Poster 9
MENSTRUAL DISORDERS IN A POPULATION OF STABLE RENAL TRANSPLANT RECIPIENTS
Mariana Markell, M.D., Annette DiBenedetto, R.N., Leslie Neve R.N., Florencio Garcia, M.D., Linda Cohen, R.N., and Yalemzewd Woredekal, M.D., Suny Health Science Center
Menstrual disorders contribute to considerable morbidity in the general population. We surveyed 41 stable renal transplant recipients attending an outpatient clinic during a one-month period in inner-city Brooklyn. Mean age at first menses was 13.1 ± 0.5 years. Thirteen patients had undergone menopause or hysterectomy prior to the onset of dialysis. Mean time on dialysis prior to transplant was 4.5 ± 0.9 years. Of the 28 patients who were not menopausal, 7 (25%) experienced loss of menses after initiation of dialysis, and of the 13 patients who reported menstrual cycles, 5 (25%) reported that the cycles were abnormal (8 patients did not answer the question). Twenty patients (70%) experienced return of menses following transplantation, with a mean time to onset of 1.3 ± 0.3 months.
Patients who reported menses were more likely to have had menses during dialysis (p = 0.033 by Fisher's exact test) and were younger (35.7 ± 2.0 vs. 46.9 ± 1.9 years, p = 0.004 by 2-tailed t-test), but did not differ in regard to time on dialysis, cause of renal disease, time since transplant, dose of prednisone or tacrolimus, hematocrit (34.2 ± 2.1 vs. 34.9 ± 1.6 vol%, p = NS), or creatinine (1.9 ± 0.3 vs. 2.38 ± 0.3 mg/dl, p = NS). Of the menstruating patients, 10 (50%) reported "heavy" flow, 4 (20%) reported "light," 7 (35%) skipped menses, 6 (30%) had menometrorrhagia, 5 (25%) reported flow greater than 7 days and 2 (10%) reported "severe pain."
Fourteen of 20 patients (70%) reported having had a pregnancy prior to the onset of renal disease, whereas 2 patients (10%) became pregnant following transplantation. Six patients (30%) were using birth control. Of the 13 patients who underwent hysterectomy or menopause, mean age was 45.7 ± 1.7 years. Only one of these patients reported taking hormone replacement therapy, and 5 (38%) were taking calcium supplements.
In summary, (1) loss of menstrual cycle during dialysis was common, but 70% of younger patients resumed menstruating rapidly upon completion of a successful transplant; (2) resumption of menses post-transplant was related to younger age and maintenance of cycle during dialysis, but not to cause of renal disease, length of time on dialysis or time since transplant, immunosuppression dose, renal function, or hematocrit; (3) abnormal menstrual patterns were reported in the majority of patients, especially menometrorrhagia, oligomenorrhea, and skipped cycles, suggesting that although menses return, the hypothalmo-pituitary axis may remain abnormal; and (4) menopausal patients infrequently reported use of hormone replacement therapy or calcium supplementation, which taken with the low prevalence of birth control use in presumably fertile, cycling patients, suggests that intensive education should be undertaken in this complex group of women at risk for osteoporosis, cardiovascular disease, and in fertile patients, complicated pregnancies.
additional poster abstracts
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