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.