GYNECOLOGICAL AND REPRODUCTIVE FUNCTION AFTER LIVER-TRANSPLANTATION

Women of reproductive age who underwent orthotopic liver transplantati on were surveyed to determine timing and pattern of menstruation, sexu al activity, contraception, and incidence of pregnancy and gynecologic al disorders. Eighty two female recipients of liver transplantation at the University of Michigan between August 1985 and January 1992 were surveyed about menstrual function and gynecological and obstetrical hi stories before and after transplantation. Additional information was r etrieved from medical records regarding their liver disease and detail s of pregnancies and gynecological care. In the year before transplant ation, 27 women (42%) reported regular menstrual cycles, 18 (28%) irre gular and unpredictable bleeding and 19 (30%) amenorrhea. After transp lantation, 30 women (48%) experienced regular menses, 16 (26%) irregul ar bleeding, and 16 (26%) amenorrhea. In women less than 46 years old, 27 (53%) had regular menses before and after transplant. Most women w ith acute liver disease had regular periods before (82%) and after tra nsplant (73%). A total of 95% of women under the age of 46 had return of menstrual bleeding within the first year after transplantation. Of these women 49% had normal liver function tests at the time of survey, 33% mildly abnormal, and 18% severely abnormal, Liver function was no t correlated with menstrual patterns. A total of 72% of women were sex ually active after transplantation. Of 24 women under age 46 who had n ot undergone sterilization or hysterectomy, six women conceived seven pregnancies. Seven women reported abnormal cervical cytology results a fter transplantation. Six underwent colposcopy and 4 required some for m of destructive therapy for cervical dysplasia, In women with liver d isease, menstrual patterns may change after orthotopic liver transplan tation. This is more common in women with chronic liver disease than i n those with acute liver disease. There was no correlation between liv er function and menstrual regularity after transplant. Return to sexua l activity can be expected and pregnancies are not rare in a populatio n of young women after liver transplantation. Regular cervical cytolog y is critical due to a recognized increase in cervical neoplasia in im munocompromised patients.