Kidney Health and Perimenopause: What Changes and What to Watch
Learn how oestrogen decline affects the kidneys, which markers to test, and how to protect kidney function during perimenopause.
How Oestrogen Protects the Kidneys
Oestrogen has a protective effect on kidney function. It influences blood flow to the kidneys, supports the integrity of the filtering structures, and has anti-inflammatory effects on kidney tissue. Research suggests that women have better kidney function than men of the same age during their reproductive years, and this advantage narrows significantly after menopause. The decline of oestrogen during perimenopause removes a layer of protection that many women were not aware they had.
What Changes in Kidney Function During Perimenopause
Glomerular filtration rate (GFR), a measure of how well the kidneys filter waste from the blood, tends to decline with age and accelerates after menopause. Blood pressure also rises as oestrogen falls, and high blood pressure is one of the most significant drivers of kidney damage. Women in perimenopause may also experience more frequent urinary tract infections as the tissues in the urinary tract thin and change, which can put additional strain on the kidneys if infections are recurrent or undertreated.
Symptoms That May Indicate Kidney Stress
Early kidney function decline is often silent. By the time symptoms appear, significant damage may have occurred. That said, some signs warrant attention: persistent swelling in the ankles or feet, foamy urine, changes in urination frequency, back or flank pain, and high blood pressure that is new or worsening. These symptoms always need medical investigation and should not be assumed to be perimenopause-related without proper assessment.
Tests to Check Kidney Health
Your GP can order a kidney function panel that includes serum creatinine, eGFR (estimated glomerular filtration rate), urea, and electrolytes. A urine test checking for protein (proteinuria) is also important, as protein in the urine is an early indicator of kidney stress. Blood pressure monitoring is a key part of kidney health monitoring. If you are on NSAIDs regularly for joint pain (a common perimenopause complaint), discussing kidney monitoring with your doctor is worthwhile, as these medications can reduce blood flow to the kidneys over time.
Lifestyle Factors That Protect the Kidneys
Staying well hydrated supports kidney filtration, though excessive fluid intake is not necessary. Managing blood pressure through a low-sodium diet, regular exercise, and stress reduction is one of the most effective things you can do. Maintaining a healthy weight reduces pressure on the kidneys. Limiting processed foods, red meat, and alcohol reduces the kidney's workload. If you smoke, stopping is one of the most powerful steps for kidney protection at any age.
HRT and Kidney Health
Some research suggests that HRT may support kidney function by maintaining blood flow and reducing inflammation in kidney tissue. Transdermal oestrogen, in particular, has a favourable profile for blood pressure compared with oral formulations. Women with existing kidney disease should discuss HRT options carefully with their specialist, as some hormone metabolites are excreted by the kidneys and dosing may need adjustment. For most women, the kidney-protective effects of oestrogen are one more reason to consider HRT early in perimenopause rather than waiting.
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