Female Reproductive Health in Kidney Disease

Female reproductive health is an important yet frequently neglected component of care in women with CKD. As the global burden of CKD rises, increasing numbers of women of reproductive age are affected, with consequences across the reproductive lifespan, including fertility, menstruation, sexual function, contraception, pregnancy and menopause. CKD disrupts normal reproductive physiology through complex and multifactorial mechanisms. The hypothalamic-pituitary-ovarian axis is often affected in CKD. Loss of pulsatile gonadotrophin-releasing hormone (GnRH) secretion and hyperprolactinemia can lead to hormonal dysregulation and menstrual irregularities. Additional mechanisms contributing to reduced fertility include diminished ovarian reserve, altered endometrial receptivity and reproductive decision-making influenced by chronic illness. Chronic inflammation, a hallmark of CKD, may also negatively affect reproductive health. Together, these factors contribute to reduced fertility, menstrual abnormalities, premature menopause and sexual dysfunction; all of which can adversely affect quality of life and long-term health outcomes. Many nephrologists report feeling ill-equipped to counsel patients on reproductive decision-making, contraception and fertility preservation, highlighting an important gap in clinical care. The use of gonadotoxic therapies, such as cyclophosphamide, further complicates reproductive planning. Early counselling and consideration of fertility preservation strategies, including GnRH agonists and oocyte cryopreservation, are therefore important.