Faculty of Sexual and Reproductive Healthcare
Clinical Effectiveness Unit
A unit funded by the FSRH and supported by NHS Greater Glasgow and Clyde
MEMBER’S ENQUIRY RESPONSE
Enquiry Reference: 4466 (repeat of 3099)
Sent: 1.10.14
Prepared: 12.9.10
A: Question
Are combined oral contraceptives (COC) contraindicated in someone with a past history of malignant
melanoma and is there any evidence of an association between COC and melanoma?
B: Response
The CEU did not find any guidance as to whether COC is contraindicated in someone with a past
history of malignant melanoma. It is not listed as a contraindication within the BNF or several of the
Summary of Product Characteristics for combined hormonal contraceptives. They do list estrogen
sensitive tumours as a contraindication.
Data is mixed on whether women who use combined oral contraceptives are at increased risk of
melanoma but most recent data would suggest not.
When dealing with specific patients, the CEU would suggest liaising with their oncologist for advice
and guidance.
C: Evidence-Based Medicine Question (which guided our literature search strategy)
Population:
Women with malignant melanoma
Intervention:
Combined oral contraception
Outcome:
Safety
D: Information Sources
The CEU searched the following sources in developing this Member’s Enquiry Response
Source Searched
Existing FSRH and RCOG guidance
The National Guidelines Clearing House
The United Kingdom Medical Eligibility Criteria for Contraceptive Use (2009)
The United Kingdom Selected Practice Recommendations for Contraceptive Use (2002)
The World Health Organization Medical Eligibility Criteria for Contraceptive Use (2009)
The World Health Organization Selected Practice Recommendations for Contraceptive
Use (2008)
The Cochrane Library
MEDLINE and EMBASE from 1996 to 2014
Information Identified
See below
No relevant information
No relevant information
No relevant information
See below
E: Evidence Reviewed
The CEU did not find any guidance as to whether COC is contraindicated in someone with a past
history of malignant melanoma. It is not listed as a contraindication within the BNF or several of the
Summary of Product Characteristics for combined hormonal contraceptives.
Data is mixed on whether women who use combined oral contraceptives are at increased risk of
melanoma. Some studies have suggested a possible increased risk1,2, whereas others indicate no
significant increased risk with use3-7.
When dealing with specific patients, the CEU would suggest liaising with their oncologist for advice
and guidance.
F: References
1. Beral V, Ramcharan S, Faris R. Malignant melanoma and oral contraceptive use among women in
California. Br J Cancer. 1977 Dec;36(6):804–809.
2. Beral V, Evans S, Shaw H, Milton G. Oral contraceptive use and malignant melanoma in Australia.
Br J Cancer. 1984 Nov;50(5):681–685.
3. Gallagher RP, Elwood JM, Hill GB, Coldman AJ, Threlfall WJ, Spinelli JJ. Reproductive factors,
oral contraceptives and risk of malignant melanoma: Western Canada Melanoma Study. Br J
Cancer. 1985 Dec;52(6):901–907
4. Helmrich SP, Rosenberg L, Kaufman DW, Miller DR, Schottenfeld D, Stolley PD, Shapiro S. Lack
of an elevated risk of malignant melanoma in relation to oral contraceptive use. J Natl Cancer Inst.
1984 Mar;72(3):617–620.
5. Hannaford PC, Villard-Mackintosh L, Vessey MP, Kay CR. Oral contraceptives and malignant
melanoma. British Journal of Cancer 1991 63(3): 430-433.
6. Pfahlberg A, Hassan K, Wille L, Lausen B, Gefeller O. Systematic review of case-control studies:
oral contraceptives show no effect on melanoma risk. Public Health Rev. 1997;25(3-4):309-15.
7. Vessey MP, Painter R, Powell J. Skin disorders in relation to oral contraception and other factors,
including age, social class, smoking and body mass index. Findings in a large cohort study. Br J
Dermatol. 2000 Oct; 143(4):815-20.
The advice given in this Member's Enquiry Response has been prepared by the FSRH Clinical Effectiveness
Unit team. It is based on a structured search and review of published evidence available at the date of
preparation. The advice given here should be considered as guidance only. Adherence to it will not ensure a
successful outcome in every case and it may not include all acceptable methods of care aimed at the same
results. This response has been prepared as a service to FSRH members, but is not an official Faculty guidance
product; Faculty guidance is produced by a different and lengthier process. It is not intended to be construed or
to serve as a standard of medical care. Such standards are determined on the basis of all clinical data available
for an individual case and are subject to change as scientific knowledge advances. Members are welcome to
reproduce this response by photocopying or other means, in order to share the information with colleagues.
Enquiry response by JS
Checked by LM