After Your Kidney Transplant Advice for women

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1 After Your Kidney Transplant Advice for women Exceptional healthcare, personally delivered

2 Now that you have received a kidney transplant there are probably many questions you wish to ask about the changes in your body and the drugs you are taking. This booklet is designed to answer some of the most common questions and give some information about: n Smear tests (cervical screening). n Contraception. n Pregnancy. n Breast screening. n Hormone replacement therapy. Cervical screening (smear tests) We are often asked how often women should have a smear test. There is a slight increase in the risk of developing cervical cancer once you start taking immunosuppression to prevent kidney rejection. The guidelines on how often a smear is needed after a transplant have changed. We recommend that you have a smear within 12 months of having your transplant. If this is normal then we advise that you have them every 3 years as with the general population. Contraception Many women experience irregular periods whilst on dialysis with reduced fertility. A well functioning transplant usually restores fertility and menstrual cycles to normal. This, of course, means that without adequate contraception pregnancy can occur. You are advised not to conceive for at least months after your transplant (see Pregnancy section) and, therefore, adequate contraception is essential. Most forms of contraception can be used but this varies with each individual. It is advisable to check with your kidney doctor. 2 After Your Kidney Transplant

3 n The Pill can be used if your blood pressure is stable but can affect the levels of the drugs in your blood. Medical advice should be obtained prior to starting. n The Coil can also be used. Antibiotics are usually given when it is inserted to prevent infection. n Sheaths (condoms), Femidoms, or diaphragms can be used and have the extra advantage of providing some protection against sexually transmitted diseases. n Implants or Depot injections should be discussed with your doctor. Pregnancy There were more than 200 successful pregnancies in kidney recipients in the UK between (UKTSSA Pregnancy register). If you are thinking about having a baby you are strongly advised to discuss it first with your kidney doctor. Here are some general guidelines: n Wait at least months before attempting to get pregnant. This delay allows time for the transplanted kidney to settle down and for your medications to be stabilised. n Your blood pressure should be well controlled. Your drugs may need to be altered before you conceive, as some can be harmful to the unborn child. n Kidney function should be stable. If your transplant function is unstable, pregnancy can pose a risk to your kidney. Generally speaking, the better the kidney function the better the outcome for mother and baby. n Take folic acid 400 micrograms daily as soon as you decide to start trying for a baby and continue during the first 12 weeks of pregnancy. This is available from most chemists. After Your Kidney Transplant 3

4 n Diabetic patients need very careful monitoring during pregnancy. If blood glucose control is poor, there is an increased risk of miscarriage. You should inform your diabetic specialist if you are considering pregnancy and as soon as you become pregnant. Your Doctor will discuss pregnancy fully with you and your partner and explain the risks involved in your own case. There is a higher risk of premature labour and of babies being smaller than with non-transplant pregnancies. Osteoporosis and Hormone replacement therapy (HRT) In the past HRT was used to reduce the risk of osteoporosis associated with long-term steroid use in women after the menopause. However new guidelines suggest that HRT is not the ideal treatment to reduce this risk. Instead, they advise use of a group of drugs called bisphosphonates that are taken once a week. You may wish to discuss this further with your consultant. You can also help reduce the risk of osteoporosis by taking regular exercise, increasing your intake of calcium in your diet and stopping smoking. If you are experiencing other menopausal symptoms your GP may advise HRT and this is usually fine for transplant patients. However, please let your consultant know if you start any new drugs. Breast screening Women aged between 50 and 70 years who have had a transplant will be routinely called to have a mammogram every 3 years as in the general population. It is also advisable to check your breasts regularly and to see your GP if you find any unusual lumps. 4 After Your Kidney Transplant

5 This information is meant as a guide only. Please ask a member of the medical or nursing staff for more specific advice relating to your own personal situation on these or any other matter. Sources of Further Support / Information NHS Constitution. Information on your rights and responsibilities. Available at After Your Kidney Transplant 5

6 How to contact us: See your appointment letter for the number to phone with any queries you may have If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. This edition published May Review due May NBT002098