Kidney disease doesn’t always look the same in women as it does in men. From symptoms to how well treatments work, there are differences that researchers are still working to understand. Around the world, more women have chronic kidney disease (CKD) than men. An article in the journal Maturitas estimates that globally, 15.3 percent of women and 12.4 percent of men have CKD. About 14 percent of adults in the United States are living with CKD, according to the Centers for Disease Control and Prevention (CDC). Although CKD is more common in women, researchers are still studying how it affects them.

The effects of kidney disease can vary at different stages of life. In this article, we’ll review some of the unique symptoms of kidney disease in women and treatment considerations at different phases of life.

Kidney Disease in Young Women

The National Institute of Diabetes and Digestive and Kidney Diseases has found that CKD is most common in adults 65 years or older, but several conditions can lead to CKD in young women and girls.

According to an article in the journal BMC Nephrology, some conditions that cause kidney disease are more likely in younger women, such as systemic lupus erythematosus (SLE, or lupus). SLE affects the kidneys in about half of those with this autoimmune disease. According to Cleveland Clinic, girls and women are more likely to develop long-term urinary tract infections that can increase the risk of CKD, especially if they occur frequently or when they are not treated effectively.

Several types of rare kidney diseases can affect younger women and girls, such as:

• Complement 3 glomerulopathy (C3G)
• Immunoglobulin A (IgA) nephropathy
• Alport syndrome
• Polycystic kidney disease
• Fabry disease
• Atypical hemolytic uremic syndrome (aHUS)

Unique Symptoms in Young Women

The National Kidney Foundation reports that kidney disease symptoms that can affect both men and women include:

• Foamy urine
• Frequent urination
• Urinating less often than usual
• Fatigue (tiredness)
• Itching
• Decreased appetite
• Unintentional weight loss

When kidney disease affects young women, it can cause additional symptoms. These include hormone imbalances that affect menstruation (periods), fertility, and reproductive health. In general, the more advanced the stage of kidney disease is, the more that hormones are affected.

Having an abnormal period is relatively common with CKD. An abnormal menstrual cycle can include heavy, infrequent, or absent periods. One study from Kidney International Reports found that more than half of adolescent girls with stage 4 CKD had abnormal menstrual bleeding. Another study from the same journal found that among women under 55 years of age receiving dialysis treatment, 58 percent didn’t get their periods. Among those who did have periods, many experienced heavy menstrual bleeding.

Additional symptoms related to kidney disease in women may include:

• Delayed menarche (first menstrual period after 15 years)
• Late onset of puberty
• Infertility (inability or difficulty becoming pregnant)
• Sexual dysfunction

Some symptoms, such as abnormal menstrual bleeding and sexual dysfunction, can improve after a kidney transplant.

Treatment Considerations for Young Women

There aren’t any specific treatments for abnormal menstrual bleeding for women with different stages of CKD. Your healthcare team will weigh the risk of kidney damage against treatment options like hormonal therapies, based on how well your kidneys are working.

Heavy menstrual periods may be especially concerning. People with CKD are already at risk for anemia (low red blood cells). Having heavy periods can make anemia worse, which may require additional treatments. If you notice any changes in your menstrual cycle or bleeding, talk with your care team.

Hormonal birth control is often used to treat heavy or irregular periods. However, in women with CKD, hormonal birth control with estrogen can increase the risk of proteinuria (protein in the urine), hypertension (high blood pressure), and blood clots. These serious side effects can lead to kidney complications.

Per the National Kidney Foundation, although hormonal birth control with estrogen isn’t usually recommended for women with kidney disease, pregnancy prevention is important for those who are sexually active and haven’t gone through menopause. Condoms, diaphragms, and intrauterine devices (IUDs) are recommended forms of birth control for women with kidney disease.

Working with a doctor who specializes in female reproductive health (gynecologist) and a nephrologist or urologist can help you find the best treatment plan for you based on your symptoms and needs.

