GYNECOLOGIC AND REPRODUCTIVE ISSUES IN WOMEN ON DIALYSIS

Most women on dialysis are amenorrheic and do not ovulate, but little information about menstrual patterns in women on dialysis exists, espe cially since the introduction and use of recombinant human erythropoie tin, a therapy that may improve sexual interest and function. In this study, women who were less than or equal to 55 years of age at the sta rt of dialysis (n = 76) completed questionnaires and form the study gr oup. Women older than 55 years at the start of dialysis did not comple te the entire questionnaire (n = 115), but their medication records we re reviewed for estrogen replacement therapy. The questionnaire asked about pregnancies, menstrual periods (regularity, frequency, duration, character of flow, menopause), and menopause before beginning dialysi s and currently. Women also responded to questions about sexual activi ty, use of birth control, contraception counseling by physicians, year ly Papanicolaou smears, and mammograms. Demographic data (age, race, a ge at the time dialysis started, mode of dialysis, use of recombinant human erythropoietin, and history of renal transplant) were also obtai ned through the questionnaires. Fifty-nine percent of the 76 women who completed the study were white and had been on dialysis a median of 3 years (range, 0.1 to 18 years). The median age was 43 years, 68% were on hemodialysis, 90% were receiving recombinant human erythropoietin, and 70% had been pregnant (a total of 179 pregnancies; four pregnanci es in four women occurred after the start of dialysis). Significantly more women were menstruating before dialysis started than currently (6 3% v 42%; P < 0.025), but the difference could be explained by patient age: currently menstruating women were younger (37 +/- 9 v 46 +/- 11 years; P = 0.0002). More women reported menstrual regularity before be ginning dialysis (75% v 42% currently; P < 0.005), but there were no d ifferences in number of days between or number of days of menstruation before beginning dialysis and currently. Menstrual flow was reported as heavier currently by more women (64% heavy flow with clots v 38% be fore dialysis started; P < 0.05). The median age at menopause was 47 y ears; 28% of the women were postmenopausal, Fifty percent of the women were sexually active, but only 36% used birth control. Discussions be tween the women and their nephrologist about possible pregnancy and co ntraception were reported by only 13% of women. Sixty-three percent of the women reported having yearly Papanicolaou smears and 73% had had a mammogram. Only 5% of the 113 women who were older than 55 years whe n they began dialysis were receiving estrogen replacement therapy. Ame norrhea was reported in this study by a smaller proportion of women th an in studies conducted before the introduction of recombinant human e rythropoietin. The possibility that erythropoietin may restore normal hormonal cyclic function in women with end-stage renal disease require s further study. Nephrologists as well as primary care physicians and gynecologists need to focus more on the gynecologic concerns of women on dialysis, including the potential for pregancy. The effects of estr ogen replacement on atherosclerosis and osteoporosis, and consideratio n of such therapy in women on dialysis warrants attention. (C) 1997 by the National Kidney Foundation, Inc.