title: Gynecologic follow up of 129 women on dialysis and after kidney transplantation: a retrospective cohort study.
abstract: OBJECTIVE
  To describe the gynecologic issues and follow-up in our referral center of women on dialysis and after kidney transplantation.
  
  
  METHODS
  This retrospective cohort study included 129 dialysed women among whom 102 had had transplants. Data on menstrual pattern, pregnancies, contraception, and cervical cytology were retrieved from patients' files.
  
  
  RESULTS
  The follow-up started at age 41.6±14.2 years and lasted for 9.5±10.2 years. Of the women, 78.7% had regular menses before dialysis, decreasing to 30.6% on dialysis (p<0.001), when 43.1% were amenorrheic (p<0.001). After transplantation, more patients had regular menstruation and fewer were amenorrheic (respectively 57.1% and 23.1%, p<0.001). On dialysis and after transplantation, 25% and 30.5% of patients suffered from metrorrhagia (compared to 17.1% before, p<0.01). Concerning pregnancies, rates of spontaneous abortions (33.3%, p=0.01), intrauterine growth retardation (28.5%, p<0.001) and prematurity (23.8%, p=0.008) were significantly higher after transplantation than before dialysis. Prescriptions for the combined contraceptive pill and intrauterine device decreased whereas chlormadinone acetate was widely used: it treated metrorrhagia and relieved mastodynia in 80% and 12% of the cases. Smear tests showed more inflammation (33% vs 0.8%, p<0.05), condylomas (13.6% vs 3.1%, p=0.005) and intraepithelial neoplasias (12.6% vs 2.3%, p=0.003) among patients after renal graft than before dialysis.
  
  
  CONCLUSIONS
  Women on dialysis and after kidney transplantation suffered more from irregular menses and metrorrhagia which was improved by chlormadinone acetate. We noted high rates of obstetrical complications and abnormal smear tests. Consequently, this population must have close follow-up to identify and treat gynecologic issues.
authors: Department of Endocrinology and Reproductive Medicine, E3M Institut, La Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, Paris, France; Center for Rare Gynecologic Diseases, Paris, France. Electronic address: zeina.chakhtoura@psl.aphp.fr.
authors: Zeina
authors: Z
authors: Chakhtoura
authors: Department of Endocrinology and Reproductive Medicine, E3M Institut, La Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, Paris, France; Center for Rare Gynecologic Diseases, Paris, France.
authors: Marie
authors: M
authors: Meunier
authors: Department of Endocrinology and Reproductive Medicine, E3M Institut, La Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, Paris, France; Center for Rare Gynecologic Diseases, Paris, France.
authors: Jacqueline
authors: J
authors: Caby
authors: Department of Dialysis, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France.
authors: Lucile
authors: L
authors: Mercadal
authors: Department of Kidney Transplantation, La Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, Paris, France.
authors: Nadia
authors: N
authors: Arzouk
authors: Department of Kidney Transplantation, La Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, Paris, France.
authors: Benoît
authors: B
authors: Barrou
authors: Department of Endocrinology and Reproductive Medicine, E3M Institut, La Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, Paris, France; Center for Rare Gynecologic Diseases, Paris, France.
authors: Philippe
authors: P
authors: Touraine
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003267:Contraception; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation; D008598:Menstruation; D008599:Menstruation Disturbances / Q000453:epidemiology; D008796:Metrorrhagia / Q000453:epidemiology; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D006435:Renal Dialysis; D012189:Retrospective Studies
keywords: Cervix; Contraception; Dialysis; Menstruation; Transplantation