Welcome to the ePoster Viewing Panel of AICOG 2025

Introduction: We present a case of 33 year old teacher underwent liver transplant(2023) in view of rare genetic liver condition known as progressive familial intrahepatic cholestasis (PFIC) type 3 Patient presented in 2017 with symptoms of jaundice and pruritis in in 2nd trimester of her first pregnancy, delivered uneventfully in 2018 post that patient developed progressive liver failure and need of liver transplant in 2023.Patient suffered from severe dysmenorrhoea with heavy menstrual bleeding since 3 years, her cycles were irregular with pain disturbing her day to day activity causing fainting spells with very heavy bleeding .On examination she looked pale with per vaginal examination suggestive of normal sized uterus. Patient was on immunosuppressive drugs. Usg was done s/o- uterus normal size, ET-8.2 MM ,ovaries normal in size but right ovary showed endometriotic cyst of 2.6x2.5x1.8 cm Hysteroscopic Dilation and curettage along with Mirena insertion done in order to curtail menstrual challenges. Objectives: ? Primary Objective: To explore the effectiveness of Mirena IUD in reducing heavy menstrual bleeding and relieving dysmenorrhea in liver transplant recipients. ? Secondary Objective: To assess the safety profile of Mirena in this patient population, with particular attention to liver function, immunosuppressive therapy, and infection risk. RESULTS: : Patient has been a regular follow up patient post Mirena insertion her quality of life improved as her heavy flow and dysmenorrhea have been significantly reduced with serial ca-125 levels decreasing from 125 to 99 providing contraceptive benefits as well. The Mirena IUD offers a localized, hormone-based treatment that significantly reduces menstrual blood loss and alleviates dysmenorrhea. Its minimal systemic hormone absorption makes it a safe option for post-liver transplant patients, as it avoids significant interactions with immunosuppressive medications. Additionally, its ability to prevent anemia by reducing blood loss is particularly beneficial in this population. Proper insertion techniques and regular follow-ups mitigate risks such as infections and device-related complications. Patients and their families reported high satisfaction with the treatment, particularly due to the reduction in hospital visits related to menstrual complications and the improvement in daily life activities. CONCLUSION: PFIC3(progressive familial intrahepatic cholestasis type 3) is an inherited cholestatic disorder caused by mutations in the ABCB4 gene encoding the Multidrug resistance protein (MDR3) protein. PFIC3 often progressing to chronic liver disease and cirrhosis requiring liver transplantation. Due to altered estrogen metabolism and deregulation of various hormonal pathways, women with CLD is generally considered to be a higher risk compared to general population The Mirena IUD is a safe, effective, and patient-centred solution for managing heavy menstrual bleeding and dysmenorrhea in post-liver transplant patients. Its localized hormone delivery, compatibility with immunosuppressive therapy, and well-established safety profile, contraceptive benefits make it an excellent choice for optimizing menstrual health and improving quality of life in this medically complex population. Further research is warranted to strengthen the evidence base and refine clinical guidelines and addressing an important gap in medical knowledge.