Contraception in Chronic Kidney Disease and Renal Transplantation

Abstract

Due to the increase in the chronic kidney disease and transplant population, contraception counseling is essential in preventing unplanned pregnancies during the pre- and post-transplant period. Unintended pregnancy can have devastating effects on both mother and fetus. The physician must work with the patient to find the best method of contraception, taking into account patient preference as well as medical comorbidities. The LNG-IUS is an ideal option for the CKD and transplant patient as it is a first-line method, will help decrease monthly blood loss, and is easily reversible. In addition to the IUD, the ENG-implant is a good progestin-only method due to its high efficacy and ease of use. Individual bleeding patterns may vary but can be treated. Combined hormonal methods may be appropriate on a case-by-case basis, but have higher failure rates. If pregnancy occurs and termination is desired, the decision for an inpatient versus outpatient procedure will depend on the individual’s clinical status. Consultation with a family planning specialist is advised. Most women will not be candidates for medical termination.