A Practical Guide to Gynecologic and Reproductive Health in Women Undergoing Hematopoietic Stem Cell Transplant

Abstract

Optimum care of female transplant recipients requires gynecologic care at several stages through the allogeneic hematopoietic stem cell transplantation (HCT) process. Sex-based considerations in women post-HCT span gynecologic sequelae of transplant along with assessment and maintenance of optimal sexual and gynecologic health. Pre-HCT, managing menstruation and abnormal uterine or genital bleeding, considering fertility preservation, and assessing for sexually transmitted infections, including human papillomavirus (HPV)-related disease and cervical cancer, enhance women's health. While inpatient during transplant when women are thrombocytopenic, menstrual bleeding requires suppression. Whenever graft-versus-host disease (GVHD) is assessed, screening for genital GVHD merits consideration. After the first 100 days, periodic assessments include obtaining a menstrual history, assessing ovarian function, and reviewing current hormonal use and contraindications to hormonal methods. Regular assessment for primary ovarian insufficiency, dyspareunia, and intimacy guides provision of contraception and hormone replacement options. As part of ongoing screening for genital GVHD and HPV-related disease, including sexually transmitted infections, periodic pelvic examinations are performed. Once successful long-term survival is achieved, planning for fertility may be considered. This article offers a comprehensive approach to these aspects of gynecologic care of patients throughout the trajectory of HCT and beyond into survivorship. We review the effects of HCT treatment on sexual health, ovarian function, and resulting menstrual changes and fertility challenges. Identification, treatment, and prevention of subsequent malignancies, including breast cancer, are discussed, with a focus on regular assessment of genital HPV disease and GVHD in long-term follow-up.

Haematopoietic Stem Cell Transplantation in Adolescents and Young Adults With Acute Lymphoblastic Leukaemia: Special Considerations and Challenges

“…Affording fertility preservation procedures for future family planning often causes massive emotional distress (93). The costs of preservation, banking and of further processing when pregnancy is desired are often obstacles for cancer survivors (77). this increased risk did not significantly change with time in long-term studies.…”

Early Detection of Vulvovaginal Graft-Versus-Host Disease: An Integrative Review

“…Associated immune dysfunction or the use of immunosuppressant medications leads to an increased risk of cervical and lower genital tract neoplasia and cancer. Immunosuppression also contributes to the development of genital tract infections ( Murphy et al, 2019 ).…”

Fertility Preservation and Reproductive Health in Patients Undergoing Hematopoietic Stem Cell Transplantation

“…The very interesting article by Murphy et al [1], "A Practical Guide to Gynecologic and Reproductive Health in Women Undergoing Hematopoietic Stem Cell Transplantation," was recently published in this journal. Reproductive and gynecologic health in young patients with cancer is a major emerging problem from a quality of life standpoint, certainly meriting (today more than ever) greater clinical attention, considering that more and more patients with cancer recover completely with modern therapeutic strategies.…”