Kidney disease and your menopause: what you need to know

Chronic kidney disease is a relatively common condition for women during and after the menopause, so discover how to manage your symptoms

One in 10 people have chronic kidney disease
Risk factors include diabetes, high blood pressure and heart disease
Most women with chronic kidney disease are able to take HRT

Most of us probably haven’t given our kidneys much thought over the years but these organs, which sit in your lower back, have a range of important jobs, including filtering your blood to remove waste products, which are then passed out into your urine.

According to charity Kidney Care UK, one in 10 people in the UK have chronic kidney disease (CKD), a long-term condition where the organs can’t clean toxins from your body as effectively, and may allow blood and protein to leak into your urine.

The risk of CKD increases with age, meaning that a significant number of women will be going through the perimenopause and menopause while managing their kidney health.

Managing your health is essential to minimise any further deterioration to your kidneys and have the best journey through your menopause, says Newson Health GP and menopause specialist Dr Clair Crockett.

Who gets CKD?

Anyone can get CKD but risk increases with age, in those with diabetes, heart disease, high blood pressure, the use of some medication including ibuprofen, and those with a family history. Black, Asian and minority ethnic communities are five times more likely to develop CKD than other groups.

CKD comes in five stages, and most women will be at the milder end where it has less impact. But 3.5million people in the UK are thought to have the later stages of the condition, when symptoms become harder to control.

There is some emerging evidence that women going through earlier menopause, either naturally or due to surgery, are at higher risk of having CKD [1], and that women with CKD are more likely to go through an earlier menopause [2].

What do I need to look out?

While there are usually no symptoms of chronic kidney disease in the early stages, at the more advanced stages symptoms can include tiredness, swollen ankles, feet or hands, shortness of breath, feeling sick and blood in your urine.

Declining levels of oestrogen from your ovaries during your menopause can have an important impact on some of the conditions that can contribute to CKD.

Your body can store more fat around your middle, which can put you at higher risk of type 2 diabetes, which is normally related to lifestyle. It can also cause insulin resistance, which means that your body responds less well to insulin and leads to higher blood sugar levels, which can be harmful.

RELATED: diabetes and menopause

Having CKD can increase your chance of having high blood pressure, heart disease or a stroke. These risks are also pushed up by your menopause. Oestrogen has an important protective role in blood vessels, allowing the walls to relax and widen. As oestrogen declines, vessels become less elastic, and blood pressure can increase, which is bad for your kidneys, as well as increasing the risk of heart attacks and strokes.

Another area where women with CKD need to be alert is bone health. During and after the menopause, the drop in oestrogen leads to your bones being less strong and dense.

This risk can be further heightened for those on steroid treatment for their CKD, those on dialysis, which can also lower your hormone levels, and those on anti-rejection drugs following a kidney transplant.

‘Kidneys have an important role in how our bodies process vitamin D and calcium,’ Dr Clair says. ‘So if our kidneys are not working well we need to be really mindful about bone health.’

How can I manage my CKD and menopause?

These increased risks show the importance of making healthy lifestyle choices to maximise your wellbeing, says Dr Clair.

Keeping your body weight at a healthy level, being active, eating well and not smoking can all help reduce the risk of high blood pressure, heart disease and type 2 diabetes. Weight bearing exercise can help protect bone health.

Enjoy your meals while eating a wide variety of different foods. Kidney Care UK has suggestions on how you can do this.

Eat less salt, as too much is linked to high blood pressure and heart disease which can damage your kidneys, while avoiding salt substitutes. These contain a lot of potassium and are not suitable for those with kidney problems. Drink alcohol in moderation.

HRT should also be an option for most women with CKD who are struggling with menopausal symptoms, Dr Clair says. This may come as skin gels or creams, patches or tablets.

‘Newer types of HRT, which are body identical, can have a protective effect on heart and bone health,’ she says. ‘So alongside easing symptoms of menopause such as hot flushes, fatigue and poor sleep it can also reduce some of your health risks.’

New research has also suggested that HRT reduced dementia risk in post-menopausal women with CKD [4].

There is some confusion about whether women can take HRT with high blood pressure, with many women previously advised to get blood pressure under control before taking hormones. [Kidney Care UK still says that women shouldn’t take HRT when hypertension is not controlled]

But women with raised blood pressure can still usually take body identical HRT and it is safe to take blood pressure lowering medication at the same time, Dr Clair says.

‘All women will need an individual assessment by their GP before being prescribed HRT,’ she says. ‘But it is really important that women don’t just rule out getting menopause care for their symptoms because they have CKD. Make an appointment with your GP, and find out what your options are, don’t suffer in silence.’

Consider logging your symptoms on a menopause tracker before you see your GP, to help guide discussions on the care you need. Some menopausal symptoms may cross over with symptoms of CKD, including fatigue, low mood and itchy skin. Women on dialysis may find that their periods stop, but this doesn’t necessarily mean you are going through the menopause.

Dr Clair also urges caution on taking supplements that can be advertised as being beneficial for women during the perimenopause and menopause.

Some research suggests that rates of CKD are higher among those taking some supplements [3] and some herbal supplements are not recommended for those with kidney disease. ‘It can be hard to know exactly what is in some supplements, and whether they will interact with other medication or your condition,’ says Dr Clair. ‘Always speak to your doctor before starting to take any supplements.’

References

1. Qian D., Wang Z.F., Cheng Y.C., Luo R., Ge S.W., Xu G. (2022), ‘Early Menopause May Associate With a Higher Risk of CKD and All-Cause Mortality in Postmenopausal Women: An Analysis of NHANES, 1999-2014’, Front Med (Lausanne). 18;9: 823835. doi: 10.3389/fmed.2022.823835

2. Ahmed S.B., Ramesh S. (2016), ‘Sex hormones in women with kidney disease’, Nephrology Dialysis Transplantation, 31 (11), pp1787–1795, https://doi.org/10.1093/ndt/gfw084

3. Fang Y., Lee H., Son S., Oh S., Jo S.K., Cho W., Kim M.G. (2023), ‘Association between Consumption of Dietary Supplements and Chronic Kidney Disease Prevalence: Results of the Korean Nationwide Population-Based Survey’, Nutrients. Feb 5;15(4):822. doi: 10.3390/nu15040822

4. Huh H., Kim M., Jung S., et al. (2024), ‘Menopausal hormone therapy and risk for dementia in women with CKD: A nationwide observational cohort study’, Nephrology. 29(3): 126-134. Doi: 10.1111/nep.14260