Epidemiological data reveal that the overall risk for kidney stones disease is lower for women compared to age-matched men. However, the beneficial effect for the female sex is lost upon menopause, a time corresponding to the onset of fall in estrogen levels.
The above is from a 2013 paper, Serum estradiol and testosterone levels in kidney stones disease with and without calcium oxalate components in naturally postmenopausal women.
The aim of this study was to look at serum estradiol and testosterone levels of naturally postmenopausal women who had kidney stones.
It was a small study with 113 naturally postmenopausal women with newly diagnosed kidney stones (some with calcium oxalate stones and some with non-calcium oxalate stones) and 84 controls, all around 52 to 62 years of age.
The results were as follows:
- Serum estradiol (E2) was significantly lower in kidney stones patients compared to controls (21.1 vs. 31.1 pg/ml)
- Serum testosterone (T) levels did not significantly differ among the groups.
The authors came to the conclusion that “Naturally postmenopausal women with higher remaining estradiol levels appear less likely to suffer from kidney calcium oxalate stones.
These findings support the hypothesis that higher postmenopausal endogenous [produced by the body] estrogens may protect against kidney stones with ageing.”
This is very encouraging research because it means we can do something about it (more on that below).
My question is this: What about increased dietary oxalate issues in this age group? And can there be similar issues in perimenopausal women too? This study only looked at kidney stones but I propose that there is a connection and that declining estradiol is the common factor. I also propose that providing estrogen support may help to counter both issues – kidney stones and/or dietary oxalate issues with no kidney stones, especially with the clinical observations and feedback I have had (more on that below).
Now this may not be the case for all women and is clearly not the only factor when it comes to kidney stones and dietary oxalate issues. But I do feel it needs to be part of the discussion. In menopause, osteoporosis and heart disease are on our radar but kidney stones and dietary oxalate issues are not.
Dr. Felice Gersch talks about estrogen and calcium in bone health and osteoporosis
I really thought I was onto something after hearing Dr. Felice Gersh, MD (a integrative gynecologist who focuses on women’s health and menopause) talk about estrogen and calcium in bone health/osteoporosis on The Osteoporosis Summit earlier this year. This is some of what she shared:
Estrogen affects everything! So estrogen is involved in the development of bone, but it’s even more complex. For example, estrogen allows the proper absorption of calcium, so that you get proper absorption of calcium from food in the gastrointestinal tract. That involves having proper estrogen levels. And having proper estrogen levels allows the reabsorption of calcium in the kidneys so that you don’t excrete a lot of calcium that you shouldn’t be excreting.
As soon as I heard calcium and the kidneys, the light bulbs went off and I started looking for some research. I didn’t expect there to be much because a higher incidence of kidney stones in menopause and the estrogen connection is not something I’ve heard discussed by menopause experts. However, the above study was one of many. Here are a few more studies that support this connection:
- Estrogen replacement increased the citrate and calcium excretion rates in postmenopausal women with recurrent urolithiasis (urolithiasis is kidney stone disease)
- Etiological role of estrogen status in renal stone formation
Interestingly this 2021 paper, Association between sex hormones and kidney stones: analysis of the National Health and Nutrition Examination Survey, reports that there is “no independent association between sex hormones (testosterone and estradiol) and history of kidney stones in either males or females.” This conclusion may be related to the fact that there are fewer studies that include women. I look forward to future research in this area and until then we use the other research and what we see clinically.
How common are dietary oxalate issues in my community of perimenopausal and menopausal women?
I posted the 2013 study and this question on Facebook to see how common an issue it is:
If you have dietary oxalate issues (with or without kidney stones) I’m curious if there is a hormonal connection and specifically if things got worse for you in perimenopause, and got really bad in menopause (as estrogen declines even further). This has certainly been the case for me.
