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Chemotherapy can harm an unborn baby, and pregnancy is still possible even when fertility is affected, so anyone who could get pregnant, or get a partner pregnant, needs contraception during treatment and for a time after. Condoms are usually advised, and they also protect a partner from traces of drug in body fluids after some treatments. Ask your team which method suits you and for how long.
Patient guidance from Macmillan (2018), the NHS (2025) and NCI (2023) agrees that chemotherapy can harm a pregnancy, that contraception is needed by anyone who could get pregnant or make a partner pregnant during treatment and for a time after, that a pregnancy test may be done before treatment, and that pregnancy remains possible even when fertility is reduced. Macmillan says barrier methods are usually best during treatment, condoms (or a dental dam for oral sex) for a few days after certain drugs protect partners from drug in body fluids, and breastfeeding is not advised. NCI says to prevent pregnancy for a year after chemotherapy and that some teams suggest two methods. The Society of Family Planning (2025) recommends offering a discussion of contraception before treatment to everyone who is pregnancy-capable, says emergency contraception is safe, recommends nonhormonal contraception first line after breast cancer (GRADE 1B) and avoiding oestrogen-containing methods with oestrogen-blocking therapy (best practice), and supports access to all methods for most other cancers. US MEC 2024 lists breast cancer among conditions in which pregnancy carries added risk. ASCO 2025 says fertility preservation should be discussed before treatment. The ESMO 2020 fertility and pregnancy guideline could not be read.
Why: Choices about fertility must be made before treatment, and the right contraceptive depends on the cancer and the drugs.
“No test reliably rules out pregnancy potential in cancer survivors; clinicians should offer to discuss contraception with individuals who are pregnancy-capable before cancer treatment.”
Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 · Committee statement (Society of Family Planning); not graded in the abstract
Why: Chemotherapy can harm a developing baby, and pregnancy can still happen even if fertility has been reduced.
“It's important to use contraception during treatment if you could get pregnant or you could get your partner pregnant.”
NHS 2025 · Not graded (patient information)
Why: Some hormonal methods are unsuitable with some cancers and drugs, and barrier methods are safe for almost everyone.
“During treatment, it is usually best to use barrier methods of contraception, such as condoms or the cap (diaphragms). Ask your cancer doctor or specialist nurse which type is best for you to use.”
Macmillan Cancer Support 2018 · Not graded (patient information)
Why: Breast cancer is often hormone-sensitive, and oestrogen-containing methods work against oestrogen-blocking treatment.
“For individuals with a history of breast cancer, we recommend nonhormonal contraceptives as the first-line option (GRADE 1B); additional guidance is provided for hormonal contraception depending on breast cancer hormone receptor status.”
Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 · GRADE 1B (nonhormonal first line after breast cancer); Best Practice (avoid oestrogen with oestrogen-blocking therapy)
Why: Small amounts of some drugs reach semen and vaginal fluid, and a barrier protects a partner from them.
“To protect partners, your cancer doctor may advise that for a few days after certain drugs you use a condom for vaginal or anal sex and a condom (or a latex barrier such as a dental dam) for oral sex.”
Macmillan Cancer Support 2018 · Not graded (patient information)
Why: Most people can have sex, but very low platelets or white cells change the risks of bleeding and infection.
“Ask your doctor or nurse if it is okay for you to have sex during chemotherapy.”
National Cancer Institute (US) 2023 · Not graded (patient booklet)
Why: A missed or failed method should not be left uncovered during treatment.
“Clinicians should counsel individuals with cancer that it is safe for them to use emergency contraception.”
Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 · Committee statement (Society of Family Planning); not graded in the abstract
Why: The team can explain the risks and options, which depend on the drugs and the stage of pregnancy.
“If you know you are pregnant before starting treatment, or become pregnant during treatment, tell your cancer doctor or nurse straight away.”
Macmillan Cancer Support 2018 · Not graded (patient information)
Why: The drugs can pass to a baby in breast milk.
“Breastfeeding during chemotherapy is not advised.”
Macmillan Cancer Support 2018 · Not graded (patient information)
Why: Chemotherapy can lower hormone levels and cause dryness, which makes sex uncomfortable.
