<h3>Background</h3> Access to reproductive healthcare for adolescent girls with medical conditions requiring use of mycophenolate mofetil or sodium (MMF), a teratogenic immunosuppressant, is important to prevent unintended pregnancy and birth defects in offspring. Highly effective long acting reversible contraception (LARC), intrauterine devices (IUDs) and contraceptive implants, is recommended for this population. The aim of this study is to describe the girls prescribed MMF at a children's hospital and the reproductive healthcare they received. <h3>Methods</h3> We searched electronic health records (EHR) to identify females aged 10 through 20 years prescribed MMF at our children's hospital from January 2010 through December 2019. Of the 225 patients identified, we excluded 64 who initiated MMF before January 2010. We reviewed the EHRs of 161 subjects starting with the first visit, either inpatient or outpatient, when the MMF was prescribed and prospectively reviewed all subspecialty, and reproductive health visit notes thereafter. We entered the date and type of each health visit as well as EHR documentation of menarche, coitarche, sexual activity, pregnancies, and contraceptive use into an online database, REDCap. <h3>Results</h3> Of the 161 subjects: 50% had systemic lupus erythematosus (SLE), 25% solid organ or bone marrow transplant, 25% other disease; 39% were Hispanic, 32% Black. At MMF initiation, mean age was 15.2 ± 3.9 years; 89% were post-menarchal; 19% had coitarche. We recorded subjects' EHR data for a mean of 5 ± 3 years after MMF initiation. 42% ever had sex, with mean time to EHR documentation of sexual activity of -0.7 ± 2.4 years since MMF initiation. Of the 68 subjects who ever had sex, a higher proportion had SLE v. transplant v. other disease, [66% v. 19% v. 15%, p<0.001]. Of all 161 subjects, 68(42%) attended a reproductive health visit (49/68(72%) with adolescent medicine) a mean of 1.7 ± 1.8 years after MMF initiation. Within 3 months of the first reproductive health visit, 37/68(54%) were using an effective contraceptive method: 24(35%) IUD; 7(10%) contraceptive implant; 5(7%) combined oral contraceptive pill; 1(2%) progestin only pill. Of the 22 subjects who had a pregnancy, 14 were unplanned, 6 were using MMF at the time of diagnosis of pregnancy. <h3>Conclusions</h3> We found that adolescent girls prescribed the teratogenic immunosuppressant mycophenolate need reproductive health care; a majority were post-menarchal and more than 40% were sexually active, especially those with SLE. We also found a high uptake of LARC methods of contraception in those who attended a reproductive health visit suggesting that increasing access to contraceptive services for these high-risk adolescent girls may reduce their risk of adverse pregnancy outcomes.