Customization of hormone therapy in women with autosomal dominant polycystic kidney disease (ADPKD): actionable strategies and future perspectives


  • Martina Catania O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Micaela Petrone O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Liliana Italia De Rosa O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Rebecca S. Degliuomini O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Kristiana Kola O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Chiara Lupi O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Matteo Brambilla Pisoni O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Stefano Salvatore O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Massimo Candiani O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Giuseppe Vezzoli O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy
  • Maria Teresa Sciarrone Alibrandi O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milano - Italy



ADPKD, Contraception, Female sexual hormones, Fertile age, Hormonal therapy, Menopause transition, Polycystic kidney


Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetically inherited kidney disease and the fourth leading cause of renal replacement therapy worldwide. It is characterized by the development of multiple cysts in the kidneys and in other organs, the increase in renal volume and the progressive loss of renal function. ADPKD outcome seems to be sensitive to hormonal fluctuations, particularly those of sex hormones. Despite the limited literature available, this review presents the first comprehensive overview of contraception and hormonal replacement therapy in women with ADPKD, delving into the risks and benefits associated with different contraceptive methods, including hormonal, intrauterine devices, and non-hormonal approaches. It also explores personalized strategies for contraception based on the severity of renal disease and the presence of comorbidities.

Although the protective role of female sex hormones in slowing the progression of renal failure is acknowledged, hormonal therapy in women with ADPKD remains intricate and challenging due to its potential impact on liver disease progression. Women with ADPKD typically experience a slower progression of renal disease compared to men, largely influenced by hormonal dynamics.

This literature review underscores the importance of a multidisciplinary assessment and a thorough patient discussion to identify the most suitable contraceptive method for each woman affected by polycystic kidney disease.


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Finnigan NA, Leslie SW. Polycystic Kidney Disease In Adults. 2023 Nov 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. PMID: 29261941.

Neugarten J, Acharya A, Silbiger SR. Effect of gender on the progression of nondiabetic renal disease: a meta-analysis. J Am Soc Nephrol. 2000;11(2):319-329. PMID:10665939

Liu J, Fujikura K, Dev H, et al. Pericardial Effusion on MRI in Autosomal Dominant Polycystic Kidney Disease. J Clin Med. 2022;11(4):1127. PMID:35207400

Harris PC, Torres VE. Polycystic Kidney Disease, Autosomal Dominant. 2002 Jan 10 [updated 2022 Sep 29]. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2024. PMID: 20301424.

Coco D, Leanza S. Polycystic Kidney Disease and Polycystic Liver Disease Associated to Advanced Gastric Cancer: an External Complication of Potter III Disease. Maedica (Buchar). 2023;18(1):157-160. PMID:37266470

Sherstha R, McKinley C, Russ P, et al. Postmenopausal estrogen therapy selectively stimulates hepatic enlargement in women with autosomal dominant polycystic kidney disease. Hepatology. 1997;26(5):1282-1286. PMID:9362373

Chapman AB, Johnson AM, Gabow PA. Pregnancy outcome and its relationship to progression of renal failure in autosomal dominant polycystic kidney disease. J Am Soc Nephrol. 1994;5(5):1178-1185. PMID:7873727

Hewitt SC, Korach KS. Progesterone action and responses in the alphaERKO mouse. Steroids. 2000;65(10-11):551-557. PMID:11108859

Kolatorova L, Vitku J, Suchopar J, Hill M, Parizek A. Progesterone: A Steroid with Wide Range of Effects in Physiology as Well as Human Medicine. Int J Mol Sci. 2022;23(14):7989. PMID:35887338

Yager JD, Davidson NE. Estrogen carcinogenesis in breast cancer. N Engl J Med. 2006;354(3):270-282. PMID:16421368

Gava AL, Freitas FPS, Meyrelles SS, Silva IV, Graceli JB. Gender-dependent effects of aging on the kidney. Braz J Med Biol Res. 2011;44(9):905-913. PMID:21956533

