Contraceptives Have Multiple Protective Associations with Cancer
November 1, 2025 5 minutes read
By Melinda Young
Reproductive health literature has produced many studies involving various cancers and their association with contraception, including research that shows preventive qualities. As clinicians and researchers work to improve contraception and women’s health, they can leverage their knowledge to help women access the method that works best for them — both as a contraceptive and also for other health benefits, such as cancer prevention, says Abigail Liberty, MD, MSPH, an assistant professor in the division of complex family planning in the department of obstetrics and gynecology at the Oregon Health & Science University in Portland.
The ideal future scenario would be when clinicians can tell patients that a specific contraceptive will work for them — with their individual genetics — to prevent a particular type of cancer, she adds. “If you come to me and say, ‘I have risk of breast cancer, which contraception can I use?’ I can’t tell you this on an individual level [yet],” Liberty explains.
As research advances, it may be possible to individualize contraception advice to the level of predicting which types would work better for the overall health of each person. Here are some examples of cancers impacted by contraception:
Cervical cancer: The copper intrauterine device (IUD) is associated with lower rates of cervical cancer, and the studies controlled for rates of cervical cancer screening.1-3
One study found that IUD use was associated with less risk of cervical cancer, and there was a protective association for squamous-cell carcinoma, adenocarcinoma, and adenosquamous carcinoma if they did not test positive for human papillomavirus.3 Investigators examined 34 studies that looked at use of an IUD and cervical cancer and found that invasive cervical cancer may be about one-third less frequent in IUD users.2
Endometrial cancer: Both levonorgestrel and copper IUDs have been found to be associated with reduced risk of endometrial cancer, possibly because of alterations in the endometrium.1,4,5 Progestin-releasing IUDs are thought to decrease endometrial proliferation and suppress the endometrium by reducing uterine artery blood flow.1,6,7
A large and comprehensive study by the Epidemiology of Endometrial Cancer Consortium had a pooled analysis of data from 18 epidemiologic studies investigating IUDs and endometrial cancer risk. The study found that inert IUDs, older age at first and last use, and recent use were significantly related to lower endometrial cancer risk. Inert IUDs were defined as devices made from plastic or stainless steel. Most of these devices were taken off U.S. markets in the late 1980s because of problems with the Dalkon Shield. But a copper IUD (Paragard) and a progesterone-releasing IUD (Progestasert) were on the market in the United States in the 1990s.4
The research analyzed in the study included data going back as far as the early 1980s, when inert IUDs were most commonly used. Investigators noted that future epidemiologic studies need to investigate a possible association between endometrial cancer risk and hormonal IUDs because those products are newer. One Finnish study showed levonorgestrel-releasing IUDs reduce endometrial cancer risk.4
Ovarian cancer: Dozens of studies have shown a reduced risk of ovarian cancer among people who use combined oral contraceptives. Research shows that combined oral contraceptive users had a 27% reduced risk that lasts for 30 years.8,9 “There is strong data that use of an oral contraceptive pill reduces the risk of ovarian cancer, and that is very good data,” Liberty says.
“There is strong evidence that use of the hormonal IUD — Mirena or Liletta at 52 mg — reduces risk and prevents endometrial cancer,” Liberty says. “And there is emerging data that progesterone receptor modulators can reduce the risk of breast cancer, but — currently — there are no protocols for leveraging that protection and no long-term contraceptive options available with that class of medicine.”
The longer people use combined oral contraceptives, the greater the protection. Researchers calculate the relative risk is decreasing by 20% for every five years of use, and this was true with both low and high doses of the contraceptive pills.8,10 An observational study by the Royal College of General Practitioners that had up to nearly four decades of follow-up found that combined oral contraceptive users were 47% less likely to die from ovarian cancer than were nonusers.8,11
Bilateral salpingectomy also could reduce ovarian cancer, with studies showing a 49% reduction in ovarian cancer, including a decrease in serous carcinoma.12-14 New research into ovarian cancer prevention shows the benefits of opportunistic salpingectomy in preventing the disease.15
“We looked at patients who had a family history of ovarian cancer — first-degree relatives,” says Sara Moufarrij, MD, a gynecologic oncology fellow at Memorial Sloan Kettering Cancer Center in New York, NY. (See “Identifying Potential Missed Opportunities to Prevent Ovarian Cancer” in this issue).
