Menstrual disturbances in women with advanced heart failure and heart transplant recipients

Background: Menstrual disturbances (MDs) are common among women with advanced heart failure. These disorders can arise from hormonal, hemodynamic, pharmacological, and psychological factors. Heart transplantation (HT) involves changes in the cardiovascular system and requires adjustments in medical treatment. However, the prevalence and impact of MDs before and after HT have not been thoroughly evaluated. Methods: We conducted a single-center retrospective observational study that included all female heart transplant recipients followed from 1999 to 2020. A questionnaire was used to assess the menstrual bleeding patterns before and after HT. Results: Data from 19 female heart transplant recipients were collected. The median age at HT was 57 (IQR: 35-60) years. 15 of these women were of childbearing age at heart disease diagnosis, and among them, 9 (60%) experienced MDs before the transplant. At the time of HT, 8 women remained of reproductive age, and all reported MDs during the post-transplant period. The most common event was menorrhagia, affecting 5 of 15 (33.3%) patients of reproductive age before HT and 6 of 8 (75%) women still of childbearing age after HT. In 2 heart transplant recipients, menorrhagia improved after the withdrawal of antiplatelet therapy. Additionally, 2 women developed early menopause, one of them before HT and the other afterwards. No cases of postmenopausal bleeding were reported. Conclusion: MDs are prevalent in patients with advanced heart failure and those who undergo HT. Changes in hemodynamic status and medical treatment may be associated with these disorders. Further studies are needed to assess these issues.