George Washington University School of Nursing, Washington, District of Columbia.
Loyola University Medical Center, Maywood, Illinois; NIH Clinical Center, Bethesda, Maryland.
Biol Blood Marrow Transplant. 2019 Nov;25(11):e331-e343. doi: 10.1016/j.bbmt.2019.07.038. Epub 2019 Aug 5.
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.
最佳的女性移植受者护理需要在异基因造血干细胞移植 (HCT) 过程中的几个阶段进行妇科护理。HCT 后女性的基于性别的考虑因素涵盖了移植后的妇科后遗症，以及评估和维持最佳的性健康和妇科健康。在 HCT 前，管理月经和异常子宫或生殖器出血，考虑生育力保存，并评估性传播感染，包括人乳头瘤病毒 (HPV) 相关疾病和宫颈癌，可增强女性健康。当女性在移植期间因血小板减少而住院时，月经出血需要抑制。每当评估移植物抗宿主病 (GVHD) 时，都应考虑筛查生殖器 GVHD。在最初的 100 天后，定期评估包括获取月经史、评估卵巢功能、审查当前激素使用情况和激素方法的禁忌症。定期评估原发性卵巢功能不全、性交困难和亲密关系可指导避孕和激素替代方案的选择。作为对生殖器 GVHD 和 HPV 相关疾病（包括性传播感染）的持续筛查的一部分，定期进行盆腔检查。一旦成功实现长期生存，就可以考虑生育计划。本文提供了一种全面的方法来处理 HCT 期间及之后生存期间患者的妇科护理的这些方面。我们回顾了 HCT 治疗对性健康、卵巢功能以及由此导致的月经变化和生育挑战的影响。讨论了随后恶性肿瘤的识别、治疗和预防，包括乳腺癌，并重点关注长期随访中生殖器 HPV 疾病和 GVHD 的常规评估。
