Your Heart and Menopause

Cardiovascular disease remains the leading cause of death for both men and women in the United States. What is cardiovascular disease exactly, and how can you reduce your risk? How does it impact women, especially when we reach menopausal age? Let’s cover all the bases.

What is Cardiovascular Disease?

Cardiovascular disease refers to a group of heart-related conditions. Coronary artery disease, heart attack, stroke, congestive heart failure, arrhythmia, peripheral artery disease, and high blood pressure all fall under this larger umbrella.

The Signs of Cardiovascular Disease

Some of the most common signs of cardiovascular disease and heart attack include:

• Chest pain, tightness, or discomfort
• Shortness of breath
• Pain in the jaw, throat, neck, upper abdomen, or back
• Pain, numbness, weakness, or a feeling of cold in your limbs

However, some symptoms are unique to women. Even though chest pain is the most common symptom, it’s not always severe enough for women to seek medical attention. You should also look for symptoms like:

• Feeling more fatigued than usual
• Shortness of breath
• Pain in one or both arms
• Nausea or vomiting
• Sweating out of the ordinary
• Feeling lightheaded or dizzy

Why Are Women More At Risk?

Cardiovascular disease is the #1 killer of women over 50. Twice as many women die from it than cancer. What’s more, postmenopausal women are at 2.7 times higher risk of coronary artery disease than premenopausal women of the same age. Those who start their period before age 12 or who begin menopause before the age of 45 also have an increased risk.

One study also found that women who experienced more frequent daily hot flashes also had an increased risk of cardiovascular disease, potentially due to their link to the stiffening of arteries.

Postmenopausal women are also more likely to experience “broken heart syndrome,” which is a medical diagnosis in which the heart muscle temporarily fails—usually after severe emotional stress.

Other factors that increase your risk include smoking, diabetes, depression and anxiety, stress, inactivity, complications during pregnancy, certain chemotherapy or cancer medications, and poor diet.

Do Hormones Play a Role?

These pesky hormones always seem to be influencing something. And yes, both the natural and therapeutic changes in sex hormones after menopause appear to be a risk factor for cardiovascular disease.

During menopause, your body undergoes changes that influence your heart health. When your estrogen levels decrease, it’s common for your blood pressure to rise, your HDL (“good”) cholesterol to drop, and your triglycerides to increase.

Lower estrogen can also bring insulin resistance, which increases your risk for diabetes and, subsequently, cardiovascular disease. Menopausal women are also more likely to gain and maintain additional weight, which can put added stress on your heart.

According to a 2018 study published in the Journal of the American College of Cardiology, the higher testosterone/estradiol ratio present in postmenopausal women was associated with an increased risk for cardiovascular disease, coronary heart disease, and heart failure-related events. Having higher estradiol levels was associated with a reduced risk for coronary heart disease.

When it comes to the impact of menopausal hormone therapy (MHT), the results are mixed. It used to be thought that HRT reduced risk, but a couple of large studies in the 1990s changed the conversation.

The Heart and Estrogen/Progestin Replacement Study (HERS) of over 2,700 women found a slightly increased risk among women who used estrogen and progestin combined therapy, whereas estrogen alone had no impact.

Then there was the Women’s Health Initiative (WHI). This involved over 160,000 women and was the world’s largest clinical trial looking at various health interventions for mid-life women, including MHT and cardiovascular disease risk. The combined estrogen/progestin part of the WHI was halted in 2002 because it was found to significantly increase risk. In 2004, the estrogen-only component was also stopped because it was increasing participants’ risk for blood clots and stroke while not reducing the risk of heart attack.

Regardless, disease risk always depends on many individual factors. Many medical professionals still believe the benefits of MHT outweigh the risks for those who need it. Women are advised to talk to their physician about their risk factors and make an informed decision about MHT.

How To Protect Your Heart

As with most chronic diseases, the best protection is prevention. Experts recommend a healthy lifestyle that includes regular cardiovascular exercise, strength training and a nutrient-dense diet. Focus on whole grains, fruits and vegetables, healthy fats and proteins, and minimize or eliminate processed, high-sugar foods.

In 2018, The Study of Women’s Health Across the Nation looked at the smoking, diet, and physical activity habits of 1,143 middle-aged women. Researchers found that healthy habits were associated with less subclinical atherosclerosis, a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls. As you may guess, the researchers concluded that making healthy choices is critical during (and before!) the menopause transition.

Finally, the head-heart connection is also a real thing. Stress, depression, and anxiety can be additional risk factors for cardiovascular disease. Engaging in self-care activities that support your mental health plays a big role in disease prevention.

It’s Never Too Late To Help Your Heart

A healthy heart gives you a long and healthy life. So take care of it! Understand your risk factors—both as an individual and as a female—and be aware of the lifestyle changes you can make in the name of prevention. It’s never too late to start caring better for yourself.

Whether cardiovascular disease is part of your life today or you’re looking for ways to help prevent it, we’re here for you! Making small changes adds up.