How Can CKD Affect Women’s Reproductive Health?

Editor’s Note: For simplicity and ease of reading, in this article, we use the terms "women" and “mothers." But we want to acknowledge that not all people who can get pregnant identify as women and that some people who give birth identify as men or nonbinary. Health Union strives to create an inclusive space while providing accurate health information.

Chronic kidney disease (CKD) can affect many aspects of a person’s health. This includes reproductive health. CKD is more common in women than in men. And women’s reproductive health is strongly linked to their life span and quality of life. So, it is important to understand the effects of living with CKD and how to manage them.^1,2

Effects of CKD on women’s reproductive health

In people with a uterus, CKD can cause a variety of hormonal changes. Kidney disease changes the levels of thyroid and sex hormones in the body. These changes can lead to several reproductive health problems, especially in women.³

The more CKD has progressed, the more extreme these hormonal changes are. That means that people in end-stage kidney disease are the most likely to experience lower reproductive health.³

Menstruation

Up to 2 out of 3 women with CKD have some kind of menstrual disorder. Common changes in menstruation include:^3,4

• Menstrual bleeding that is heavier or lasts longer than normal
• Lack of menstruation (amenorrhea)
• Early initial onset of period
• Early menopause

Fertility

Having kidney disease reduces a woman’s fertility. This is because changes to thyroid and sex hormones interfere with ovulation. Ovulation is the release of an egg from the uterus. If a woman does not ovulate, she cannot become pregnant.⁴

Pregnancy

Pregnancy requires the kidneys to work harder than usual. So if your kidneys are already damaged, being pregnant can put an extra strain on them. Having kidney disease makes pregnancy more dangerous and increases the risk of complications.⁵

Pregnancy in people with CKD has been linked to a higher risk of:⁵

• Preeclampsia, a dangerous complication that can lead to seizures and death
• Premature birth, also known as preterm delivery
• Low birth weight
• C-section
• Progression of kidney disease

People who can become pregnant should use birth control (contraception) unless they have made a plan with their doctor to safely conceive. There is a natural drop in the ability to get pregnant in people with CKD. But women with kidney disease can still get pregnant. Unfortunately, 1 survey of women with CKD showed that they often do not use contraception.²

If you have CKD and want to get pregnant, your kidney function must be stable and any other health conditions well controlled. For example, a woman with diabetes or high blood pressure should treat these conditions before becoming pregnant. This will help reduce the risk of further damage to her kidneys.¹

Doctors may adjust or replace any current medicines to reduce the risk of harm to the mother or baby. They also may recommend folic acid supplements to reduce the risk of harm. Breastfeeding is recommended. But new mothers should not take certain medicines while they breastfeed.^1,5

Women who have had a kidney transplant should generally wait 1 to 2 years before getting pregnant. Parents should know that genetic factors leading to kidney disease may be passed to a child. Also, pregnancy can injure healthy kidneys, leading to future kidney disease. Discuss all these issues with your doctor if you are planning to get pregnant.^1-3

Sexual health

In people of all genders, sexual problems commonly occur with CKD. Experts believe up to 80 percent of women with CKD have challenges with sexual activity. These challenges may include:¹

• Lower sexual desire
• Trouble reaching orgasm
• Vaginal dryness, pain, or itching

Changes in sexual function may be caused by:^1,6

• Hormonal changes – Changes in sex hormones can lead to many sexual challenges.
• Mental health challenges – Depression, anxiety, or poor self-image are common in women with CKD.
• Other medical conditions – Related conditions like diabetes and heart disease are also common in women with CKD.
• Medicines used to treat other conditions – For example, drugs used to treat depression, inflammation, or high blood pressure can disrupt sexual function in women. Certain types of birth control also may damage kidneys, ultimately leading to sexual problems.
• Dialysis – One side effect of this treatment can be sexual problems.

Menopause

On average, people who menstruate enter menopause around age 49. Those with end-stage CKD, though, tend to enter menopause around age 46. Having kidney disease puts women at greater risk of entering menopause early. Likewise, women who have gone through early menopause may be at greater risk of developing CKD.⁷

Early menopause also has been linked to risk for other serious health problems, such as:⁷

• Heart disease
• Diabetes
• Thinning bones (osteoporosis)

This may be because estrogen levels decline after menopause. Estrogen has a protective effect on certain body systems. More research is needed to understand the link between menopause and CKD.⁷

Risk factors specific to women and gender-nonconforming people

Certain factors may put women with CKD at higher risk for reproductive health problems. These factors include:^1,3,8

• Socioeconomic factors – Trouble accessing safe and effective menstrual products can make CKD effects worse. This problem with access is sometimes called “period poverty.”
• Lack of training for nephrologists – Doctors who specialize in kidney health may not know about its effect on women’s reproductive health.
• Gender difference (disparities) in CKD care – Women are less likely to receive kidney transplants, be on dialysis, or be prescribed SGLT2 inhibitor drugs. These drugs are a primary treatment for people with type 2 diabetes and CKD.
• Gender-nonconforming identities – There is little research on CKD’s reproductive effect on transgender and nonbinary people. And many doctors do not have training on how to treat these groups effectively.

Protective factors and treatment

Women with CKD face unique challenges to reproductive health. But they can work with their doctors to protect or restore their sexual health. Treatment for sexual health problems in women with CKD may include:^3,5,6

• Kidney transplant – A successful kidney transplant can reverse some of the sexual complications of kidney disease. For example, a transplant may restore fertility and sexual function.
• Hormone therapy – Drugs that balance sex hormones may reduce some effects of CKD. For example, drugs that increase the hormone estrogen may help increase a woman’s sexual desire. And a drug containing progestin may help reduce heavy menstrual bleeding.
• Medicine adjustments – Doctors may suggest changing certain medicines that are known to affect sexual function.
• Intensive dialysis – For women with kidney failure, having frequent dialysis may improve the health of their babies.
• Psychotherapy – Talk therapy can help decrease mental health challenges those with CKD may be facing.

If you have CKD, regular monitoring of your kidney function and hormone levels is essential to reduce possible complications. If you want to have children, talk to your doctor about:

• Risks
• Proper timing
• Managing any medicine you take