Xue B, Johnson AK, Hay M. Sex differences in angiotensin II- and aldosterone-induced hypertension: the central protective effects of estrogen. Am J Physiol Regul Integr Comp Physiol. 2013;305(5):R459-R463. PMID:23883676

Komukai K, Mochizuki S, Yoshimura M. Gender and the renin-angiotensin-aldosterone system. Fundam Clin Pharmacol. 2010;24(6):687-698. PMID:20608988

Renke G, Kemen E, Scalabrin P, Braz C, Baesso T, Pereira MB. Cardio-Metabolic Health and HRT in Menopause: Novel Insights in Mitochondrial Biogenesis and RAAS. Curr Cardiol Rev. 2023;19(4):e060223213459. PMID:36748220

O’Donnell E, Floras JS, Harvey PJ. Estrogen status and the renin angiotensin aldosterone system. Am J Physiol Regul Integr Comp Physiol. 2014;307(5):R498-R500. PMID:24944241

Pechere-Bertschi A, Burnier M. Gonadal steroids, salt-sensitivity and renal function. Curr Opin Nephrol Hypertens. 2007;16(1):16-21. PMID:17143066

Heller HJ, Sakhaee K, Moe OW, Pak CYC. Etiological role of estrogen status in renal stone formation. J Urol. 2002;168(5):1923-1927. PMID:12394677

Conte C, Antonelli G, Melica ME, Tarocchi M, Romagnani P, Peired AJ. Role of Sex Hormones in Prevalent Kidney Diseases. Int J Mol Sci. 2023;24(9):8244. PMID:37175947

Howard SA, Benhabbour SR. Non-Hormonal Contraception. J Clin Med. 2023;12(14):4791. PMID:37510905

Bahamondes L, Fernandes A, Monteiro I, Bahamondes MV. Long-acting reversible contraceptive (LARCs) methods. Best Pract Res Clin Obstet Gynaecol. 2020;66:28-40. PMID:32014434

Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009;79(5):356-362. PMID:19341847

Horvath S, Schreiber CA, Sonalkar S. Contraception. 2018 Jan 17. In: Feingold KR, Anawalt B, Blackman MR, et al. Endotext [Internet]. South Dartmouth (MA):, Inc.; 2000. PMID: 25905371.

Hardeman J, Weiss BD. Intrauterine devices: an update. Am Fam Physician. 2014;89(6):445-450. PMID:24695563

World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed.; 2015. (Accessed March 2024)

RCOG/BSGE. Management of Endometrial Hyperplasia (Green-top Guideline No. 67). (Accessed March 2024)

ACOG Practice Bulletin No. ACOG Practice Bulletin No. 121: Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol. 2011;118(1):184-196. PMID:21691183

Alhamdan D, Bignardi T, Hardas G, Merkur H, Condous G. Mirena intra-uterine system: does it improve long term symptoms in women with chronic pelvic pain and/or endometriosis after laparoscopy? A multicentre randomized controlled trial. Rev Recent Clin Trials. 2010;5(3):143-146. PMID:20482495

Magalhaes J, Ferreira-Filho ES, Soares-Junior JM, Baracat EC. Uterine volume, menstrual patterns, and contraceptive outcomes in users of the levonorgestrel-releasing intrauterine system: A cohort study with a five-year follow-up. Eur J Obstet Gynecol Reprod Biol. 2022;276:56-62. PMID:35809459

Bahamondes L, Petta CA, Fernandes A, Monteiro I. Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhea. Contraception. 2007;75(6)(suppl):S134-S139. PMID:17531605

Kamani M, Akgor U, Gültekin M. Review of the literature on combined oral contraceptives and cancer. Ecancermedicalscience. 2022;16:1416. PMID:36072240

Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. In: Grimes DA, ed. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2009.

