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Contraception for Women with a History of Solid Organ Transplantation

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Contraception for the Medically Challenging Patient

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Abstract

For women with uncomplicated solid organ transplantation, the US Medical Eligibility Criteria for Contraceptive Use consider all methods of contraception category 2 (benefits generally outweigh risks). Pregnancy is not recommended until graft function is stable, and thereafter should be carefully timed in conjunction with a transplant team. For this reason, it is recommended that patients with a history of transplantation use highly effective methods of contraception when not actively trying to conceive. The only types of contraception that have been systematically studied in women after transplantation are combined hormonal contraception and the intrauterine device (IUD). IUDs were historically thought to be contraindicated in a post-transplant population, but modern literature is overwhelmingly reassuring. These studies, though small series, are largely reassuring. Long-acting reversible contraception (LARC) methods are underutilized in this population.

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Notes

  1. 1.

    It should be noted that the mechanism of immunosuppression for solid organ transplantation is largely the TNF-alpha pathway, which is different than the protease pathway inhibited by HIV. However, the same concepts apply, namely that immunosuppression does not present a contraindication for most contraceptive use, including IUD. For a full discussion of HIV and contraception, please see Chap. 6.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Magee Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Colleen M. Krajewski M.D., M.P.H.

  2. Departments of Gynecology and Obstetrics/Population, Family, and Reproductive Health, Johns Hopkins Bayview Medical Center, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Anne E. Burke M.D., M.P.H.

Authors
  1. Colleen M. Krajewski M.D., M.P.H.
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  2. Anne E. Burke M.D., M.P.H.
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Correspondence to Colleen M. Krajewski M.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

    Rebecca H. Allen

  2. Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA

    Carrie A. Cwiak

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Krajewski, C.M., Burke, A.E. (2014). Contraception for Women with a History of Solid Organ Transplantation. In: Allen, R., Cwiak, C. (eds) Contraception for the Medically Challenging Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1233-9_9

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  • DOI: https://doi.org/10.1007/978-1-4939-1233-9_9

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  • Online ISBN: 978-1-4939-1233-9

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