Abstract
For the millions of women who have successfully battled breast cancer, the question of contraception presents a unique and often complex challenge. Navigating the landscape of hormonal options requires a deep understanding of how cancer treatments have altered their bodies' hormonal physiology and a careful weighing of the risks and benefits. Contraceptive management in breast cancer patients also requires scientific evidence. This review discusses the interaction between sexual steroids and the mammary gland, bridging basic science with large studies such as the WHI and the Million Women Study, which have demonstrated the risks associated with combined hormonal therapy. Based on these data, hormone-containing contraceptives are contraindicated, and the copper intrauterine device (Cu-IUD) emerges as the main safe option. However, while non-hormonal methods have traditionally been the first line of defense, ongoing research and a shift towards personalized medicine are opening up new perspectives and potential future options for this growing population. The use of progestin-only methods, particularly the levonorgestrel-releasing intrauterine system (LNG-IUS), presents a more nuanced picture, and remains a matter of debate. Although it offers benefits such as endometrial protection in tamoxifen users, its oncological safety is still uncertain. Some studies suggest that the low levels of circulating progestin may not pose a significant risk of recurrence. As a future perspective, new molecules such as estetrol (E4) are emerging as promising alternatives due to their selective action profile. The conversation around hormonal contraception is evolving, and future researches will provide choices that align with patients’ individual needs and desires.