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Reproductive late effects after hematopoietic stem cell transplant can have a significant impact on cancer survivors’ quality of life. Potential late effects include gonadal insufficiency, genital graft‐versus‐host disease, uterine injury, psychosexual dysfunction, and an increased risk of breast and cervical cancer in patients treated with total body irradiation. Despite guidelines, screening and treatment are not standardized among at‐risk patients. Provider barriers include lack of knowledge of at‐risk therapies and evidenced‐based guidelines. Patient barriers include a reluctance to report symptoms and lack of awareness of treatment options. System barriers include inefficient implementation of screening tools and poor dissemination of guidelines to providers who serve as the medical home for survivors. This review guides the clinician in identifying and managing reproductive late effects after hematopoietic stem cell transplant to improve outcomes.

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An estimated 500,000 cancer survivors of reproductive age in the United States will live to experience the long‐term consequences of cancer treatment. Therefore, a focused aspect of cancer care has appropriately shifted to include quality of life in survivorship. Infertility is a late effect of therapy that affects 12% of female survivors of childhood cancer receiving any cancer treatment in large cohort studies and results in a 40% decreased likelihood of pregnancy in young adults of ages 18–39 years. Nonfertility gynecologic late effects such as hypoestrogenism, radiation‐induced uterine and vaginal injury, genital graft‐versus‐host disease after hematopoietic stem cell transplant, and sexual dysfunction also significantly affect quality of life in survivorship but are underdiagnosed and require consideration. Several articles in the special edition “Reproductive Health in Adolescent and Young Adult Cancer Survivorship” address infertility, genital graft‐versus‐host disease, and psychosexual functioning in survivorship. This review article focuses on other adverse gynecologic outcomes of cancer therapies including hypogonadism and hormone replacement therapy, radiation‐induced uterovaginal injury, vaccination and contraception, breast and cervical cancer screening, and pregnancy considerations in survivorship.