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Reproductive and sexual dysfunction in uremic women

Biff F Palmer, MD
William L Henrich, MD, MACP
Peter J Snyder, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


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 [6]. 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 [8]. 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".)


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".)


Assessment of ovulation indirectly suggests that anovulatory cycles are the rule in uremic women [12]. This conclusion is supported by the following observations [6,12,13]:


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Literature review current through: Sep 2016. | This topic last updated: Aug 18, 2015.
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