How does menopause affect heart health?

It’s a stark fact but one that’s worth reflecting on: the leading cause of death in postmenopausal women is cardiovascular disease [1]. This can take some people by surprise, as cardiovascular disease is often associated as being more of a men’s health issue.

Risks to women’s heart health do alter at menopause. The risk of heart attack is five times higher post-menopause than pre-menopause [2]. Post-menopause, women have a higher risk of cardiovascular disease than men. Levels of LDL cholesterol (the bad cholesterol that can clog your arteries) often rises during menopause and this can continue into old age – 65% of women aged 65 and over have raised cholesterol compared to 48% of men [3].

Why can menopause cause heart problems?

Oestrogen is known to have a protective role on your heart, so when levels of oestrogen fluctuate during perimenopause, then drop and remain low at menopause, some of this benefit is diminished.

When oestrogen levels fall, the level of LDL cholesterol in your blood often rises – 77% of women aged 45 to 64 have raised cholesterol [3]. This can lead to fatty deposits building up in your large blood vessels, which narrow. This narrowing can increase your risk of heart attack, heart disease and stroke [4].

Oestrogen also increases the levels of chemicals that protect your heart and blood vessels.

While the drop in oestrogen levels doesn’t directly raise your blood pressure, it’s important to realise that blood pressure does tend to rise with age. High blood pressure can damage the walls of your arteries, which can cause coronary artery disease, and it can damage your heart and lead to heart failure.

Your menopause symptoms can sometimes affect your heart. For instance, some women find their muscle and joint pains, vaginal dryness or lack of energy prevents them from exercising or reduces the amount of exercise they can do. Other women find it difficult to stick to a balanced healthy diet.

Progesterone and testosterone can also have beneficial effects on the cardiovascular system.

You can book an appointment to speak to a Newson Clinic healthcare professional about your perimenopause or menopause symptoms here.

How can I help protect my heart health during perimenopause and menopause?  

Perimenopause or menopause is a good time to take stock and reevaluate your lifestyle in order to benefit your heart.

You can reduce your chance of developing high blood pressure by maintaining a healthy weight, and the best way to do this is through a healthy, balanced diet and regular exercise. Exercise makes your heart and blood circulatory system more efficient, lowers your cholesterol level, and keeps your blood pressure at a healthy level. If you smoke, quitting is crucial, as smoking is a major risk factor in furring up and narrowing your arteries. Also try to stick within recommended alcohol limits.

Taking hormone replacement therapy (HRT) to treat your menopause symptoms can also help protect the health of your heart, according to a growing body of research. Evidence shows if you start taking HRT during perimenopause, or within 10 years of your menopause, you have a lower risk of developing heart disease. Reviews of evidence have also shown that the risk of dying from heart disease in women taking HRT is reduced by about 30% [5].

This is because by replacing the missing hormones, there is less furring and clogging of the lining of your arteries, which reduces the risk of heart disease. Some forms of HRT (natural, body identical hormones including oestrogen through the skin via a patch, gel or spray) can also lower blood pressure and usually lower cholesterol.

References

1. El Khoudary, S.R. et al. (2020), ‘Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association’, Circulation, 142 (25), e506-e532. doi:10.1161/CIR.0000000000000912
2. 2. Boardman, H. et al. (2015), ‘Hormone therapy for preventing cardiovascular disease in post-menopausal women’, The Cochrane database of systematic reviews, doi:10.1002/14651858.CD002229.pub4
3. NHS health survey for England 2021
4. Lobo R.A. (1990), ‘Cardiovascular implications of estrogen replacement therapy’, Obstetrics and Gynecology, doi: 10.1016/0020-7292(90)90539-w
5. Boardman, H. et al. (2015), ‘Hormone therapy for preventing cardiovascular disease in post-menopausal women’, The Cochrane database of systematic reviews, doi:10.1002/14651858.CD002229.pub4