Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series

Huguelet, Patricia; Sheehan, Carolyn; Spitzer, Rachel F.; Scott, Stephen

doi:10.1016/j.contraception.2016.11.008

“…12 Similar results were reported in KT and LT recipients using hormonal IUDs, with no pregnancies in 3 years of follow-up. 8,13,14 Current data also indicate that immunosuppressed women have no increased risk of pelvic inflammatory disease compared to the general population of non-IUD users. 15,16 There have been no published cases of pelvic inflammatory disease among >200 KT and LT recipients to date.…”

Section: | Contraception In Transplant Recipientsmentioning

confidence: 99%

“…Only progestin-only agents have a favorable safety grade 2 for complicated graft function, although these recommendations did not incorporate additional larger studies also demonstrating favorable safety data of intrauterine devices (IUDs). 7,8 …”

Section: | Contraception In Transplant Recipientsmentioning

confidence: 99%

“…15,16 There have been no published cases of pelvic inflammatory disease among >200 KT and LT recipients to date. 8,10,12,13 …”

Section: | Contraception In Transplant Recipientsmentioning

confidence: 99%

“…Only progestinonly agents have a favorable safety grade 2 for complicated graft function, although these recommendations did not incorporate additional larger studies also demonstrating favorable safety data of intrauterine devices (IUDs). 7,8 Of note, the CDC does not provide a specific threshold of liver or kidney impairment when classifying graft function as "complicated." However, the primary contraceptive option that is affected by severity of graft dysfunction is combined hormonal contraception (CHC).…”

Section: Contr Acep Ti On In Tr An S Pl Ant Recipientsmentioning

confidence: 99%

“…15,16 There have been no published cases of pelvic inflammatory disease among >200 KT and LT recipients to date. 8,10,12,13 commonly associated with liver enzyme elevation, though current agents carry only rare risk of cholestatic liver injury. 17 There are no controlled studies evaluating side effects in transplant patients.…”

Section: Concerns Surrounding the Use Of Iuds In Transplant Recipientsmentioning

confidence: 99%

See 3 more Smart Citations

Reproductive health in women following abdominal organ transplant

Sarkar

¹

,

Bramham

²

,

Moritz

³

et al. 2018

American Journal of Transplantation

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Fertility is commonly impaired in women with end-stage kidney and liver disease, although most women will have restoration of fertility within 1 year of transplant. Family planning is therefore critical to discuss with reproductive-aged transplant recipients in the early posttransplant period, in order to ensure timely initiation of contraception, and optimal timing for conception. For women seeking pregnancy, the risks to the mother, graft, and baby should be discussed, including evaluation of immunosuppression safety and potential for adjusting medications prior to conception. With an increasing number of transplant patients now breastfeeding, immunosuppression safety in lactation continues to carry great importance.

show abstract

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Sammaritano

¹

,

Bermas

²

,

Chakravarty

³

et al. 2020

Arthritis Care & Research

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Objective To develop an evidence‐based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD). Methods We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary. Results This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti‐Ro/SSA and/or anti‐La/SSB antibodies. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre‐pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy‐compatible medications, and ongoing physician‐patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD. Conclusion This guideline provides evidence‐based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low‐level data. We intend that this guideline be used to inform a shared decision‐making process between patients and their physicians on issues related to reproductive health that incorporates patients’ values, preferences, and comorbidities.

show abstract

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Sammaritano

¹

,

Bermas

²

,

Chakravarty

³

et al. 2020

Arthritis & Rheumatology

View full text Add to dashboard Cite

Objective To develop an evidence‐based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD). Methods We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary. Results This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti‐Ro/SSA and/or anti‐La/SSB antibodies. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre‐pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy‐compatible medications, and ongoing physician‐patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD. Conclusion This guideline provides evidence‐based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low‐level data. We intend that this guideline be used to inform a shared decision‐making process between patients and their physicians on issues related to reproductive health that incorporates patients’ values, preferences, and comorbidities.

show abstract

Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series

Cited by 35 publications

References 16 publications

Reproductive health in women following abdominal organ transplant

Reproductive health in women following abdominal organ transplant

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

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