How does menopause affect heart health?

Doctors generally believe that cardiovascular disease affects more men than women, but the American Heart Association (AHA) recently highlighted that heart disease kills more women than all forms of cancer.

Moreover, the risk for a woman is high heart disease can increase enormously in the years before and after menopausethe phase of life after the end of the menstrual cycle.

The periods leading up to, during and after the cessation of the menstrual cycle are called:

• perimenopausewhich may start several years before the last menstrual period and end 12 months after the last menstrual period
• menopause, which occurs 12 months after the last menstrual period, at an average age of 52 or after surgery, such as removal of the ovaries, which causes menstruation to stop
• And postmenopausethe years after menopause.

For some people, perimenopause and menopause can pass virtually unnoticed, other than the cessation of menstruation. But for most, time can bring with it a series of symptoms can include:

• hot flashes
• irregular periods
• mood swings
• night sweats
• sensitive breasts
• vaginal dryness
• reduced libido
• thinning hair and brittle nails.

Many of these symptoms are caused by a reduction in reproductive hormones, estrogen And progesteroneassociated with menopause.

“Estrogen is very protective of women’s heart health. Premenopausal women, who have high estrogen levels, have a much lower risk of heart disease and high blood pressure than men. After menopause, when estrogen levels drop, the risk of heart disease increases in women and becomes higher than in men of the same age.”

Estrogen protects the cardiovascular system in several ways. Robin Noble, MDa board-certified OB/GYN and Chief Medical Advisor for Let’s talk about menopauseexplained some of them MNT.

“We only see a lot of cardiovascular disease in women after menopause – probably because estrogen has a vasodilatory effect on the vascular system. In addition, estrogen has anti-inflammatory effects, and inflammation and oxidative stress appear to be the main mechanisms for the development of cardiovascular plaques,” Noble told us.

Once estrogen drops, these cardioprotective effects are lost, increasing the risk of heart disease.

“With declining estrogen levels during menopause, there may be a rise in cholesterol levels, higher blood pressure and an increase in visceral fat, leading to plaque buildup and hardening of the arteries,” he notes. Jennifer Wong, MDa board-certified cardiologist and medical director of non-invasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.

“There may also be increased inflammation, which is associated with an increase atherosclerotic plaqueespecially unstable plaque. Autonomous Menopausal changes can lead to an increase in heart rate and lower heart rate variability,” she added.

According to the AHASome common symptoms of menopause – hot flashes, night sweats, depression, sleep disturbances and increased fat around the abdomen – are associated with a higher risk of cardiovascular disease.

And the risk of cardiovascular disease is higher in those who experience early menopause, before age 40, than in those whose menopause occurs later.

Matthew outlined a range of cardiovascular risks that can increase after menopause. These include:

• coronary artery disease — estrogen deficiency can promote atherosclerosis, the buildup of plaque in the arteries, increasing the risk of heart attacks
• high blood pressure (hypertension) — estrogen maintains the elasticity of tissues and promotes vasodilation, therefore loss of estrogen can result in higher blood pressure
• cardiac arrhythmias — Hormonal fluctuations can affect the heart rhythm, potentially leading to palpitations or AFib
• myocardial infarction — the risk of stroke is higher due to higher blood pressure and arterial stiffness
• heart failure — Decreased cardiac efficiency may develop due to weakened heart muscle, often due to untreated high blood pressure or coronary artery disease
• high cholesterol – estrogen is actually made from cholesterol, and a deficiency of estrogen after menopause can cause higher levels of LDL (bad) cholesterol and HDL (good) cholesterol
• insulin resistance or prediabetes – after menopause, women become more insulin resistant, which increases the risk of prediabetes and diabetes, which in turn are major risk factors for heart disease and stroke.

Some pre-existing heart conditions can make menopause symptoms worse, and the hormonal changes during menopause can affect pre-existing conditions, as Matthew explained.

“Women with cardiovascular disease may have more severe symptoms of menopause, such as hot flashes, anxiety and fatigue. The drop in estrogen levels during menopause can worsen existing cardiovascular conditions such as atherosclerosis, high cholesterol and high blood pressure, increasing the risk of heart attacks and strokes,” she told us.

Noble shared a similar comment:

“Menopause, and the characteristic changes associated with menopause, can certainly worsen (cardiovascular disease). People with obesity may experience more hot flashes, sleep disturbances and sleep apnea – a serious condition that needs to be evaluated and treated.”

“Pre-existing cardiovascular disease and other health conditions can hinder a person’s ability to pursue some of the healthy lifestyle interventions recommended to alleviate symptoms,” she added.

In the years surrounding menopause, people should follow general healthy living advice to maintain heart health. Noble recommended “Lifestyle modifications including increased exercise, stress management and healthy eating – with an increase in plant-based foods and whole grains.”

“A green Mediterranean diet, which includes fish, is probably the healthiest diet – less animal fat and animal protein, eliminating ultra-processed foods. Intermittent fasting can also be a healthy strategy,” she said MNT.

In addition to a healthy lifestyle, hormone replacement therapy (HRT) can be an effective way to reduce the risk of heart disease at this stage of life.

One studynot yet published in a peer-reviewed journal, suggests that estrogen therapy may have long-term benefits in reducing the risk of heart disease.

They had increased levels of HDL-C (“good” cholesterol), lower LDL-C (“bad” cholesterol), reduced insulin resistance and reduced lipoproteins – all of which can be beneficial for heart health.

“Estrogen replacement, when initiated within 10 years of menopause, is associated with a reduction in the progression of atherosclerosis and a reduced risk of death from heart disease (and reduced mortality from all causes). Discussions about hormone therapy should be individualized with a female doctor,” Matthew advised.

A judgement also suggests that transdermal estrogen (such as gels and patches) may have a greater cardioprotective effect than oral estrogen or estrogen combined with progesterone. However, estrogen alone can do that increase the risk of endometrial cancer (uterine cancer), and is therefore generally only given after a hysterectomy.

The timing of starting estrogen therapy may also be important. One study from 2016 showed that there was more cardiovascular benefit when HRT was started within 6 years of menopause than when it was started later.

Although the risk of cardiovascular disease increases in women around menopause, there are several steps a person can take to help minimize that risk.

Experts recommend following a healthy lifestyle, including a healthy diet and regular exercise, not smoking and moderating alcohol consumption.

For many women, hormone therapy will not only help manage menopausal symptoms but also reduce cardiovascular risk.

However, experts advise that any hormone therapy should be discussed with a doctor to ensure the most appropriate type is prescribed.

So while the risk of cardiovascular disease increases with the advent of menopause, there are many ways to keep the heart healthy later in life.