Menopause signifies the end of menstrual cycles, marking a significant transition in a woman’s life. During the transitional periods surrounding menopause, namely the years leading up to and following, women experience a myriad of changes that can result in various symptoms, which commonly include hot flashes, emotional fluctuations, and disturbances in sleep patterns. However, the ramifications of menopause extend far beyond these surface-level symptoms and can have profound implications for women’s overall health. Medical News Today explores the intricate relationship between menopause and cardiovascular health, providing insights on how women can effectively safeguard their heart health as they age.
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The prevalent belief among healthcare professionals is that cardiovascular diseases predominantly affect men; however, recent findings from the American Heart Association (AHA) has underscored a startling reality — heart disease is responsible for more fatalities among women than all forms of cancer combined.
Furthermore, a woman’s vulnerability to heart disease can escalate significantly during the perimenopausal and postmenopausal stages, periods that follow the cessation of menstrual cycles.
The transitions preceding, during, and following menopause are categorized as:
- perimenopause, a phase that may commence several years prior to the final menstrual period and concludes 12 months after the last menstrual cycle
- menopause, defined as the moment 12 months have passed since the last menstrual period, typically occurring around the average age of 52, or following surgical interventions such as oophorectomy that result in the permanent cessation of menstruation
- and postmenopause, which encompasses the years after menopause.
For some individuals, the perimenopausal and menopausal phases may pass with minimal disruption, aside from the ceasing of menstrual cycles. However, for the majority, these transitions bring forth a spectrum of symptoms that may encompass:
- hot flashes
- irregular periods
- mood changes
- night sweats
- breast tenderness
- vaginal dryness
- decreased libido
- thinning hair and brittle nails.
These symptoms are primarily attributed to a decline in essential reproductive hormones, namely estrogen and progesterone, that typically occurs during menopause.
“Estrogen is very protective of heart health for women. Pre-menopausal women, who have plentiful levels of estrogen, have a much lower risk for heart disease and high blood pressure than men. After menopause, when estrogen levels drop, the risk of heart disease in women goes up and becomes higher than in men of the same age.”
Estrogen plays a crucial role in safeguarding cardiovascular health through various mechanisms. Robin Noble, MD, a board-certified OB/GYN and Chief Medical Advisor for Let’s Talk Menopause, elucidates some of these mechanisms for MNT.
“We do not see much cardiovascular disease in women until after menopause — likely because estrogen has a vasodilatory effect on the vascular [system]. Moreover, estrogen has anti-inflammatory effects, and inflammation and oxidative stress seem to be the primary mechanisms of the development of cardiovascular plaques,” Noble told us.
With the reduction of estrogen levels, women lose the critical cardioprotective effects that this hormone provides, consequently elevating their susceptibility to heart diseases.
“With decreasing estrogen levels in menopause, there can be an increase in cholesterol levels, higher blood pressures, and increase in visceral fat leading to plaque buildup and hardening of the arteries,” cautioned Jennifer Wong, MD, a 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 can also be increased inflammation which has been associated with increased atherosclerotic plaque, especially unstable plaque. Autonomic changes in menopause can lead to an increase in heart rate and lower heart rate variability,” she added.
According to the AHA, several prevalent menopause symptoms — including hot flashes, night sweats, depression, sleep disturbances, and an increase in abdominal fat — correlate with a heightened risk of cardiovascular disease.
The evidence indicates that those who undergo early menopause, particularly before the age of 40, face a greater risk of heart disease compared to those experiencing menopause later in life.
Matthew outlined an array of cardiovascular risks that may escalate following menopause, including:
- 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 elasticity of tissues and promotes vasodilation, therefore loss of estrogen can result in higher blood pressure
- arrhythmias — hormonal fluctuations may influence heart rhythm, potentially leading to palpitations or AFib
- stroke — the likelihood of stroke increases due to elevated blood pressure and arterial rigidity
- heart failure — reduced cardiac efficiency resulting from weakened heart muscle may develop, often as a consequence of untreated high blood pressure or coronary artery disease
- high cholesterol — since estrogen is synthesized from cholesterol, deficiency post-menopause can elevate levels of LDL (bad) cholesterol and alter levels of HDL (good) cholesterol
- insulin resistance or prediabetes — post-menopause, women demonstrate increased insulin resistance, augmenting the risk of prediabetes and diabetes, both of which are significant factors for heart disease and strokes.
