What are the mechanisms of action of the different contraceptive methods to reduce the risk of ovarian cancer?

Abstract

Objective

Ovarian cancer (OvCa) is the deadliest gynaecologic malignancy. Knowing that OvCa, as a disease, has different origins has allowed us to relate them to the mechanisms of action of different contraceptive methods with the aim of evaluating the possibility of their use in reducing risk.

Study Design

This commentary review article will instead focus on the recent findings on the role of contraceptive methods in preventing of OvCa.

Results

• Combined hormonal contraceptive (CHC) use is an effective method of chemoprevention for OvCa in the general population and in women with genetic disorders.

• Salpingectomy, better than tubal ligation, should be offered for ovarian/tubal/peritoneal cancer prevention.

• Progestogen-only methods can decrease the risk of OvCa via reduced menstrual bleeding and by changes in the hormonal environment that surrounds the ovary.

• IUDs of any type, through different mechanisms, decrease the risk of OvCa.

• Barrier methods prevent the passage of germs into the tubes and ovaries and the inflammatory state they produce.

Conclusions

Most contraceptive methods have a mechanism of action that may favour a reduction in the risk of OvCa. The theories of incessant ovulation, retrograde menstruation, and that the fallopian tubes are the site of origin of a proportion of high-grade serous OvCa, have led to the recommendation that anovulatory methods, those that decrease menstrual bleeding, and those that blocked tubes, or even better, ‘opportunistic salpingectomy’ are a current approach to prevent OvCa in the population general and, above all, in the population at risk.

摘要

目的：卵巢癌（OvCa）是最致命的妇科恶性肿瘤。众所周知, 卵巢癌是一种具有不同病因来源的疾病, 这使我们能够将其与不同避孕方法的作用机制联系起来, 目的是评估它们用于降低卵巢癌风险的可能性。

实验设计：这篇述评文章将重点放在避孕方法在预防卵巢癌中作用的最新发现上。

结果：

• 复方激素类避孕药（CHC）是一种有效的化学预防卵巢癌的方法。

• 输卵管切除术比输卵管结扎术更能预防卵巢、输卵管及腹膜癌。

• 单纯孕激素疗法可以通过减少经量和改变卵巢周围的激素环境来降低卵巢癌的风险。

• 任何类型的宫内节育器, 通过不同的机制, 均可降低卵巢癌的风险。

• 屏障方法阻止细菌进入输卵管和卵巢, 防止它们产生的炎症状态。

结论：大多数避孕方法的作用机制可有利于降低卵巢癌的风险。持续排卵、经血逆行、输卵管是一部分高级别浆液性卵巢癌起源的理论, 引出了无排卵疗法、减少经量疗法和阻塞输卵管疗法, 甚至一项更好的治疗方法——“机会性输卵管切除术”, 成为目前针对一般人群, 特别是高危人群预防卵巢癌的手段。

Keywords:

• Ovarian cancer
• contraceptive methods
• prevention
• chemoprevention
• counselling

Disclosure statement

RS-B reports research funding from Astellas, Mitra, and Exeltis and personal fees from Seid, and Lacer, outside the submitted work. There are no other conflicts of interest. MS-P report no conflicts of interest.