Gynaecological health in adult congenital heart disease women: Addressing menorrhagia, infertility, contraception, menopause.

Developments in medical and surgical techniques have improved survival in women with congenital heart disease (CHD) with most now surviving well into adulthood. Reproductive health amongst these women is underexplored and needs more attention. Women with CHD are known to have more menstrual dysfunction than the general population and have higher maternal and fetal risks when they become pregnant. Adequate and timely preconception counselling, including contraception within a multidisciplinary team (MDT) are essential to optimise pre pregnancy cardiac status and improve pregnancy outcomes. Counselling regarding fertility, sexuality, contraception and menopause is necessary and should start early, around 12-13 years, and as they transition into adult services. Fertility seems to be reduced in women with complex CHD and consideration for assisted reproduction technique (ART) should be assessed by the MDT as risks associated with ART including ovarian hyperstimulation syndrome, bleeding, thrombosis and infection can have profound effects on women with complex cyanotic CHD.