People with a family history of ovarian cancer can request an opportunistic salpingectomy, and clinicians can recommend the procedure if patients decide they are finished with having children, she adds. “We always recommend salpingectomy at the time of [other abdominal] procedures,” Moufarrij says.
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Cason P, Cwiak C, Edelman A, et al. Contraceptive Technology, 22nd Edition. Jones & Bartlett Learning.;2025:304-305.
2. Cortessis VK, Barrett M, Wade NB, et al. Intrauterine device use and cervical cancer risk: A systematic review and meta-analysis. Obstet Gynecol. 2017;130(6):1226-1236.
3. Castellsagué X, Diaz M, Vaccarella S, et al. Intrauterine device use, cervical infection with human papillomavirus, and risk of cervical cancer: A pooled analysis of 26 epidemiological studies. Lancet Oncol. 2011;12(11):1023-1031.
4. Felix AS, Gaudet MM, La Vecchia C, et al. Intrauterine devices and endometrial cancer risk: A pooled analysis of the Epidemiology of Endometrial Cancer Consortium. Int J Cancer. 2015;136(5):E410-E422.
5. Guleria K, Agarwal N, Mishra K, et al. Evaluation of endometrial steroid receptors and cell mitotic activity in women using copper intrauterine device: Can Cu-T prevent endometrial cancer? J Obstet Gynaecol Res. 2004;30(3):181-187.
6. Curtis KM, Marchbanks PA, Peterson HB. Neoplasia with use of intrauterine devices. Contraception. 2007;75(6 Suppl):S60-S69.
7. Gardner FJE, Konje JC, Bell SC, et al. Prevention of tamoxifen induced endometrial polyps using levonorgestrel releasing intrauterine system. Long-term follow-up of a randomized control trial. Gynecol Oncol. 2009;114(3):452-456.
8. Cason P, Cwiak C, Edelman A, et al. Contraceptive Technology, 22nd Edition. Jones & Bartlett Learning.;2025:373.
9. Collaborative Group on Epidemiological Studies of Ovarian Cancer; Beral V, Doll R, Hermon C, et al. Ovarian cancer and oral contraceptives: Collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet. 2008;371:303-314.
10. Ness RB, Grisso JA, Klapper J, et al. Risk of ovarian cancer in relation to estrogen and progestin dose and use characteristics of oral contraceptives. SHARE Study Group. Steroid Hormones and Reproductions. Am J Epidemiol. 2000;152:233-241.
11. Hannaford PC, Iversen L, Macfarlane TV, et al. Mortality among contraceptive pill users: Cohort evidence from Royal College of General Practitioners’ Oral Contraception Study. BMJ. 2010;340:c927.
12. Cason P, Cwiak C, Edelman A, et al. Contraceptive Technology, 22nd Edition.Jones & Bartlett Learning;2025:231.
13. Cibula D, Widschwendter M, Zikan M, Dusek L. Underlying mechanisms of ovarian cancer risk reduction after tubal ligation. Acta Obstet Gynecol Scand. 2011;90(6):559-563.
14. Yoon SH, Kim SN, Shim SH, et al. Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: A meta-analysis. Eur J Cancer. 2016;55:38-46.
15. Moufarrij S, Hazimeh D, Rockwell T, et al. Gauging the magnitude of missed opportunity for ovarian cancer prevention. JAMA Surg. 2025;Aug 13:e242810.
As clinicians and researchers work to improve contraception and women’s health, they can leverage their knowledge to help women access the method that works best for them — both as a contraceptive and also for other health benefits, such as cancer prevention.
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