Reproductive health care after transplantation

• Safety and efficacy of modern contraception, with particular attention to intrauterine devices.
• Safety and efficacy of human papillomavirus (HPV) vaccination.
• Screening for and treatment of precancerous conditions of the cervix.
• Screening for and treatment of sexually transmitted infections (STIs).
• Management of benign gynecologic conditions such as heavy vaginal bleeding and adnexal masses.

Contraception, cervical cancer screening, human papillomavirus (HPV) vaccination, sexually transmitted infection (STI) screening, and menstrual disorders are issues that need to be addressed in all reproductive-aged women, including those with a history of solid organ transplantation. There are specific considerations that may alter routine care in this population. Due to teratogenic immunosuppressive medications, highly effective contraception is important to planning or appropriately timing pregnancy. Estrogen-containing methods (pill, patch, and ring) may be contraindicated. Immunosuppression is also a consideration when screening for and treating STIs including precancerous conditions of the cervix. This chapter will provide a framework to address the specific gynecologic needs of women with a history of solid organ transplantation.