Chronic kidney disease is a relatively common condition for women during menopause, so discover how to manage your symptoms and improve your health
• One in 10 people have chronic kidney disease
• Risk factors for chronic kidney disease include diabetes, high blood pressure and heart disease as well as being menopausal
• Women with chronic kidney disease can be prescribed body identical HRT containing progesterone, estradiol and testosterone
Your kidneys are positioned in your lower back and have a range of important roles, including filtering your blood to remove waste products, which are then passed out into your urine.
Globally, 850 million people (around one in 10) have chronic kidney disease (CKD) [1], a long-term condition where your kidneys can’t clean toxins from your body as effectively and may allow blood and protein to leak into your urine.
Managing your health is essential to minimise any further deterioration to your kidneys and to manage your menopause.
Who gets CKD?
Anyone can get CKD but risk increases with age, meaning that a significant number of women will be perimenopausal or menopausal while managing their kidney health. Menopause is also a risk factor for CKD and women who have an earlier menopause, either naturally or due to surgery, are at higher risk of having CKD [2]. Research has shown that premenopausal women who had a bilateral oophorectomy (removal of both ovaries) before the age of 50 have a higher risk of developing CKD and that this risk was particularly higher for those under the age of 45 [3].
Risk of CKD also increases in those with diabetes, heart disease or high blood pressure, with the use of some medication including ibuprofen, and those with a family history of CKD [4]. Black, Asian and minority ethnic communities are five times more likely to develop CKD than other groups – although it’s not fully understood why this is, Kidney Research UK suggests it could be due in part to high rates of diabetes and high blood pressure in these groups, and these are the most common causes of kidney failure [5].
RELATED: Diabetes and menopause
There are five stages of CKD, and most women will be in the milder stages – they may not have any symptoms and may be unaware they have CKD [6].
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.
How do hormones affect kidney function?
Declining levels of hormones progesterone, estradiol and testosterone can have direct negative effects on the function of your kidneys – renal function has been found to be significantly lower in postmenopausal women than premenopausal women [7].
This is because “sex hormones” can be reno-protective in women [8]. Studies have shown that estradiol and estradiol receptors play important roles in many physiological processes in your kidney, including kidney repair [9].
Your hormones, progesterone, estradiol and testosterone, have important protective roles in your blood vessels: estradiol and progesterone help to relax and widen your blood vessels and testosterone increases blood flow to the arteries. As these hormones decline, vessels can become less elastic, and blood pressure can increase, which can damage the blood vessels in your kidneys and affect renal function. High blood pressure can also increase your future risk of heart attacks and strokes.
RELATED: Blood pressure and menopause: what you need to know
Testosterone can also have a direct influence on improving renal function, with anti-inflammatory effects [10]. Testosterone plays critical roles in kidney health, and low testosterone is increasingly recognised as a risk factor for kidney dysfunction and chronic kidney disease [11]. Low testosterone can also lead to more inflammation throughout your body and increase blood pressure and risk of cardiovascular disease [10]. Testosterone can also help make new red blood cells, which is important for people with CKD.
In addition, low hormones can cause insulin resistance, which means that your body responds less well to insulin and leads to higher blood sugar levels, which increases risk of type 2 diabetes. Menopausal women with low hormones also have an increased risk of developing cardiovascular disease, which if a risk factor for developing CKD.
How might being prescribed hormones affect my CKD?
Body identical hormones are usually the first-line treatment for symptoms of perimenopause and menopause. ‘Body identical hormones can improve symptoms of menopause such as hot flushes, fatigue and poor sleep, and can reduce some of your health risks,’ says Dr Clair. These natural hormones have protective effects on heart and bone health, and research has shown that taking hormones can reduce dementia risk in menopausal women with CKD [12].
Women with end-stage kidney disease often have lower levels of hormones [8], which contributes to both their symptoms and health risks in the future.
A study of just over 2,000 menopausal women with kidney disease found that HRT was associated with higher current eGFR (a calculation that indicates how well your kidneys are working) [7]. And treatment with HRT with menopausal women with end-stage kidney disease has been associated with improved quality of life [8].
In men, studies have suggested that the consequences of low testosterone in patients with CKD is profound and that testosterone replacement might improve clinical outcomes [10]. Although there are no good quality studies in which women with kidney disease have been prescribed testosterone, there are studies showing benefit in men with kidney disease. As testosterone helps kidneys to function and work properly and many women with kidney disease have low testosterone levels then it makes sense that testosterone replacement could have beneficial effects in menopausal women with kidney disease.
If you have CKD, it also important to optimise your bone health. During menopause, the drop in hormones can lead to your bones being less strong and dense, with an increased risk of developing osteoporosis. This risk is further increased if you are taking steroid treatment, which can lower your hormone levels, and for those on anti-rejection drugs following a kidney transplant.
‘Kidneys have an important role in how your body processes vitamin D and calcium,’ says Dr Clair Crockett, Newson Health GP and menopause specialist. ‘So if your kidneys are not working well, you need to be really mindful about bone health.’
RELATED: How can I keep my bones strong during menopause?
There has been confusion about taking HRT if you have high blood pressure 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, says Dr Clair.
‘All women will need an individual assessment by a healthcare practitioner before being prescribed hormones,’ she says. ‘But it is really important that women don’t rule out being prescribed hormones for their symptoms because they have CKD. Make an appointment with your GP, find out what your options are, and don’t suffer in silence.’
How else can I manage my CKD and menopause?
The increased health risks with CKD 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.
RELATED: Healthy eating for perimenopause and menopause
Consider logging your symptoms on the Balance app before you see your GP, to help guide discussions on the care you need. Some menopausal symptoms may be the same as symptoms of CKD, including fatigue, low mood and itchy skin.
Dr Clair also urges caution on taking supplements that can be advertised as being beneficial for women during perimenopause and menopause. Some research suggests that rates of CKD are higher among those taking some supplements [13] 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.’
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