Pregnancy and Kidney Disease

The National Kidney Foundation notes that pregnancy can cause stress on the body even in healthy women because of the many changes it causes. For those with kidney disease, pregnancy can be more risky for both the mother and the baby.

Even in the early stages of CKD, pregnancy can increase the risk of health problems for both the mother and the baby. However, the risks become even higher as CKD progresses. According to the journal Kidney International Reports, women with CKD are more likely to have high-risk pregnancies, meaning there are greater health risks for both the mother and baby. During pregnancy, women with kidney disease or those who have had a kidney transplant have an increased risk of:

• High blood pressure
• Preeclampsia (a serious complication that causes high blood pressure and proteinuria or other organ damage in the second half of pregnancy)
• Worsening kidney function
• Blood clots
• Anemia

Kidney Care UK found that babies born to mothers with kidney problems are more likely to be born prematurely (before 37 weeks of pregnancy). Since kidney disease in the mother can affect the baby’s growth, some babies may have a low birth weight.

Pregnancy itself can also lead to kidney problems. Acute kidney injury or preeclampsia during pregnancy may contribute to developing CKD later in life. Additionally, Cleveland Clinic notes that pregnancy can be a trigger for aHUS in women with a certain genetic mutation — a change in their DNA that affects how the body works.

Treatment Considerations During Pregnancy

It’s important to talk to your healthcare team about your risk of complications before conceiving. Many people with mild kidney disease can have a healthy pregnancy. However, the National Kidney Foundation reports that women with more advanced kidney disease have a higher risk of serious complications. If the risk of complications is too high, doctors may recommend avoiding pregnancy. Additionally, complications of dialysis and advanced kidney disease — such as anemia and hormone changes — can make it more difficult to become pregnant.

Many women who’ve had a kidney transplant can have a healthy pregnancy. Most healthcare providers will recommend waiting at least one year after a transplant before trying to become pregnant. Some medications that help prevent kidney transplant rejection can harm a developing baby. Medication changes should be made before a woman tries to become pregnant after a kidney transplant.

In addition to antirejection medications, some blood pressure medications can harm an unborn baby. Medication changes may also be necessary if you’re planning to breastfeed, per Kidney Care UK. Careful planning and monitoring before, during, and after pregnancy are important to reduce the risk of serious complications for mother and baby.

Kidney Disease and Menopause

Menopause is the stage in life when menstrual periods stop permanently due to hormone changes. The average age for menopause is 52 years. However, the transition to menopause (called perimenopause) often begins in the late 40s. Some studies suggest that beginning menopause at an earlier age may be associated with an increased risk of developing CKD later in life.

Women who have kidney disease before menopause are 2.64 times more likely to have early menopause (menopause before age 45). A 2022 study found that the average age of menopause in women with end-stage kidney disease was 45.9 years, compared to 48.8 years in the general population. Although dialysis can sometimes cause menstrual periods to stop, it doesn’t necessarily mean menopause has started.

Women with CKD may also be more likely to develop other health problems after menopause, such as heart disease and osteoporosis (weak, brittle bones).

Treatment Considerations in Menopause

Hormone therapy can help manage the symptoms of menopause. However, doctors are still trying to determine the best ways to give these hormones to women with CKD.

Hormone therapy can be considered for women with CKD after proper assessment of the risks and benefits. Kidney disease can affect how the body processes hormones, such as estrogen and progesterone, causing unwanted side effects. For example, a buildup of extra fluid may be more common in people with CKD taking progesterone. Additionally, an article in Maturitas cites that estrogen can interact with some antirejection medications in women who’ve had a kidney transplant.

Healthy lifestyle habits such as eating a balanced diet, staying active, and taking certain vitamins or mineral supplements can help manage menopause symptoms in people with CKD. Talk to your healthcare team about how diet and exercise can improve menopause symptoms and reduce your risk of heart disease and osteoporosis.

Find Your Team

On MyKidneyDiseaseTeam, the social network for people with kidney disease and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with kidney disease.

Are you living with kidney disease? What advice do you have for other women with kidney disease? Share your experience in the comments below, or start a conversation by posting on your Activities page.