Female Reproductive and Gynecologic Considerations in Chronic Kidney Disease: Adolescence and Young Adulthood

Abstract

Chronic kidney disease (CKD) increasingly affects younger people, including adolescents and young adults. CKD among females is accompanied by unique reproductive and gynecologic health concerns; though to date, this area has not been well studied. Hormonal disruptions attributed to CKD may underlie the high prevalence of abnormal uterine bleeding and influence the age of menarche in adolescents. Period poverty as a socioeconomic barrier further exacerbates the female-specific burdens of CKD. Reduced fertility in CKD is likely multifactorial and may be related to a reduction in ovarian reserve, reproductive hormone disturbances, and gonadotoxic medication use in addition to low sexual function and activity. Fertility, sexual function and activity, and risk of sexually transmitted infections increase with transplantation. Pregnancy is possible at any stage of CKD, although often accompanied by high risks of maternal and fetal complications. Contraception is thus an important consideration in CKD, but use is low and the risks and benefits of different forms in the setting of CKD are not well characterized. Though patients with CKD report reproductive health as an important element of care, many nephrologists report lack of confidence and training in this area, highlighting the need for targeted research and education. The unique reproductive health care needs of the growing transgender youth population warrant attention in nephrology training with multidisciplinary input. This review will discuss female reproductive health and gynecologic considerations in adolescents and young adults with CKD while proposing clinical and research strategies to improve this understudied yet important aspect of kidney care.

Rates of Menstrual History-Taking and Counseling With Anticancer Treatments Are Low: People Who Menstruate Deserve Gender-Specific Cancer Care

“…3 Higher engagement could be achieved by better educating medical students and doctors on the relevant questions patients should be asked, 40,41 and the importance of timely menstrual history-taking. 42 In the hospital, higher engagement could be attained through automating this history-taking process via templates in the electronic medical record, 43,44 which has been successful in improving oncology/ hematology referral rates for fertility preservation. [45][46][47] Regular audits of the electronic documentation process and use of the menstrual tool could also be performed to monitor compliance.…”

Causas poco frecuentes de amenorrea debida a hipogonadismo hipogonadotrópico

“…En mujeres con diversos grados de enfermedad renal crónica (ERC) es común la presencia de irregularidades menstruales, y estas suelen empeorar y ser más frecuentes en pacientes conforme avanza la disfunción renal (30,31). Se han visto inclusive ciclos menstruales regulares en solamente aproximadamente 8-10% de las mujeres que reciben diálisis (30).…”

“…En la mayoría de las mujeres ocurre amenorrea/anovulación para el momento en que se llega a recibir diálisis, y esto afecta no solamente la fertilidad de estas mujeres, sino también su salud ósea (30). Cuando hay ERC, se produce un defecto en la pulsatilidad de secreción de GnRH, lo cual resulta en una falta de ciclicidad de FSH y LH (31). Esto provoca niveles bajos de estradiol, lo cual inhibe el aumento de LH y ovulación.…”

“…Esto provoca niveles bajos de estradiol, lo cual inhibe el aumento de LH y ovulación. Asimismo, en la ERC se tienen niveles altos de prolactina debido a un aumento de la producción y disminución del aclaramiento, lo cual inhibe igualmente la ovulación (31). El tratamiento de estas irregularidades no está bien establecido, y el uso de medicamentos utilizados en mujeres sin ERC debe ser considerado ajustando la dosis según corresponda.…”

Menstrual Abnormalities and Reproductive Lifespan in Females with CKD

“…Although considerable attention has been placed on improving fertility rates and complications of pregnancy in the CKD population (3), menstrual abnormalities have received notably less consideration despite menarche, menstruation, and menopause being fundamental parts of female reproductive biology. Despite the fact that they are commonly experienced in individuals with CKD (4), studies exploring menstrual abnormalities, shorter reproductive lifespan, and early menopause are often limited by sample size and combine results from populations across CKD stages, including those with kidney transplants (5). Menstrual abnormalities, premature menopause, and shortened reproductive lifespan are associated with lower life expectancy, higher risk of cardiovascular disease (6,7), and osteoporosis (8) in the general population.…”