Here is some of the feedback I’ve received on this post and related posts:
Cynthia shared this: “Really interesting! I definitely had oxalate issues (perimenopause) provoked by ruptured appendix/SBO/abscesses and fistula formation (13 day hospitalization)….I had to remove all oxalates and go full carnivore for 9 months….I’m still oxalate sensitive and had not been before…. I will definitely be sharing this with my communities….there are SO many middle aged women with oxalate issues”
Kirsten shared this: “Interesting to know. At the age of 49 (I am now 51), for the first time in my life I developed kidney stones – probably the most painful experience of my life. I eliminated vitamin C supplements and some oxalates (I had a daily dose of “green juice” that I was consuming as well that I no longer take) however I never understood the relationship between estrogen and their development. I am not post menopausal as of yet -but definitely experiencing symptoms common in peri-menopause… Perimenopausal symptoms include – anxiety (the worrying type) which is at its worst around the time I menstruate (taking 5-HTP which helps but doesn’t completely resolve), night sweats, hypoglycemia, HPA dysfunction (which could be a result of perimeno as well as its own issue – or both). If I don’t keep my stress levels in check, everything becomes exacerbated – meditation helps too.”
Leah shared this: I developed oxalate issues after menopause (I’m in my 60s) and didn’t realize what is was until I read your post about it during the early days of the pandemic when people were overdosing on vitamin C (at least you were trying to figure out if there was a connection at the time). With more research, I discovered a product called Kidney Cop that I still take (though I never get stones, only skin issues on my face). I also switched to liposomal vitamin C and amla and cut back on the offensive [high oxalate] foods for me. I do also experience a similar effect when I use collagen powder with peptides (skin issues). When I switched to a powder that didn’t contain peptides but has collagen types 1-5 in it, I had no issues. I don’t know if this is oxalate-related or not, but the skin issue is the same (clear fluid-filled bumps around my mouth and chin only).”
A number of women in the Facebook group Trying Low Oxlaates have shared comments like this: “I was never bothered by oxalate issues before menopause” and “I can tell you that my oxalate problems became far worse – along with everything else, pyroluria, copper toxicity etc – in perimenopause.”
Personally, my severe dietary oxalate issues started in 2012, when I was 52, and it manifested as excruciating foot pain. It was a combination of hot-burning-coals-pain and shards-of-glass-pain. Later it affected my left eye and more recently it impacted my sleep in a big way. I eat low oxalate and use vitamin B6 and calcium citrate (carefully timed) to keep symptoms away. My next plan is to see if addressing my low estrogen will help even more (more on that below).
Approaches to support declining estrogen levels in perimenopause and menopause
Briefly, here is a summary for supporting declining estrogen levels in perimenopause and menopause:
- Diet and lifestyle including exercise and stress-reduction
- Amino acid support as needed (GABA supports progesterone and tryptophan supports estrogen) and the pyroluria protocol of zinc, vitamin B6 and evening primrose oil (more on this here)
- Adrenal support
- Essential oils such as geranium and rose otto and clary sage and other oils to help with anxiety and stress
- Liver and kidney support
- Avoiding environmental toxins, especially xenoestrogens (plastics, fragrances, pesticides etc) which bind to estrogen receptor sites
- Maca – the research on Femmenessence Maca-Pause for bone and cardio health is very encouraging and I suspect there may be benefits for dietary oxalate issues and kidney stones too (when there is a low estrogen trigger). I will be trying this approach and I’ll report back on what I find.
- Other herbal approaches for hormonal support: Black cohosh, red clover, dong quai (which, interestingly, are reno-protective too)
- Bioidentical hormone replacement therapy
This section deserves an entire blog post and is important to address over and above the mood issues, increased anxiety, compromised sleep, low libido, vaginal issues and hot flashes – because of the impacts for heart health, cognitive decline and bone health.
Kidney stones and dietary oxalate issues in men
This 2016 paper addresses kidney stones in males and makes the testosterone connection for men under 60 years of age: Possible role of elevated serum testosterone in pathogenesis of renal stone formation
Urolithiasis [kidney stones] occurs with greater frequency in males with incidences three times higher compared to females indicating some role played by androgens. Stone formation in renal tissues before puberty is similar between males and females, whereas greater frequency is seen in the third to the fourth decade of life when the levels of serum testosterone are also the highest in males.
With advancing age, the probability for stone formation also decreases as consistent with the decline in serum testosterone levels with more than 20% of healthy men over 60 years of age presenting with serum levels of hormone below the range for young men.
