Women's gynaecological and reproductive health in UK nephrology: gaps in confidence, training and service delivery from a UK National Survey.

BACKGROUND

Women with chronic kidney disease (CKD) face unique gynaecological and reproductive health challenges, including menstrual and menopausal disturbances, fertility issues, and increased pregnancy-related risks. Despite the clinical relevance of these issues, it is unclear how well equipped nephrologists are to address them in routine practice.

METHODS

We conducted a national cross-sectional survey of UK nephrologists and renal trainees to assess their confidence, clinical experience, and perceived barriers in managing women's health within the context of CKD. The survey captured responses on a range of topics, including menstrual health, contraception, and pregnancy counselling.

RESULTS

A total of 147 responses were received. Most respondents reported low confidence in managing menstrual disorders, menopause, and sexual dysfunction, with only a minority feeling comfortable addressing these issues. Confidence was modestly higher for contraception and pregnancy counselling, but fewer than half of respondents felt adequately prepared to adjust teratogenic medications or provide breastfeeding advice. Commonly cited barriers included time constraints, lack of formal training, and limited clinical exposure-particularly in managing pregnancy in dialysis patients, which most encountered rarely. Variability in service delivery was also noted, with some centres offering dedicated nephrology-obstetrics clinics, while others relied on fragmented care pathways.

CONCLUSIONS

There are significant gaps in training, confidence, and service provision for women's health in UK nephrology practice. Addressing these gaps requires the integration of reproductive health into nephrology education, improved multidisciplinary service models, and clearer delineation of nephrologists' roles in gender-specific care. These changes are essential to improve outcomes and ensure equitable, patient-centred care for women with CKD.