Prioritising gynaecological care in post-haematopoietic stem cell transplant patients

An adolescent girl with acute myeloid leukaemia underwent chemotherapy followed by haematopoietic stem cell transplantation (HSCT). Post-HSCT, she developed oral chronic graft-versus-host disease (cGvHD), which was successfully treated. Twenty months later, she was referred to the gynaecology department for evaluation of secondary amenorrhoea. Hormonal assessment led to a diagnosis of primary ovarian insufficiency due to chemotherapy. She was prescribed hormone replacement therapy (HRT), but the absence of withdrawal bleeding prompted vaginal examinations, which revealed vaginal adhesions. A sonogram confirmed haematocolpos and haematometra resulting from silent genital cGvHD. The patient was managed surgically, followed by treatment with topical oestrogen and vaginal moulds. HRT was restarted, and she resumed regular menstruation. Over a routine 20-month follow-up period, no recurrence of symptoms was observed. This case highlights gynaecologic complications of cGvHD and emphasises the importance of gynaecological monitoring in post-transplant care to proactively identify and address genital cGvHD, preventing its irreversible complications.