Reproductive and sexual dysfunction in uremic women
- Biff F Palmer, MD
Biff F Palmer, MD
- Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- Professor of Medicine
- President of the Health Science Center
- University of Texas Health Science Center School of Medicine
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
Disturbances in menstruation, fertility, and sexual dysfunction are commonly encountered in women with chronic kidney disease (CKD), usually leading to hypogonadism, as manifested by amenorrhea, by the time the patient reaches end-stage renal disease (ESRD). Milder degrees of hypogonadism are manifested by continued regular menses, but anovulation or oligomenorrhea. The menstrual cycle typically remains irregular, with scanty flow after the initiation of maintenance dialysis, although normal menses are restored in some women [1-5]. In others, menorrhagia develops, sometimes leading to significant blood loss and increased transfusion requirements.
The major menstrual cycle abnormality in uremic women is anovulation, resulting in infertility . Women receiving chronic dialysis also tend to experience decreased libido and reduced ability to reach orgasm [7-11].
Although rare, pregnancy can occur in women with advanced renal failure, but fetal wastage is markedly increased . Some residual renal function is usually present in the infrequent pregnancy that can be carried to term. (See "Pregnancy in women with underlying renal disease".)
NORMAL MENSTRUAL CYCLE
The normal menstrual cycle is divided into a follicular or proliferative phase and a luteal or secretory phase. During the follicular phase, gradually increasing secretion of follicle-stimulating hormone (FSH) causes recruitment and maturation of a single ovum and increasing secretion of estradiol. When the estradiol concentration reaches a sufficiently high level, it stimulates a sudden increase in luteinizing hormone (LH) secretion, thereby causing the release of a mature ovum, called ovulation. LH then stimulates the remainder of the follicle, called the corpus luteum, to secrete both estradiol and progesterone. (See "Physiology of the normal menstrual cycle".)
HORMONAL DISTURBANCES IN UREMIC PREMENOPAUSAL WOMEN
- Holley JL, Schmidt RJ, Bender FH, et al. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis 1997; 29:685.
- Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol 1999; 10:1381.
- Palmer BF. Sexual dysfunction in men and women with chronic kidney disease and end-stage kidney disease. Adv Ren Replace Ther 2003; 10:48.
- Matuszkiewicz-Rowinska J, Skórzewska K, Radowicki S, et al. Endometrial morphology and pituitary-gonadal axis dysfunction in women of reproductive age undergoing chronic haemodialysis--a multicentre study. Nephrol Dial Transplant 2004; 19:2074.
- Peng YS, Chiang CK, Kao TW, et al. Sexual dysfunction in female hemodialysis patients: a multicenter study. Kidney Int 2005; 68:760.
- Zingraff J, Jungers P, Pélissier C, et al. Pituitary and ovarian dysfunctions in women on haemodialysis. Nephron 1982; 30:149.
- Toorians AW, Janssen E, Laan E, et al. Chronic renal failure and sexual functioning: clinical status versus objectively assessed sexual response. Nephrol Dial Transplant 1997; 12:2654.
- Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis 1999; 33:235.
- Steele TE, Wuerth D, Finkelstein S, et al. Sexual experience of the chronic peritoneal dialysis patient. J Am Soc Nephrol 1996; 7:1165.
- Diemont WL, Vruggink PA, Meuleman EJ, et al. Sexual dysfunction after renal replacement therapy. Am J Kidney Dis 2000; 35:845.
- Finkelstein FO, Shirani S, Wuerth D, Finkelstein SH. Therapy Insight: sexual dysfunction in patients with chronic kidney disease. Nat Clin Pract Nephrol 2007; 3:200.
- Lim VS, Henriquez C, Sievertsen G, Frohman LA. Ovarian function in chronic renal failure: evidence suggesting hypothalamic anovulation. Ann Intern Med 1980; 93:21.
- Swamy AP, Woolf PD, Cestero RV. Hypothalamic-pituitary-ovarian axis in uremic women. J Lab Clin Med 1979; 93:1066.
- Gómez F, de la Cueva R, Wauters JP, Lemarchand-Béraud T. Endocrine abnormalities in patients undergoing long-term hemodialysis. The role of prolactin. Am J Med 1980; 68:522.
- Sievertsen GD, Lim VS, Nakawatase C, Frohman LA. Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure. J Clin Endocrinol Metab 1980; 50:846.
- Hochstetler LA, Flanigan MJ, Lim VS. Abnormal endocrine tests in a hemodialysis patient. J Am Soc Nephrol 1994; 4:1754.
- Ginsburg ES, Owen WF. Reproductive endocrinology and pregnancy in women on hemodialysis. Semin Dial 1993; 6:105.
- Matuszkiewicz-Rowiñska J, Skórzewska K, Radowicki S, et al. The benefits of hormone replacement therapy in pre-menopausal women with oestrogen deficiency on haemodialysis. Nephrol Dial Transplant 1999; 14:1238.
- Rice GG. Hypermenorrhea in the young hemodialysis patient. Am J Obstet Gynecol 1973; 116:539.
- Strippoli GF, Collaborative Depression and Sexual Dysfunction (CDS) in Hemodialysis Working Group, Vecchio M, et al. Sexual dysfunction in women with ESRD requiring hemodialysis. Clin J Am Soc Nephrol 2012; 7:974.
- Seethala S, Hess R, Bossola M, et al. Sexual function in women receiving maintenance dialysis. Hemodial Int 2010; 14:55.
- Yazici R, Altintepe L, Guney I, et al. Female sexual dysfunction in peritoneal dialysis and hemodialysis patients. Ren Fail 2009; 31:360.
- Weisbord SD. Female sexual dysfunction in ESRD: an underappreciated epidemic? Clin J Am Soc Nephrol 2012; 7:881.