Contraceptive counseling and use among 197 female kidney transplant recipients

Background. There is growing interest about the quality of life of female transplant recipients, including their sexual and reproductive health. Although menstrual irregularity and infertility are common in women with advanced chronic diseases, most regain their reproductive function shortly after transplantation. Because an unplanned pregnancy soon after transplantation can expose both mother and fetus to considerable risk, it is recommended that these women should receive contraceptive counseling. However, the actual implementation and effectiveness of this recommendation has not been extensively studied. Methods. A total of 197 reproductive age, female, stable kidney graft recipients attending a large Brazilian transplantation clinic were interviewed. They were asked about menstrual pattern, sexual activity, counseling, and their use of contraceptive methods both before and after the transplant. Results. Before transplantation 70.6% reported menstrual irregularity, 91.9% of them were sexually active, 74.1% were counseled to use contraception and 86.3% used some contraceptive method. After the graft, 50.2% had menstrual irregularity, 79.7% were sexually active, 48.7% were advised to use contraceptives and 72.1% were actually using a method. After transplantation, there were 14 pregnancies in 11 women and 92.9% (13/14) of these were unplanned. Conclusions. Although most female kidney transplant recipients were sexually active both before and after transplantation, many were not counseled about the need for contraception and did not use any form of birth control. Health professionals involved in the management of these patients need to include contraceptive counseling as part of their routine care.