This paper does also support the menopausal estrogen connection I’ve mentioned above: “With females, the frequency for stone formation is considered more compared with premenopausal postulated mainly due to low estrogen levels.”
There is so mention of dietary oxalate issues but we do see this clinically.
My other resources on oxalates if this is new to you
This blog, Oxalate crystal disease, dietary oxalates and pain: the research & questions, came out of my quest for finding a medical explanation/term for my own pain caused by dietary oxalates and a desire to gain a better understanding for my clients who experience similar pain.
You can read an overview of oxalates, my pain issues with dietary oxalates, a deeper dive into the condition called oxalate crystal disease (with some of my insights and questions), and the autism and atherosclerosis research.
As I mentioned above, my severe dietary oxalate issues started in 2012 (when I was 52) and it manifested as excruciating foot pain. It was a combination of hot-burning-coals-pain and shards-of-glass-pain. Later it affected my left eye.
You can also read how oxalates can contribute to anxiety, sleep issues (this has been a more recent issue for me), headaches, fatigue and other symptoms.
When I did the research for this older blog I didn’t come across any studies related to menopause and estrogen levels.
I published this blog, Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?, to help folks identify the increase in different types of pain they were seeing as a result of using high dose vitamin C. This could be joint pain, eye pain, foot pain, vulvodynia, bladder issues, insomnia, gut pain, kidney pain, changes in thyroid health/labs, bone pain etc.
This blog, Vitamin C causes oxalate formation resulting in pain, anxiety, and insomnia (when there is a defect in ascorbic acid or oxalate metabolism)? is part 2 and reviews some of the research on vitamin C/ascorbic acid being a possible trigger for the formation of oxalates in certain instances.
I do mention the big disconnect that we see in this research is always the mention of kidney stones. The missing piece – in the research and in many articles – is that you can have issues with dietary oxalates when there is no kidney disease/no kidney stones. I propose similar logic for dietary oxalate issues in perimenopause and menopause with declining estrogen levels i.e. dietary oxalate issues with or without kidney stones.
If you’re in perimenopause or menopause have approaches for supporting estrogen (estradiol) made your dietary oxalate issues and/or kidney stones less severe? Please share what has helped and if you have both – dietary oxalate issues and kidney stones/kidney disease.
If you’re a younger woman and have dietary oxalate issues and kidney stones/kidney disease, have you noticed any hormonal connections?
If this doesn’t affect you personally, have you seen the benefits of supporting estrogen with your perimenopausal/menopausal female clients/patients who have dietary oxalate issues and kidney stones/kidney disease?
If you’re male and have had dietary oxalate issues and/or kidney stones have you found they get less severe as you get older and testosterone declines?
If you have questions please share them here too.
Hi! I remember in the past you reported on the importance in menopausal woman who are on bio identical hormone replacement therapy, of stopping progesterone maybe estrogen, on a monthly basis for a few days then resuming to simulate what the body does pre menopausal.
What are your thoughts? Also please refer me back to that original article if possible.
Thanks for your time! All the best ,
Margarita Woodbury MD
Dr. Woodbury
Dr. Felice Gersh writes about this on her site: “A new area of hormone use in menopause entails the use of cream versions of estradiol and progesterone given in a manner to replicate a natural menstrual cycle. This approach is not mainstream, but is used by thousands of women who believe that mimicking nature is always the best approach. Dr. Gersh is trained and skilled in the use of Rhythmic Hormones and prescribes them to women who wish to go that route and are fully aware of the unorthodox view taken on it by “conventional” doctors.” https://integrativemgi.com/tame-the-flames/menopause-and-peri-menopause/
I like this approach but you may find other practitioners using a different approach. What approach do you use with success?
Hi, you also might want to seek out Dr. Michell Sands. She has a virtual program and treats people all over the world. She creates personal bio-identical hormones based on testing and re-testing. Yes, you do get off them for 4-5 days a month. This is a yearly program where they test you every 3 months and you have access on a daily basis to her team and can arrange private consults. She occasionally offers a special on her program.
