Oncol. 2013;2(1):25–30. https://doi.org/10.1089/jayao.2012.0035.

    Article  PubMed  PubMed Central  Google Scholar 

  60. WHO. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: WHO; 2015.

    Google Scholar 

  61. Winther JF, Boice JD Jr, Svendsen AL, Frederiksen K, Olsen JH. Induced abortions in Danish cancer survivors: a population-based cohort study. J Natl Cancer Inst. 2009;101(9):687–9. https://doi.org/10.1093/jnci/djp064.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Xiao S, Coppeta JR, Rogers HB, Isenberg BC, Zhu J, Olalekan SA, McKinnon KE, Dokic D, Rashedi AS, Haisenleder DJ, Malpani SS, Arnold-Murray CA, Chen K, Jiang M, Bai L, Nguyen CT, Zhang J, Laronda MM, Hope TJ, Maniar KP, Pavone ME, Avram MJ, Sefton EC, Getsios S, Burdette JE, Kim JJ, Borenstein JT, Woodruff TK. A microfluidic culture model of the human reproductive tract and 28-day menstrual cycle. Nat Commun. 2017;8:14584. https://doi.org/10.1038/ncomms14584.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Zigler RE, McNicholas C. Unscheduled vaginal bleeding with progestin-only contraceptive use. Am J Obstet Gynecol. 2017;216(5):443–50. https://doi.org/10.1016/j.ajog.2016.12.008.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Washington University in St. Louis – Barnes Jewish Hospital, St. Louis, MO, USA

    Carley Zeal

  2. Department of Obstetrics and Gynecology, Ste-Justine Hospital, University of Montreal, Montreal, QC, Canada

    Janie Benoit

  3. Pediatric & Adolescent Gynecology, Washington University School of Medicine/St. Louis Children’s Hospital, St. Louis, MO, USA

    Holly R. Hoefgen

Authors
  1. Carley Zeal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janie Benoit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Holly R. Hoefgen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Holly R. Hoefgen .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Northwestern University , Chicago, IL, USA

    Teresa K. Woodruff

  2. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA

    Divya K. Shah

  3. Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA

    Wendy S. Vitek

Appendices

Appendix: Medical Eligibility Criteria for Contraceptive Use

figure a
figure b
figure c
figure d

Review Questions and Answers

  1. Q1.

    Which of the following describes the CDC medical eligibility criteria for contraceptive use category 2?

    1. (a)

      A condition for which there is no restriction for the use of the contraceptive method

    2. (b)

      A condition that represents an unacceptable health risk if the contraceptive method is used

    3. (c)

      A condition for which the advantages of using the method generally outweigh the theoretical or proven risks

    4. (d)

      A condition for which the theoretical or proven risks usually outweigh the advantages of using the method

  1. A1.

    (c)

  1. Q2.

    When weighing the risks of administration of estrogen or estrogen-containing contraceptives to control acute heavy vaginal bleeding in a patient with chemotherapy-induced thrombocytopenia, we should consider…

    1. (a)

      Volume of bleeding and hemodynamic stability

    2. (b)

      Thromboembolic risks

    3. (c)

      Relative medical risks of alternative therapies

    4. (d)

      All of the above

  1. A2.

    (d)

  1. Q3.

    According to American Academy of Pediatrics (AAP) published recommendation, what is the first-line contraceptive choice for adolescents who choose not to be abstinent?

    1. (a)

      Barrier methods

    2. (b)

      Injectable contraceptive (depot medroxyprogesterone acetate – DMPA)

    3. (c)

      Long-acting reversible contraceptive (LARC)

    4. (d)

      Combined hormonal contraceptives (pill, patch, ring)

  1. A3.

    (c)

  1. Q4.

    Which of the following clinical scenarios would be a contraindication to the use of emergency contraception 1 day following unprotected intercourse?

    1. (a)

      An adolescent girl in active treatment for leukemia

    2. (b)

      A young adult woman with known liver disease

    3. (c)

      A teenage female, 2 months after BMT for sickle cell disease

    4. (d)

      There are no instances in which the risks outweigh the benefits of use

  1. A4.

    (d)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Zeal, C., Benoit, J., Hoefgen, H.R. (2019). Contraception and Menstrual Suppression for Adolescent and Young Adult Oncology Patients. In: Woodruff, T., Shah, D., Vitek, W. (eds) Textbook of Oncofertility Research and Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-02868-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-02868-8_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-02867-1

  • Online ISBN: 978-3-030-02868-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation