Reproductive Health and Contraception in Females with Chronic Kidney Disease
Creators: name: Chang, Danica
Publisher: name: Cumming School of Medicine
Year: 2022
Subjects: subject: Menstruation
subject: Abnormal Uterine Bleeding
subject: Contraception
subject: Female Reproductive Health
subject: Women
subject: Chronic Kidney Disease
subject: Kidney Failure
subject: Health Sciences
subject: Medicine and Surgery
subject: Obstetrics and Gynecology

description: Background: Chronic kidney disease (CKD) is a global epidemic that affects &gt;13% of the population worldwide. Abnormal uterine bleeding is common in CKD, but most studies are limited to the kidney failure population. Abnormal menstruation is associated with cardiovascular risk, despite CKD already being a risk factor for cardiovascular disease. Pregnancy is known to be risky in CKD, therefore, contraception is paramount to prevent unplanned pregnancies in this reproductive-aged population; however, existing literature, though limited to the dialysis and transplant populations, has found that contraceptive use is low. Objectives: Using two separate yet complementary studies, we had multiple objectives. Project 1 aimed to describe self-assessed menstruation and contraceptive use among females across all stages of CKD using a global online survey. Project 2 aimed to (1) describe menstruation and changes in menstrual patterns with CKD progression, and (2) assess associations between reproductive hormones and menstrual patterns among females with kidney failure. Methods: In Project 1, females aged 18-50 years with a CKD diagnosis were invited to participate in an online survey. The survey was disseminated globally through 112 kidney organizations, patient groups, and social media. Whereas, in Project 2, females aged 18-50 years were recruited from dialysis clinics around Calgary, Alberta and completed a self-administered survey to capture demographic, kidney health, and menstrual health histories. Blood samples were also collected to measure the following reproductive hormone levels: follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, testosterone, prolactin, sex hormone binding globulin, and anti-Müllerian hormone. Results: Project 1 included 98 participants [n=20 dialysis (age 35±1 years), n=59 non-dialysis (age 32±1 years), n=19 transplant (age 35±2 years)]. One participant each in the dialysis and non-dialysis groups experienced primary amenorrhea, though more reported secondary amenorrhea (n=5 dialysis, n=9 non-dialysis, n=5 transplant). Of those experiencing current menses (n=14 dialysis, n=49 non-dialysis, n=14 transplant), 86%, 94%, and 100% of the dialysis, non-dialysis, and transplant groups reported heavy menstrual bleeding. Regarding, contraception, 50%, 63%, and 37% of dialysis, non-dialysis, and transplant participants reported no use, though among users, male condoms were notably popular in the dialysis (33%) and non-dialysis (48%) groups. Project 2 comprised of 27 females [n=23 hemodialysis (age 36 (IQR: 31,44) years), n=4 peritoneal dialysis (age 38 (IQR: 30,45) years)]. In the hemodialysis group, 52% reported absent menstrual bleeding during dialysis, though only 17% reported this during CKD and 9% before CKD diagnosis (p=0.01); however, there was no difference in proportions across timepoints in the peritoneal dialysis group. Further, in both groups, the prevalence of heavy menstrual bleeding was high, but did not differ throughout the progression of CKD. All the relevant hormone levels did not differ between those with absent and present menstrual bleeding, nor in those with heavy and normal menstrual bleeding. Conclusions: Together, these projects suggest that among the female CKD population, the prevalence of abnormal menstruation is high and contraception use is low, underscoring an important gap in the sex-specific care of this population. Given the lack of associations between hormone levels and menstrual status, we highlight the uncertainty around how kidney disease affects female reproductive health.