Hormonal contraception in female transplant recipients

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In the last years, the surgical progress led to progressive increase of number and survival time of transplant female recipients. 

Oral and intrauterine device contraceptives are generally,considered contraindicated, but if pregnancy occurs in the first year after transplantation, the survival graft may be in danger. While, the quality of life of these women, including sexuality and childbearing, have become important issues.

Hormonal contraception in female kidney recipients
The choice of an optimal contraception free-risk, is difficult in allograft recipient woman,even when successful renal transplantation restores normal menstrual cycle and fertility, in previously uremic patients ⁽¹⁾.

In fact, ovulatory cycles are observed in 72% of these patients ⁽²⁾. In fact, post-transplant diabetes, osteonecrosis, cataracts, and nephrotoxicity may be directly related to the various immunosuppressive drugs currently used. The lowest dose compatible with graft acceptance should help reduce the incidence of these nonfatal but significant complications. 

Patients with a lower glomerular filtration rate are more susceptible to the development of secondary hypertension and worse graft survival ⁽³⁾. The development of the graft nephroarteriosclerosis, as a consequence of hypertension may accelerate the progression of the post-transplant nephropathy ⁽⁴⁾ Adequate counseling on contraception is imperative in order to avoid unwanted pregnancies.  In fact, if pregnancy occur too soon after transplantation, the survival graft is in danger. ⁽¹⁾

Nevertheless these contraindication to hormonal contraception, in women showing stable graft function and without other risk factors, effective hormonal contraception may be considered ⁽⁵⁾. 

A study carried out on twenty six women with mean serum creatinine of 1.3 mg/dl, taking combined oral contraceptives (20-35 mcg EE and 3th generation of progestins) versus contraceptive patch (20mcg EE and 150mcg norelgestromin) reported good cycle control and high acceptability Oral contraceptives were discontinued in two cases:  in one because of deep thrombophlebitis and in another case because of deterioration of liver function.

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

No other side-effects were reported, until the end of study (18 months). Hormonal contraception did not significantly influence body mass index, blood pressure, serum creatinine, or other biochemical parameters. Although, in the first year post-transplant blood pressure may be a non-immunological risk factor in long term graft survival ⁽⁶⁾.

Adequate counseling on contraception is imperative in order to avoid unwanted pregnancies and to delay parenthood for at least 1 year.

Premature delivery is the major problem in these patients and can be avoided by maintaining adequate graft function and controlling hypertension and infections ⁽⁷⁾.

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

1. Rongieres-Bertrand, C., Fernandez, H.  (1998). Contraceptive use in female transplant recipients. Contracept. Fertil. Sex, 26(2), 845-50. 
2. Pietrzak, B., Wielgos, M., Kaminski, P., Jabiry-Zieniewicz, Z., Bobrowska, K. (2006). Menstrual cycle and sex hormone profile in kidney-transplanted women. Neuro Endocrinol.Lett,27(1-2), 198-202.
3. Fernandez-Fresnedo, G., Palomar, R., Escallada, R., Martin de Francisco, A.L., Cotorruelo, J.G., Zubimendi, J.A., Sanz de Castro, S., Ruiz, J.C., Rodrigo, E., Arias, M.  (2001).  Hypertension and long-term renal allograft survival:effect of early glomerular filtration rate. Nephrol. Dial. Transplant, 16(1),105-9.
4. Fabrega, A.J., Lopez –Boado, M., Gonzales, S.  (1990).  Problems in the long-term renal allograft recipient. Crit. Care Clin, 6(4), 979-1005. 
5. Pietrzak, B., Kaminski, P., Wielgos, M., Bobrowska, K., Durlik, M. (2006). Combined oral contraception in women after renal transplantation. Nuuro Endocrinol.Lett, 27(5), 679-82.
6. Pietrzak, B., Bobrowska, K., Jabiry-Zieniewicz, Z., Kaminski, P., Wielgos M., Pazik, J., Durlik, M.  (2007). Oral and transdermal hormonal contraception in women after kidney transplantation. Transplant.  Proc, 39(9), 2759-62.
7. Oko, A., Idasiak-Piechocka, I., Czekalski, S.  (2001).  Post-transplant nephropathy and arterial hypertension. Przegl. Lek, 58(9), 859-63.

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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