Safety and effectiveness of contraception among women with solid organ transplants: An updated systematic review

To update a previous systematic review on contraceptive safety and effectiveness among women with solid organ transplants.

We searched multiple databases from inception through December 7, 2022, for studies of any design that examined contraceptive safety and effectiveness for any contraceptive method among women with solid organ transplants. We extracted data from included articles; for studies that were not case series/reports, we assessed risk of bias and determined certainty of evidence.

Twenty-six articles satisfied inclusion criteria, 11 cohort studies and 15 case series/reports. Among the 11 cohort studies, most had moderate or high risk of bias. For levonorgestrel intrauterine devices (LNG-IUDs), four non-comparative cohort studies of women with transplants (total n = 55) observed no pregnancies and no pelvic infections. One comparative cohort study (n = 16) suggested similar LNG-IUD effectiveness between women with and without transplants, based on uterine histologic and inflammatory markers. Another comparative cohort study found no unwanted pregnancies among 178 IUD users (type unspecified) with kidney transplants. For non-IUD hormonal contraception, one comparative cohort study (n = 48) found no differences in transplant-related safety outcomes or pregnancy rates for etonogestrel implant use compared with no hormonal contraception; another (n = 126 with kidney transplant) observed fewer unwanted pregnancies among oral contraceptive users (11.8%) compared with non-users (59.8%). Four non-comparative cohort studies of combined hormonal contraception users (total n = 76) observed no clinically meaningful safety outcomes and no pregnancies.

Very low certainty evidence does not suggest adverse safety or effectiveness outcomes among LNG-IUD and non-IUD hormonal contraception users with solid organ transplant.

While limited, this evidence can be used by health care providers and women with solid organ transplants in counseling and shared decision-making about contraception. Further studies are needed to address concerns about contraceptive use among women with transplants, such as the risk of thrombosis and other cardiovascular risks with hormonal contraceptive use.