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Does the Pill Reduce Endometrial Cancer Risk?

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Updated March 02, 2011

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Question: Does the Pill Reduce Endometrial Cancer Risk?
Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus. Most cases of endometrial cancer occur between the ages of 60 and 70, but some cases can occur before age 40. According to the National Cancer Institute, uterine cancer is the most common type of gynecologic cancer, and endometrial cancer accounts for about 90% of all uterine cancers. In the United States, approximately 37,000 new cases of uterine cancer are diagnosed and about 6,000 women die from this disease each year.
Answer:

Hormonal birth control (like the Pill) tends to be a popular contraceptive choice for many women. This type of contraception contains either progestin, estrogen, or both. Certain hormonal contraception also adds the extra benefit of reducing endometrial cancer risk.

Please be aware that the main reason to use hormonal birth control is for contraception (to prevent an unintended pregnancy) -- possible noncontraceptive benefits can be considered when determining which hormonal birth control method to choose.

The following is a list of specific prescription birth control methods that have been shown to be effective in lowering the risk of endometrial cancer:

  • Combination Birth Control Pills: Evidence strongly suggests that women who use combination oral contraceptives have a 50% reduction in the risk of endometrial cancer compared to women who have never used them. Both short-term (less than 5 years) and long-term (equal to or greater than 5 years) use of combination pills resulted in similar reductions in risk. Additionally, the longer you use combination birth control pills, the greater the decrease in endometrial cancer risk. Plus, this protective effect can last for up to 20 years.

  • Depo Provera: The progestin-only Depo Provera injection also shows a similar protective effects on endometrial cancer risk, reducing the risk of endometrial cancer by approximately 80%. Although research studies have been based on small numbers of exposed women, results indicate that the protective effect of Depo Provera appears to last for at least 8 years after stopping Depo Provera use.

    The reduced risk of endometrial cancer in Depo-Provera users is thought to be due to how the progestin may inhibit tumor cell growth in the endometrium, as well as how the progestin may suppress ovulation, which, in turn, reduces estrogen levels. It appears that the reduction of endometrial cancer risk for Depo Provera users is comparable to that of those who use combination oral contraceptives.


  • Mirena IUD: This progestin-only IUD may reduce the risk of endometrial cancer by 50%. Mirena is thought to be effective because it is inserted into the uterus, so progestin concentrations to the endometrium may be much higher. Research also indicates that the Mirena IUD may be an effective treatment for endometrial hyperplasia (a condition that occurs when the lining of the uterus grows too much). Endometrial hyperplasia is not cancerous, yet it can lead to cancer of the uterus. However, using the Mirena for this purpose must be done so cautiously as there have been reports of endometrial hyperplasia progressing into endometrial cancer even with the Mirena IUD inserted.

Sources:

Buttini MJ, Jordan SJ, Webb PM. "The effect of the levonorgestrel releasing intrauterine system on endometrial hyperplasia: An Australian study and systematic review." Aust N Z J Obstet Gynaecol 2009;49:316–22. Assessed via private subscription.

Centers for Disease Control. "Oral contraceptive use and the risk of endometrial cancer." JAMA 1983;249:1600–04. Assessed via private subscription.

"Depot-medroxyprogesterone acetate (DMPA) and risk of endometrial cancer." The WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Int J Cancer 1991;49:186–90. Accessed 2/25/11.

Henderson BE, Casagrande JT, Pike MC, Mack T, Rosario I, Duke A. "The epidemiology of endometrial cancer in young women." Br J Cancer 1983;47:749–56. Assessed via private subscription.

Jick SS, Walker AM, Jick H. "Oral contraceptives and endometrial cancer." Obstet Gynecol 1993;82:931–5. Assessed via private subscription.

Kaufman DW, Shapiro S, Slone D, Rosenberg L, Miettinen OS, Stolley PD, et al. "Decreased risk of endometrial cancer among oral-contraceptive users." N Engl J Med 1980;303:1045–7. Assessed via private subscription.

Kaunitz AM (2001). "Current options for injectable contraception in the United States." Semin Reprod Med 19(4):331–7. Accessed 2/25/11.

Kresowik J, Ryan GL, Van Voorhis BJ. "Progression of atypical endometrial hyperplasia to adenocarcinoma despite intrauterine progesterone treatment with the levonorgestrel-releasing intrauterine system." Obstet Gynecol 2008;111:547–9. Assessed via private subscription.

La Vecchia C, Altieri A, Franceschi S, Tavani A. "Oral contraceptives and cancer: An update." Drug Safety 2001; 24:741–54. Assessed via private subscription.

Nilsson CG, Haukkamaa M, Vierola H, Luukkainen T. "Tissue concentrations of levonorgestrel in women using levonorgestrel-releasing IUD." Clin Endocrinol 1982;17:529–36. Assessed via private subscription.

Reproductive Health Online. Levonorgestrel Intrauterine System (Mirena). Accessed 2/25/11. http://www.reproline.jhu.edu/english/1fp/1advances/1IUD/mirena.htm

Santen, Richard J. (2004). "Endocrinology of Breast and Endometrial Cancer". In Strauss, Jerome F. III; Barbieri, Robert L. (eds.). Yen and Jaffe's Reproductive Endocrinology (5th ed.). Philadelphia: Elsevier Saunders. pp. 787–809.

Schlesselman JJ. "Risk of endometrial cancer in relation to use of combined oral contraceptives. A practitioner’s guide to meta-analysis." Hum Reprod 1997;12:1851–63. Assessed via private subscription.

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