Karen
Thanks for sharing this resource – and it’s a great one if someone chooses to use bHRT/bioidentical hormone replacement therapy
I’m 70 years old and I’ve recently had kidney stones/infection twice in the past year. On a separate note, I’ve tried GABA, without any notable affects regardless of dosage, what are your thoughts on trying pharmaGABA?
Terri
Sorry to hear about the kidney stones/infection. Is this the first time you’ve had this and nothing before menopause. I do hope your doctor has discussed a low oxalate diet with you and it’s helping with pain and other possible oxalate issues?
I’d want to confirm low GABA is the issue. I always start with the questionnaire/symptoms and a trial of GABA if there are low GABA symptoms i.e. physical anxiety. The best way to determine if someone may have low GABA is to look at the low GABA symptoms, rate them on a scale of 1-10 with 10 being worst, do a trial of GABA and rate the symptoms again right afterwards (in the next 2 to 30 minutes). Here are the symptoms https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/
I’d also want to know what GABA was trialed, if it was used sublingually and if it was increased to find the ideal amount. If all that was done then we would certainly trial pharmaGABA and also other GABA products. I have folks sometimes trial up to 4 or 5 GABA products before landing on one that works for them.
If you are new to the amino acids (and other anxiety nutrition solutions like real whole food, quality animal protein, fermented foods, organic produce, health fats, gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
My online GABA Quickstart group program is helpful when you have questions and need guidance (and moral support/encouragement). More here about the program and purchase info https://www.anxietynutritioninstitute.com/gabaquickstart/
Hi Trudy,
I have two questions. Firstly, what is your opinion on anhedonia and what might help it? Secondly, I have tried NAC on several occasions and it seems to work quite well for me in terms of anxiety but wondered what the mechanism is? It seems to work better for me than GABA. Thanks
Tim
When I hear anhedonia (the inability to feel pleasure) I immediately consider low endorphins and the amino acid DPA. More here https://www.everywomanover29.com/blog/what-is-the-difference-between-dpa-and-dlpa-amino-acids-and-which-one-do-i-use-for-weepiness-heart-ache-pain-and-energy/
GABA will work well when GABA levels are low. But the GABA must also be used sublingually, away from protein and dosed according to each person’s unique needs to be most effective. Do you have low GABA levels, how have you used GABA and how much?
I have found NAC to work well when there is toxin exposure (because it boosts glutathione). It does also counter high glutamate and is calming in this way.
If you are new to the amino acids (and other anxiety nutrition solutions like real whole food, quality animal protein, fermented foods, organic produce, health fats, gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/ It’s a comprehensive approach – amino acids AND diet.
Thank you for your response Trudy. Let me just explain to you my situation. I am taking Clomipramine for anxiety, depression and OCD plus I take quetiapine as a mood stabiliser for my bipolar type 2. I cannot tolerate Clomipramine without a mood stabiliser hence the quetiapine as well. I feel that these medications have contributed to my anhedonic state either individually or the combination of the two. Could this be true? Could they have supressed my dopamine system?
Now I don’t have any DPA but I do have some DLPA which come in 500mg tablets so I can certainly try and see what happens. Could anhedonia be also due to low dopamine though? Being in an anhedonic state is quite awful and unfortunately I am not in a position to reduce my psychiatric medications at the moment.
Tim
Tim
I can’t consult on meds via the blog but when dopamine is also low and contributing to the anhedonia (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181880/) I can share that DLPA is often a better fit. We always know by looking at the low dopamine and low endorphin symptoms and doing a trial of the respective amino acids (tyrosine, DPA and or DLPA). That said there is a precaution with tyrosine and DLPA with a bipolar diagnosis.
And a reminder that discussing new supps with the prescribing doctor is always recommended.
I am 54 and have had a slowly increasing issue with oxalates for years now. No Dr has spotted it, I have had to figure it out on my own. I just can’t work out how to get rid of it! It first started in perimeno with a bout of having trouble walking – the soles of my feet burned and turned white for a couple/few weeks. Then I had a weird similar situation with my knees some months later. Then I started to become sensitive to oxalate foods and I get aura migraines, migraines and vicious headaches. I am on a low oxalate diet and even have an oxalate app to help me check anything before I eat! It is now at the point where I feel I am suffering nutritionally. How long can one go eating so limitedly??
