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“When I’m on my period, my drain bag looks like a fruit punch. Is it normal?” one member of MyKidneyDiseaseTeam asked.
If you’re on peritoneal dialysis (PD), your periods may change. Some people notice pink or red fluid in their drain bags. Others have heavier periods, worse cramps, or periods that come and go. Some stop getting their periods altogether.
With so many different experiences, it can be hard to know what’s normal, what’s related to dialysis, and when to be concerned. Here’s what to expect and when to call your doctor.
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Kidney disease can affect menstrual health in several ways, including period changes. Menstrual changes are common in people receiving dialysis, although research specifically about PD is limited. Here’s what you might notice.
While you’re on peritoneal dialysis, your period may come early, arrive late, skip a month, or stop for several months. You might also notice light spotting instead of your usual flow.
Some people notice these changes before starting dialysis, while others notice them afterward. Pregnancy, medications, and other health conditions can also affect your cycle. Tell your care team if your periods change or stop so they can check for other causes, including blood in urine.
Some people have heavier or longer periods on PD. Others notice spotting between periods, blood clots, or more painful cramps.
Heavy bleeding can worsen anemia, a condition in which you don’t have enough healthy red blood cells.
Tell your doctor if your periods last longer than seven days, you soak through a pad or tampon every hour for several hours, or you pass large clots. Seek urgent medical care if you have heavy bleeding along with dizziness, fainting, or shortness of breath.
Your period depends on a balance of hormones. Kidney failure can disrupt the signals that control these hormones. It can also make it harder to clear some hormones from your blood.
For example, prolactin levels, a hormone that helps your body make breast milk, can rise. High levels can interfere with ovulation — when an ovary releases an egg — making your periods irregular or causing them to stop.
Kidney failure can also affect estrogen and progesterone, the two main hormones that control your menstrual cycle. PD removes waste from your blood, but it doesn’t always correct these hormone changes.
Seeing pink or red fluid in your PD drain bag can be scary. Yet it doesn’t always mean something serious is wrong. Even a small amount of blood can change the fluid’s color.
When It May Be Related to Menstruation or OvulationBlood can mix with your dialysis fluid during your period or around ovulation. This can happen in two ways:
Bleeding related to your period or ovulation may clear on its own. However, blood in your drainage fluid can have other causes, so don’t assume it’s related to your cycle.
Call your dialysis team right away if you notice new blood in your drainage, even if you’re on your period.
Contact your team right away if:
Cloudy drainage fluid or belly pain can signal peritonitis, inflammation usually related to an abdominal infection that needs urgent treatment. Don’t wait for a fever before escalating it to your dialysis team.
Seek emergency care if you have severe belly pain or faint.
Even with stage 5 kidney disease, pregnancy may still be possible. Whether you want to avoid pregnancy or have a baby, knowing your options can help you plan.
Yes, pregnancy is possible on PD, even if your periods are irregular or have stopped.
You may still release an egg without regular periods. That means tracking your cycle isn’t a reliable way to prevent pregnancy. If you don’t want to get pregnant, ask about birth control.
Some birth control methods may not be suitable for people on dialysis. Your blood pressure, risk of blood clots, medicines, and pregnancy plans can affect your options.
Your nephrologist and gynecologist can help you find an option that fits your health and plans. Ask them:
Pregnancy on dialysis carries higher risks, including high blood pressure, early delivery, and low birth weight. Still, successful pregnancies are possible with careful planning and specialist care.
Before trying to get pregnant, talk to your care team about:
If you’re considering a kidney transplant, ask how it may affect your pregnancy plans. Fertility often improves after a successful transplant, but the best timing depends on your health and goals.
You don’t have to wait until your period becomes difficult to manage before bringing it up at an appointment.
Depending on what you’ve noticed, you might ask:
Tip: Keep a simple record of your periods, including when they start, how heavy they are, and any changes in your PD drainage. This can help your care team spot patterns and decide what to check.
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