Hormonal contraception in female liver transplant recipients

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In the last years, the surgical progress led to progressive increase of number and survival time of heart transplant female recipients. While, the quality of their reproductive life, assumed important relief.Counseling for contraception when sterilization is not desired, must take into account the increased risk of infection and genital carcinoma associated with immunosuppressant drug therapy ⁽¹⁾.

Teratogenicity has not been reported either with traditional immunosuppressive agents (prednisone, azathioprine) or with cyclosporine. Osteoporosis prophylaxis is particularly important in the female heart transplant recipient, because the chronic use of prednisone increases this risk. Guidelines are provided to counsel patients in these areas. ⁽²⁾. 

Generally, reproductive function improves after transplant and many cases of pregnancy had been reported in this time. The female transplant recipient attempting successful conception, pregnancy, and delivery ^(3,4).

When the couple has completed the familial nucleus or does not desire offspring, is important to realize whether safer method of contraception is advisable in such women.

The new low-dose hormonal contraceptives can provide suitable birth control in these women but accurate and correct information about both, risks and advantages is mandatory ⁽⁵⁾.

It is obligatory that the choice of a contraceptive takes into account the possible development of arterial hypertension often associated to immunosuppressive therapy and, the possible effects of the conbined formulation on coagulation and, carbohydrate and lipid metabolisms ^(5,6).

Adverse Effects of Hormonal contraception Cardiovascular Effects - Myocardial Infarction - Stroke - Arterial Accidents - Venous Thromboembolism - Blood Hypertension Other Effects - Angioedema - Peliosis Hepatis - Severe Adverse Ocular Reactions - Vasculitis Moderate adverse effects Cancer Risks - Breast cancer risk - Ovarian cancer risk - Endometrial cancer risk - Cervical cancer risk - Colorectal cancer risk - Skin cancer risk - Liver cancer risk - Pancreatic cancer risk - Neurofibromas growth - Unclear cancer risks Hazardous prescription Hormonal contraception in female transplant recipients - Hormonal contraception in female kidney recipients - Hormonal contraception in female liver transplant recipients - Hormonal contraception in female heart transplant recipients - Contraception in women HIV infected Mild Adverse effects New Perspectives immunocontraception Contraceptive counseling Conclusion

However, a study carried-our on twenty-four female transplant recipient, before of pregnancy, reported no side-effects during combined oral contraceptive use without the need for increasing the doses of antihypertensive drugs ⁽⁶⁾.

Generally, low-dose gestagen preparations are indicated for high risk patients, while low-dosage combined preparations may be indicated for low-risk cardiac patients ⁽⁷⁾.

Therefore, choice of progestagen would be guided considering its metabolic effects.

Unfortunately, hormonal contraception in heart transplant female recipients, is hitherto unresolved issue; however its use can avoid in first instance a tubal ligature. 

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Rosa Sabatini
General Hospital Policlinico, University of Bari, Italy
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REFERENCES

1. Meier, P.R., Makowski, E.L. (1984). Pregnancy in the patient with a renal transplant.Clin. Obstet. Gynecol, Dec, 27(4), 902-13. 
2. Kossoy, L.R., Herbert, C.M.,Wentz, A.C.  (1988).  Management of heart transplant recipients:  guidelines for the obstetrician-gynecologist.  Am.  J. Obstet. Gynecol, 159(2), 490-9. 
3. Akin, S.J.  (1992).  Pregnancy after heart transplantation.  Prog. Cardiovasc.Drug, 7(3), 2-5. 
4. Maurer, G., Abriola, D.  (1994).  Pregnancy following renal transplant.  J. Perinat. Neonatal. Nurs,8(1), 28-36. 
5. Spina, V., Aleandri, V., Salvi, M.  (1998).  Contraception after heart transplantation. Minerva Ginecologica, 50(12), 539-43.
6. Seifert-Klauss, V., Kaemmerer, H., Brunner, B., Schneider, K.T., Hess, J. (2000). Contraception in patients with congenital heart defects.  Z.  Kardiol, 89(7), 606-11.
7. Taurelle, R.  (1979).  Micro-pill use by cardiac patients.  Contracept.  Fertil Sex. (Paris), 7(11),789-93.

RELATED STORIES:
Contraceptive counseling   Progesterone Receptor Modulators (PMRS) and Progesterone Antagonists (PAS)   Conclusion - adverse effects of Hormonal contraception   New Perspectives immunocontraception   Low Libido as adverse effect of Hormonal contraception   Vaginal Infections as adverse effect of Hormonal contraception   Depression as adverse effect of Hormonal contraception   Ovarian cysts as adverse effect of Hormonal contraception   Irregular Bleeding Pattern as adverse effect of Hormonal contraception   Mild Adverse effects of Hormonal contraception   Dermatological Adverse effects   Headache as Adverse Effect of Hormonal contraception   Adverse effects on carbohydrate and lipid metabolism   Moderate adverse effects hepatobiliary complications   Hormonal contraception in female heart transplant recipients

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