when I came into dialysis the teaching RN told me that dialysis was going to affect my menses. She said it might start and stop erraticlly or stop altogether. Well she was right. It has gone haywire. Can you tell me what about dialysis causes this and what this means long term? I've also heard it's not dialysis that causes this but reuse. Which is it?

Ellen:

There are many myths floating around about reuse... your example of reuse affecting the menstrual cycle is just one of them.

What is really going on here is that it is very common for women to develop amenorrhea (absence of menses) when the glomerular filtration rate (GFR - how well your kidneys are functioning) falls to less than 10 ml / minute. This is usually due to the fact that the body no longer is ovulating like it was before, and without ovulation, the menstrual cycle is not appropriately completed.

Some studies have shown that women on CAPD maintain regular menstrual function longer and with higher percentages than women treated with hemodialysis.

With maintenance dialysis therapy, however, it is very common to see menstrual flow that is irregular and scanty. With this said, almost ten to fifteen percent of women will experience hypermenorrhea (abnormally heavy menses) while on maintenance dialysis therapy.

Sound like a bit of a contradiction? In fact, it is, but all of our bodies react differently to different things, including renal replacemet therapy.

What is of greater concern is to look at a couple of things:

1. Treatment of anemia: Prevention of blood loss is very important in the treatment of anemia. It is important to remember to tell your care team when you are menstruating, so that appropriate adjustments can be made to heparinization. Epogen allows for us to treat anemia very well, however, if you happen to have very heavy menstrual bleeding, it is possible to lose any of the anemia gains we have made with your Epogen doses. If heavy bleeding is long term, you should consult your physician.

2. Ruling out of other underlying disorders: Although uncommon, it is possible that there may be another cause for your irregular menstrual cycle. If you have not had a menstrual cycle for the last year, and suddenly start to have vaginal bleeding, further intervention should be performed as soon as possible. Your physician may refer you to a gynecologist who will most likely perform a pelvic exam, and perhaps sample some of the tissue in your uterus to see if it is healthy. It is important to remember that this does not rule out the need to continue to see a physician on a yearly basis for pelvic exams, that will include screening for diseases. (Remember that any woman over the age of 18, or any woman who is sexually active should have regular Pap Smears and pelvic exams to help in staying healthy.)

Women on PD sometimes will see bloody peritoneal dialysis fluid during menstruation or ovulation. Although this may cause worry, it is normal, and unless the patient is experiencing other symptoms, is not a cause for great concern. If this should happen, it is always best to consult with your nurse or doctor just to make sure that the peritoneal cavity is healthy.

So what can be done?

When you see your physician, he or she may recommend some type of hormonal therapy to help regulate your menstrual cycle. This can be done with oral contraceptives (the pill), but can also be done with other combinations of hormone replacement therapies. The one that is best for you needs to be determined by a physician who is well aware of your complete medical history. In some cases (for example, severe high blood pressure that does not respond to medications, past history of blood clots in your legs, or family history) hormone therapy is not appropriate. Again, this needs to be discussed in depth with your physician. Never, ever should you just 'borrow' a friends hormones or pills and try to treat this yourself.

Be open and honest in your discussions with your physician when they inquire about sexual partners, desire to have children, current sexual activities, and past pregnancies and appropriate treatment can be determined. I know that sometimes we do not like discussing intimate items such as these with a physician, but by doing so you are doing what needs to be done to stay as healthy as you possibly can.

I hope that this helps a bit. Please see your physician, and together the two of you can determine what is the best way to treat this for you.

Please let me know if I can offer any further help.

Best wishes,
Carol

Carol,
Thank you for this terrific answer to my question! I had stewed over this issue quite a bit as no one on my medical team could give me the instructive response I needed. This really puts my mind at rest. God bless you.

Ellen:

Glad to have helped a bit!!

Best wishes,
Carol

I'm one of those patients with the heavy menses on dialysis. I'm on the Pill, but it's still really heavy. When I started dialysis I stopped having a period, but after about six months it came back. I get hassled just about every month because my crit drops.

Is there any medication I can take to stop the periods altogether? I am 36 and don't plan on having any kids. If I'm not going to use my reproductive capabilities, should I just get rid of them?

I have known of physicians who have recommended total hysterectomies in years past for complaints such as this. However, it is the general belief of most practitioners that the hormones that are produced by our ovaries play an important role in our lives, even if we elect not to have children. For that reason, total hysterectomies are not as commonly recommended for heavy menses without further investigation as they have been in the past.

I would suggest talking to a gynecologist (hopefully someone your nephrologist can recommend, and who is accustomed to working with ESRD patients) about this issue. In most cases, birth control pills should 'even out' your estrogen and progesterone levels enough that you are not having severe bleeding. Since you still are experiencing this, I think further follow up is necessary. It is possible that there may be other causes for your heavy menses.

You do not say if you are bleeding between periods, or simply on a monthly basis. Whatever the case is, please be sure to share openly and candidly with the gynecologist you chose to visit. To help fully evaluate you, she will need to know how frequently you are bleeding, for how long, and the approximate blood loss. If you can show her what your Hct is dropping monthly (from your clinic labs) that would be very helpful. AND, I know I have said this before, but please be open and candid about your sexual history. This will help narrow down causes and problems, and allow your physician to better treat you.

There are medications you can take to cease menstruation. However, it is important to shed the lining of the endometrial cavity (the uterus) on a regular basis to help reduce your risks of endometrial or uterine cancer. It is not unusual to prescribe medications to help diminish the bleeding, and to continue to allow for appropriate shedding of the endometrial cavity.

Again, I strongly encourage you to see a gynecologist for further evaluation. Please let us know how things turn out for you.

Best Wishes,
Carol