“If sex is still painful because of dryness, ask your doctor or nurse about medications to help restore moisture in your vagina.”
National Cancer Institute (US) 2023 · Not graded (patient booklet)
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
Contraception for anyone pregnancy-capable, or with a pregnancy-capable partner, during chemotherapy and for a period after is agreed by every source read (NHS 2025, NCI 2023, Macmillan 2018, Society of Family Planning 2025). The Society of Family Planning 2025 series is the most recent specialist guidance: discuss contraception before treatment with everyone pregnancy-capable, emergency contraception is safe, nonhormonal methods first after breast cancer (GRADE 1B), no oestrogen with oestrogen-blocking therapy (best practice), and access to all methods for most other cancers. How long to continue after treatment is not agreed: NCI says a year, Macmillan says 'for a time after', and the real figure depends on the drug's label, which the team gives.
Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 · Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 · Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 · NHS 2025 · National Cancer Institute (US) 2023 · Macmillan Cancer Support 2018
Where it differs: Sets a fixed year after chemotherapy for women and says some teams suggest two forms of birth control.
Evidence: NCI booklet, not graded: 'It is very important to prevent pregnancy while having chemotherapy and for a year afterwards.' Other sources leave the period to the drug and the team.
Where it differs: Supports access to all contraceptive methods for most other cancers, with shared decision-making for some hormone-sensitive tumours (for example adult granulosa cell, low-grade serous and endometrioid ovarian tumours, melanoma, meningioma, follicular lymphoma), and advises against an IUD with active cervical cancer.
Evidence: Society of Family Planning 2025 parts 2 and 3: GRADE 1B to 2C depending on the cancer, as printed in the abstracts.
Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 · Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025
Where it differs: After high-dose chemotherapy or a stem cell transplant, the team may advise no close physical contact for a while, to prevent infection.
Evidence: Patient information, not graded.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Nonhormonal contraception first line after breast cancer “For individuals with a history of breast cancer, we recommend nonhormonal contraceptives as the first-line option (GRADE 1B); additional guidance is provided for hormonal contraception depending on breast cancer hormone receptor status.” | GRADE 1B | Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 |
| No oestrogen-containing contraception with oestrogen-blocking therapy “Estrogen-containing contraceptives should be avoided by individuals treated with estrogen-blocking therapy (Best Practice).” | Best Practice | Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 |
| Access to all methods after colorectal, pancreatic, oesophageal and gastric cancer “For individuals with a history of colorectal, pancreatic, esophageal, and gastric cancer, we recommend clinicians provide access to all available contraceptive methods (GRADE 1C).” | GRADE 1C | Society of Family Planning and Society of Gynecologic Oncology (Contraception) 2025 |
| Breast cancer is hormonally sensitive; LNG-IUD may carry less concern than combined or higher-dose progestogen methods “Breast cancer is a hormonally sensitive tumor. Concerns about progression of the disease might be less with LNG-IUDs than with COCs or higher-dose POCs.” | US MEC 2024 classification comment | CDC (MMWR Recommendations and Reports) 2024 |
| Fertility preservation discussed before treatment “FP approaches should be discussed before cancer-directed therapy.” | ASCO guideline recommendation (strength not shown in the abstract) | ASCO (Journal of Clinical Oncology) 2025 |
Shares Default fertility preservation referral for every patient under 40 before treatment, Oncofertility and fertility preservation.
Shares Default fertility preservation referral for every patient under 40 before treatment, Oncofertility and fertility preservation.
Shares Default fertility preservation referral for every patient under 40 before treatment, Oncofertility and fertility preservation.
Shares Default fertility preservation referral for every patient under 40 before treatment, Oncofertility and fertility preservation.
Shares Default fertility preservation referral for every patient under 40 before treatment, Oncofertility and fertility preservation.
Shares Cancer during pregnancy, Default fertility preservation referral for every patient under 40 before treatment, Oncofertility and fertility preservation.
Shares Cancer during pregnancy, Oncofertility and fertility preservation.
Shares Default fertility preservation referral for every patient under 40 before treatment, Oncofertility and fertility preservation.