Perimenopause vs Kidney Disease: Shared Symptoms That Should Not Be Ignored
Fatigue, fluid retention, brain fog, and high blood pressure appear in both perimenopause and kidney disease. Learn the distinguishing features and key tests.
When Hormonal Assumptions Can Miss Something Serious
Chronic kidney disease (CKD) is a progressive condition in which the kidneys lose their ability to filter waste products from the blood effectively. It affects around 13 percent of adults globally and is particularly common in people with diabetes, hypertension, obesity, or a family history of kidney disease. All of these conditions become more prevalent in midlife, and women in perimenopause are precisely the group in whom CKD is most likely to go undetected under the assumption that fatigue, fluid retention, and brain fog are simply hormonal. Because the early stages of CKD produce few specific symptoms, and because they overlap significantly with perimenopause, the diagnosis is often delayed.
Symptoms That Appear in Both Conditions
Fatigue is the most common complaint in both perimenopause and CKD. In perimenopause it arises from disturbed sleep, hormonal fluctuations, and anaemia from heavy periods. In CKD it results from anaemia (the kidneys produce less erythropoietin, the hormone that stimulates red blood cell production), uraemic toxin accumulation, and disrupted sleep. Fluid retention and puffiness, particularly around the ankles and face in the morning, can occur in perimenopause due to hormonal effects on fluid regulation, and in CKD due to the kidneys' reduced ability to excrete sodium and water. Brain fog and cognitive slowing feature in both. Disrupted sleep, including difficulty falling asleep and frequent waking, is common in perimenopause and increasingly recognised as a feature of CKD. High blood pressure may appear as a consequence of declining oestrogen in perimenopause, and is both a cause and a consequence of CKD.
Distinguishing Features of Kidney Disease
Certain features point more specifically toward kidney disease and should prompt testing. Oedema (swelling) in CKD tends to be dependent and symmetrical, appearing in both ankles, and may extend up the legs over time. Perimenopause-related fluid retention is usually less severe and more cyclical. Foamy urine is a sign of proteinuria (protein leaking into the urine from damaged kidneys) and is not a feature of perimenopause. Persistent high blood pressure that does not respond well to standard lifestyle measures in a perimenopausal woman should raise suspicion of a secondary cause, including CKD. Advanced CKD can cause a metallic taste in the mouth, reduced appetite, nausea, and itching due to uraemic toxin accumulation, none of which are perimenopausal symptoms.
The eGFR Test: What It Is and Why It Matters
Estimated glomerular filtration rate (eGFR) is a calculated measure of how well the kidneys are filtering the blood, derived from a creatinine blood test along with age and sex. A normal eGFR is above 90 mL/min/1.73m2. CKD is staged from G1 (mildly reduced) to G5 (kidney failure). Most people with CKD stages 1 to 3 have no symptoms whatsoever, which is why routine testing is important. Urine albumin-to-creatinine ratio (uACR) detects proteinuria and is a sensitive early marker of kidney damage. Both tests can be done from a simple urine sample and a blood draw at your GP surgery. If you have diabetes, hypertension, or a family history of kidney disease and you have not had these tests recently, requesting them at your next appointment is worthwhile.
Risk Factors for Kidney Disease in Midlife Women
Several conditions that become more prevalent during perimenopause are also risk factors for CKD. Type 2 diabetes or insulin resistance, which increases as oestrogen falls, is the leading cause of CKD. Hypertension, also more common in perimenopause, is the second most common cause. Obesity, recurrent urinary tract infections (more common due to genitourinary changes in perimenopause), use of NSAIDs such as ibuprofen for joint or menstrual pain, and a history of autoimmune conditions such as lupus or Sjogren's syndrome all increase kidney disease risk. Knowing your risk profile is an argument for proactive testing, particularly if you fall into more than one of these categories.
HRT and Kidney Health
The relationship between HRT and kidney function is nuanced. Oestrogen has protective effects on kidney vasculature, and observational data suggests that postmenopausal women on HRT may have slower rates of kidney function decline than those not on HRT. HRT is generally considered safe for women with mild-to-moderate CKD, but prescribing in this context requires careful thought, particularly around fluid retention (transdermal oestrogen is preferred over oral) and blood pressure effects. Women with advanced CKD or on dialysis require specialist nephrology input before starting any hormonal therapy. If you have CKD and are considering HRT, a shared conversation between your GP, gynaecologist or menopause specialist, and nephrologist is the appropriate pathway.
Logging Symptoms to Notice What Does Not Fit
One of the reasons kidney disease goes undetected is that symptoms are vague and easy to attribute to perimenopause. Tracking symptoms consistently over months lets you notice patterns that do not fit the expected hormonal picture. If fatigue is not cyclical, if oedema appears persistently rather than premenstrually, if brain fog is worsening rather than fluctuating, these deviations from the typical perimenopausal pattern are worth noting and bringing to your GP. PeriPlan lets you log symptoms and track patterns over time, which makes it easier to spot when something does not fit and to communicate that clearly in a clinical setting. Routine blood and urine tests at your GP should happen annually if you have risk factors for CKD, regardless of perimenopausal status.
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