Study: Women with CKD face abnormal menstruation, infertility
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Key takeaways:
- Heavy menstrual bleeding and inability to afford period products were commonly reported in women with chronic kidney disease.
- Patients want more nephrologist engagement in multidisciplinary care.
Women with chronic kidney disease commonly experience abnormal menstruation and infertility, but knowledge and discussion around these issues are lacking, according to a study of women’s reproductive health in CKD.
Researchers also found low use of contraception and suggested that increased dialogue with patients is “urgently warranted,” Danica Chang, MSc, and colleagues wrote in Kidney Medicine.
“This is something that people with kidney disease want to talk to their physicians about,” Sofia B. Ahmed, MD, another author on the paper, told Healio. “It’s not an easy thing to bring up. It is important for the nephrologist or other kidney care provider to create that space.”
Researchers reached 98 patients with CKD with an online survey about their menstruation, fertility and contraceptive use. Mean age of patients was 33 years. Six patients also underwent semi-structured telephone interviews in which they described their reproductive health issues and experiences discussing such topics with health care professionals.
Most participants (58%) were white and cisgender women (81%). Participants resided in different countries, representing three continents. Twenty percent of patients were currently receiving dialysis, 60% were not and 20% had a currently functioning kidney transplant.
Of the 77 patients who reported current menstrual cycles, most reported predictable bleeding. Heavy menstrual bleeding was common across the cohort — particularly among transplant patients, affecting all 14 patients who were menstruating.
Overall, 30 patients reported sometimes not being able to afford period products, which is referred to as “period poverty.”
“If they’re bleeding heavily and they don’t have access to period products, it’s surprising that no one has addressed this issue or there aren’t any sound results to help resolve this problem,” Chang told Healio. “From a policy stance, that is something that has been surprising.”
Overall, 38% of patients reported having needed a blood transfusion, a potential response to heavy menstrual bleeding that Ahmed said could worsen outcomes in CKD.
“Thinking about this as a nephrologist, if someone gets a blood transfusion, that increases their sensitization and risk of potentially rejecting a kidney transplant,” Ahmed said. “Ideally, you'd rather not have people need to have blood transfusions if their periods can be controlled using IUDs or other forms of hormonal birth control.”
In all three groups, use of contraception was less than 50%, with the most common reasons for avoidance being “fear” or a wish to conceive. Overall, 19% of participants reported secondary amenorrhea and 9% reported history of infertility.
In interviews, patients “revealed a desire for greater discussion of reproductive health with nephrologists,” as well as more multidisciplinary care. Chang said she found it “striking” for patients to express that given the lack of dialogue around these issues, adding that “they were passionate about voicing their menstrual and kidney health concerns.”
The study was conducted in consultation with Taryn Gantar, a patient advisor at Alberta Health Services who has been on dialysis for 23 years. Gantar said she served as “a champion” throughout the work and was “vocal” with recommendations of how it should be done.
Researchers concluded that menstrual abnormalities and infertility in CKD represent “an unmet need in nephrology education,” as well as “an opportunity for multidisciplinary teamwork” to promote reproductive health in women with CKD.
“We think that even asking questions related to menstrual health, contraceptive use and reproductive health — something as small as that could create a space where patients could feel safe talking about this,” Chang said, adding nephrologists “could also communicate a bit more across disciplines to ensure that the patients were getting the care that they need and want.”
Reference:
Chang DH, et al. Kidney Med. 2023;doi:10.1016/j.xkme.2023.100713.
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