Barrionuevo P, Nabhan M, Altayar O, et al. Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab. 2018;103(4):1258-1264. PMID:29522176

Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol. 2017;216(6):580.e1-580.e9. PMID:28188769

Dayal M, Barnhart KT. Noncontraceptive benefits and therapeutic uses of the oral contraceptive pill. Semin Reprod Med. 2001;19(4):295-303. PMID:11727171

Ahrendt HJ, Karckt U, Pichl T, Mueller T, Ernst U. The effects of an oestrogen-free, desogestrel-containing oral contraceptive in women with cyclical symptoms: results from two studies on oestrogen-related symptoms and dysmenorrhoea. Eur J Contracept Reprod Health Care. 2007;12(4):354-361. PMID:17853159

Harwood B, Mishell DR Jr. Contraceptive vaginal rings. Semin Reprod Med. 2001;19(4):381-390. PMID:11727180

Madden T, Blumenthal P. Contraceptive vaginal ring. Clin Obstet Gynecol. 2007;50(4):878-885. PMID:17982330

Lete I, Dueñas JL, Esplugues JV, Marti-Cabrera M. Is the vagina an adequate route for the administration of hormonal contraceptives? Curr Drug Metab. 2010;11(10):839-849. PMID:21208175

Milsom I, Korver T. Ovulation incidence with oral contraceptives: a literature review. J Fam Plann Reprod Health Care. 2008;34(4):237-246. PMID:18854069

World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. Contraception. 1998;57(5):315-324. PMID:9673838

Casper RF. Introduction: A focus on the medical management of endometriosis. Fertil Steril. 2017;107(3):521-522. PMID:28259256

Spritzer PM, Motta AB, Sir-Petermann T, Diamanti-Kandarakis E. Novel strategies in the management of polycystic ovary syndrome. Minerva Endocrinol. 2015;40(3):195-212. PMID:25781065

Cameron CR, Cohen S, Sewell K, Lee M. The Art of Hormone Replacement Therapy (HRT) in Menopause Management. J Pharm Pract. 2023 Apr 1:8971900231167925. PMID:37002679

Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28(9):973-997. PMID:34448749

de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised Global Consensus Statement on Menopausal Hormone Therapy. Climacteric. 2016;19(4):313-315. PMID:27322027

Langer RD. The evidence base for HRT: what can we believe? Climacteric. 2017;20(2):91-96. PMID:28281363

Langer RD, Hodis HN, Lobo RA, Allison MA. Hormone replacement therapy - where are we now? Climacteric. 2021;24(1):3-10. PMID:33403881

Nilsson S, Henriksson M, Berin E, Engblom D, Holm AS, Hammar M. Resistance training reduced luteinising hormone levels in postmenopausal women in a substudy of a randomised controlled clinical trial: A clue to how resistance training reduced vasomotor symptoms. PLoS One. 2022;17(5):e0267613. PMID:35617333

Franco OH, Chowdhury R, Troup J, et al. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. JAMA. 2016;315(23):2554-2563. PMID:27327802

Johnson KA, Martin N, Nappi RE, et al. Efficacy and Safety of Fezolinetant in Moderate to Severe Vasomotor Symptoms Associated With Menopause: A Phase 3 RCT. J Clin Endocrinol Metab. 2023;108(8):1981-1997. PMID:36734148



How to Cite

Catania, M., Petrone, M., De Rosa, L. I., Degliuomini, R. S., Kola, K., Lupi, C., Brambilla Pisoni, M., Salvatore, S., Candiani, M., Vezzoli, G., & Sciarrone Alibrandi, M. T. (2024). Customization of hormone therapy in women with autosomal dominant polycystic kidney disease (ADPKD): actionable strategies and future perspectives. Giornale Di Clinica Nefrologica E Dialisi, 36(1), 29–35.



Polycystic kidney disease - In collaboration with AIRP


Received 2024-03-14
Accepted 2024-03-19
Published 2024-04-30


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