Pre-existing heart conditions can exacerbate menopause symptoms, while the hormonal fluctuations during this phase can complicate existing conditions, as Matthew explained.
“Women with cardiovascular disease can have more severe menopause symptoms, like hot flashes, anxiety, and fatigue. The drop in estrogen with menopause can worsen existing cardiovascular conditions like atherosclerosis, high cholesterol, and high blood pressure, increasing the risk of heart attacks and strokes,” she indicated.
Noble echoed this sentiment:
“Menopause, and the characteristic changes associated with menopause, can certainly worsen [cardiovascular disease]. People with obesity may experience more hot flashes, sleep disruption, and sleep apnea — a serious condition that should be evaluated and treated.”
“Pre-existing cardiovascular disease and other health issues may hinder someone’s ability to adopt some of the healthy lifestyle changes recommended to alleviate symptoms,” she added.
In the years surrounding menopause, individuals should adhere to general healthy living guidelines aimed at preserving heart health. Noble recommends “Lifestyle modifications that include increased exercise, stress management, healthy eating — with an increase in plant-based foods and whole grains.”
“A green Mediterranean diet, incorporating fish, is likely the healthiest diet — less animal fat and animal proteins, eliminating ultra-processed foods. Intermittent fasting can also be a beneficial strategy,” she advised MNT.
In addition to embracing a healthy lifestyle, hormone-replacement therapy (HRT) is recognized as an effective option to mitigate the risk of heart disease during this pivotal period in a woman’s life.
One study, yet to be published in a peer-reviewed journal, posits that estrogen therapy may confer long-term protective benefits against heart disease.
Findings indicated that participants had increased levels of HDL-C (“good” cholesterol), lower LDL-C (“bad” cholesterol), decreased insulin resistance, and reduced lipoproteins — all of which potentially favor heart health.
“Estrogen replacement, if initiated within 10 years of menopause, is linked to a reduction in the progression of atherosclerosis and lower mortality rates from heart disease (and overall causes of mortality). The conversation regarding hormone therapy should be tailored to each woman’s health needs in consultation with her doctor,” Matthew recommended.
Further, a review suggests that transdermal estrogen, delivered through gels and patches, may provide greater cardioprotective effects compared to oral estrogen or estrogen combined with progesterone. However, estrogen monotherapy may increase the risk of endometrial (uterine) cancer, thus it is generally prescribed post-hysterectomy.
The timeliness of commencing estrogen therapy may also influence outcomes. A 2016 study revealed that commencing HRT within 6 years of menopause provided greater cardiovascular advantages compared to initiation at a later stage.
While the onset of menopause elevates women’s risk of cardiovascular disease, there are numerous proactive steps individuals can adopt to minimize that risk.
Experts recommend adhering to a healthy lifestyle, incorporating a balanced diet, engaging in regular physical activity, abstaining from smoking, and moderating alcohol intake.
For many women, hormone therapy not only assists with the management of menopause symptoms, but can also lower cardiovascular risk.
Nonetheless, professionals stress that discussions about hormone therapy must occur with a healthcare provider to ensure the most suitable treatment option is prescribed.
Thus, although the onset of menopause correlates with an increased risk of cardiovascular disease, there are numerous strategies available for maintaining a healthy heart throughout later stages of life.
Menopause transition physiology and symptoms
Nds.
menopause represents not only a significant transition in a woman’s reproductive life but also a pivotal moment for cardiovascular health. The decline in estrogen levels during this phase has far-reaching implications, increasing susceptibility to heart disease and related conditions. However, through awareness, healthy lifestyle choices, and potential medical interventions like hormone-replacement therapy, women can take proactive steps to safeguard their heart health during and after menopause. Regular consultations with healthcare providers are essential for personalized advice and management options.