I am now also very sensitive to vitamin D as well. I went on a holiday, spent lots of time walking and swimming and enjoying what I thought would be a therapeutic break… I started to feel worse and when I got home, felt like I’d had a ‘flare’. (I tested the theory with VitaminD drops and sure enough, felt terrible). I am still trying to get back to where I was months after that holiday!
I take Oestrogel and progesterone lozenges. I took a break to test and felt much worse, so I do think it helps. I try very hard…. I eat only organic foods, no alcohol, no caffeine, water only. No sugar, no gluten, etc I have an IQAir Filter, a whole house water filter, I have switched all cleaning products to clean ones and all personal care products to organic ones. This is years now and it just slowly gets worse no matter what I try. Can anyone suggest a resolution to this?
Jessica
Thanks for sharing your struggles which sadly are all too common. Well done for figuring it out. As someone who is also trying to figure it out I can relate.
Vitamin D tends to be an issue because it affects calcium levels. Options I’d explore include: making sure Oestrogel is enough for your estrogen needs, gut health/dysbiosis, fat malabsorption, calcium intake, vitamin B6, adrenal/liver/kidney health.
Trudy, You are a gem….. thank you for your reply!
I was wondering if the Oestrogen was enough as its only one form of oestrogen. What would be another safe and BHRT?
You will also find this fascinating…. I was told that my COMT pathway is too fast and therefore clears out my oestrogen too quickly! I was advised to take red clover and passion flower to slow it down. It worked really well for sometime and I could even manage to eat some oxalates (for anyone that this may relate to, I switched brands of the red clover and it stopped working and when I switched back, it was great again-meaning, if something doesn’t work, don’t give up, it could be the brand or excipients or amounts that make the difference) Then, I took some Galactomune and everything went haywire (I do not understand why). I am now trying to fix that mistake and things are slowly calming. I have tested for SIBO (breath test) and it was ok. I do not take a calcium supplement as I read that it can be bad for you (?) and I don’t eat dairy. I take 200mg B6 and day and lots of zinc orotate (suspecting pyroluria). I definitely need to check my liver and kidney health, but not sure how to attempt that? I had a very bad asymptomatic urinary tract infection that spread to my kidneys and created and terrible kidney infection some years ago. I have always wondered if that was a catalyst for for so many of my issues…. Thanks heaps for your help and listening
Dear Jessica,
I am the same age with exactly the same problems I have had to figure out myself just like you!
So frustrating! Suspected I needed to start oestrogen patches but wasn’t sure. Be so nice to share our journey and information to hopefully get better!
Be great to hear how your getting on.
Trudy ( another Trudy 🙂
I’m 37 and have long virus that is worsening for my hormones each month.
At 29 I developed oxalate issues and have controlled them w low-med ox diet. Histamines we’re a problem in that stage and also diet controlled. I take seeking health optimal multivitamin to support my +/-mthfr and I am well regulated on it.
When my cycle returned after my 2nd child at 18mos pp my body had a very hard time and it sent me into shingles at age 31. Cycles have been regular but I battle night sweats, insomnia the week before my period starts.
However, since long virus all this has gotten WAY worse. I did the Ascorbic Acid high dosing during acute infection and the effects were severe. Most recently (5 months post virus) the week before my cycle I was awake 5 days in a row, soaked every pajama I own, and was so weak following Day 1 of my cycle every time I stood up I fainted.
Healing group women have directed me to your article on increased kidney stones in menopause (discouraging since I’m already in the trenches premenopausal). Any suggestions welcomed.
Nicole
I would recommend working with someone who can test hormone levels (and knows when to test them and interpret results in conjunction with your period). With extensive sweating I also consider parasites and with stress/shingles I’d also want to see adrenal results (the adrenals pick up the slack when sex hormones are not optimal).
