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Contraceptives in MPN patients

Myeloproliferative neoplasms (MPNs) are a group of blood disorders that cause abnormal growth of blood cells in the bone marrow. They can affect people of any age, but they are more common in older adults. MPNs can cause various symptoms and complications, such as fatigue, bleeding, infections, and blood clots.

If you have an MPN and you are of reproductive age, you may have some questions about how your condition affects your contraceptive choices.

Contraceptives – considerations and risks

One of the main goals of contraception is to prevent unintended pregnancies. This is especially important for people with MPNs who are taking certain medications that can harm the developing fetus. These medications include hydroxycarbamide (also known as hydroxyurea), interferon, ruxolitinib, and other drugs that are used to lower the number of blood cells or reduce the size of the spleen.

Another goal of contraception is to reduce the risk of blood clots, which can be life-threatening. People with MPNs have a higher risk of developing blood clots than the general population, and some contraceptives can increase this risk even further. Contraceptives that contain estrogen, such as the combined oral contraceptive pill (COCP), the patch, the ring, and some types of intrauterine devices (IUDs), are not recommended for women with MPNs. Estrogen can make the blood stickier and more prone to clotting.

Therefore, if you are a woman with an MPN and you need contraception, you should avoid estrogen-containing methods and opt for other alternatives. These include:

  • Progestogen-only methods: These include the progestogen-only pill (POP), the implant, the injection, and some types of IUDs. They work by thickening the cervical mucus and preventing ovulation. They do not affect the blood clotting system and are generally safe for women with MPNs.

  • Barrier methods: These include condoms, diaphragms, caps, and spermicides. They work by physically blocking the sperm from reaching the egg. They do not contain any hormones and do not interfere with the blood clotting system. They also provide protection against sexually transmitted infections (STIs).

  • Natural methods: These include fertility awareness methods (FAMs), such as tracking your menstrual cycle, basal body temperature, cervical mucus, or ovulation tests. They work by identifying your fertile days and avoiding sexual intercourse or using a barrier method during those days. They do not contain any hormones and do not affect the blood clotting system. However, they require careful monitoring and may not be very reliable for women with irregular cycles or other factors that can affect fertility.

  • Sterilization: This is a permanent method of contraception that involves surgically cutting or blocking the tubes that carry the eggs or sperm. It works by preventing fertilization from occurring. It does not contain any hormones and does not affect the blood clotting system. However, it is irreversible and requires a medical procedure.

If you are a man with an MPN and you need contraception, you can use any method that suits you and your partner. However, if you are taking a medication that can harm the fetus, you should use a reliable method to prevent your partner from becoming pregnant. You can also consider sterilization if you do not want to have any more children.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is a treatment that provides synthetic or natural hormones to women who have low levels of estrogen and progesterone due to menopause. HRT can help relieve symptoms such as hot flashes, night sweats, mood swings, vaginal dryness, and osteoporosis. However, HRT also has some potential risks and side effects that need to be weighed carefully before starting or continuing the therapy.

Some of these risks include increased chances of developing blood clots, stroke, heart disease, breast cancer and ovarian cancer. The risks may vary depending on the type, dose, and duration of HRT, as well as the individual factors such as age, medical history, and family history of the woman.

Therefore, it is important to consult with your hematologist, who can assess your blood condition and risk of thrombosis (clotting), and your family doctor or gynecologist, who can advise you on the best option for your hormonal health and well-being.

HRT is not a one-size-fits-all solution and should be tailored to your personal needs and preferences.

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