And with insomnia and sex hormonal shifts I always look into and address low GABA and low serotonin with GABA and tryptophan or 5-HTP (and pyroluria if applicable). Here is one of many blogs on the topic https://www.everywomanover29.com/blog/tryptophan-for-pms-premenstrual-dysphoria-mood-swings-tension-irritability/
When you are new to the amino acids I really do recommend my book “The Antianxiety Food Solution” so you understand exactly how to use them. There is an entire chapter on the amino acids and how to use them.
It also covers other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc and is a great foundation. Remember, it’s the amino acids and diet. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
Can you share what you mean by “I did the Ascorbic Acid high dosing during acute infection and the effects were severe” – how high and what severe effects? You may find this useful https://www.everywomanover29.com/blog/vitamin-c-causes-oxalate-formation-resulting-in-pain-anxiety-and-insomnia-when-there-is-a-defect-in-ascorbic-acid-or-oxalate-metabolism/
Do you think Estriol transdermal cream might help the oxalate situation as effectively as estradiol?
I recently turned 60 years of age and I have been on a low oxalate diet for around three years now but my oxalates still test high. My DNA test did not show any inherited oxalate markers.
I tried taking vitamin B6 to no avail. Turns out I may have had a long standing thiamine deficiency which might factor in (Thiamine and pyridoxine are essential cofactors in the glyoxylate pathway, and a deficiency results in increased oxalate formation) and I’m in the process of repleting my thiamine. I have had to start low and increase the thiamine slowly due to paradoxical reaction. I am guessing this could be the result of a CBS gene mutation that upregulates the CBS enzyme—which in turn creates too much sulfur, ammonia, and can deplete thiamine.
My oxalate problem started after menopause I was fine up until then never had a problem with oxalates.
I can’t do estradiol because I am intolerant to progesterone HRT. The ones I tried were bio identical. I did OK with estradiol, but with the progesterone I had a severe reaction at a very very low dose. I tried 3 times and always had the same reaction.
Because of this I can’t take Estradiol due to the breast cancer risk without progesterone. (I don’t have to worry about uterine cancer because I had a hysterectomy due to endometriosis).
After thoroughly researching the topic I discovered that low-dose estriol HRT would be an option without the progesterone.
I just don’t know if the estriol will work as good as the estradiol? I don’t know if anybody will have an answer for me but I thought I would ask!
I would also like to know if anyone else with an oxalate problem has had a thiamine deficiency.
Thanks!!!
Susan
I don’t know about estriol but would expect so and would discuss with the prescribing doctor. Please do keep us posted.
Of course low oxalate eating, calcium citrate, improving fat digestion etc all help too
And yes thiamine deficiency is common with oxalate issues.
I read and heard dr Felice,I wonder how that would effect me.I had full hysterectomy and orphorectomy at 40.I was put on bio identical hormonal troche as recommended by the famous professional Barry Wren OAM in Australia.He told me I needed both estrogen and progesterone for life as I had very many problems but amongst those adenomyosis and endometriosis all over vagina, bowel,anys Puch of Douglas and if I stopped the progesterone,it can grow back as it’s like a seed and spreads.Yhey cut and remove all that’s visible,but unopposed estradiol without progesterone can bring it back.Any thoughts on this Trudy.
Felice didn’t cover women with hysterectomy when discussing her cyclical way of taking hormones with time off with small bleed.Just menopausal women with wombs.I have had many doctors over the years about why I take progesterone in my bio identical hormonal scripts.Most are silent when I tell them what I was told.
This may or may not be of interest but I am now 63.I have been on hormones since 40.
My bone density that I have checked regularly, was this year still, that of a very young woman as opposed to both my sisters who have osteoporosis and oesteopinia respective and never had hrt and my calcium score of my heart showed a 0 zero calcium score.Does this in anyway prove that hrt is actually GOOD for heart and bone health as most all the original studies predicted and dr Felice says…..I think maybe yes….or maybe I am just lucky.
Angie
I feel this out of my scope to comment since I’m a nutritionist but I would find the family difference in bone health and having a zero calcium score to be very encouraging if this was me. I do believe Dr Felice Gersch offers phone consults and I’d want to meet with her especially with adenomyosis and endometriosis.