Dr. Lindsey Thomas discusses heart health in menopause

When we think of the effects of the menopause, we are usually thinking about symptoms as these are something we can physically feel happening. But the same processes which lead to symptoms are also causing changes within our bodies we can’t always feel, and the impact on our cardiovascular health is one of these.

What is cardiovascular health?

The cardiovascular system is essentially anything in the body involving our heart and blood vessels. Changing hormone levels during the menopause transition, have an impact on the way these have previously functioned and can contribute to the development of cardiovascular disease (CVD)

Cardiovascular disease encompasses a group of disorders including heart attacks and angina, through to stroke and TIA’s (stroke symptoms which are not permanent) These occur usually when blood flow to the heart, or the brain, is reduced due to ‘furring up ‘ of blood vessels with fatty deposits.

There are a variety of risk factors which increase the chance of developing CVD, many of which we are familiar with, such as high blood pressure and smoking. But we are learning more about how being female has its own risk factors, and lower levels of hormones in the menopause is one of those.

Why is this important for women?

There has been an impression that CVD is more of a male issue which means it can be underdiagnosed and undertreated in women. But this is a significant female issue with sobering facts from the British Heart Foundation of 3.6 million women living with CVD. To put this in perspective twice as many women die from CVD than breast cancer.

Why does the menopause have an impact?

In pre-menopausal women, oestrogen has a protective effect on the heart and blood vessels, which is why in general women have lower rates of heart disease than men, but then as oestrogen levels fall in the menopause, they then start to quickly catch up.

Several processes lead to this change, including a loss of the ability of oestrogen to keep blood vessels stretchy, elastic and dilated with less chance of blockages. This is combined with changes to cholesterol levels, with a tendency to higher levels of LDL cholesterol, often referred to as ‘bad ‘ cholesterol, increasing the risk of fatty plaques in blood vessels.

Other changes are also taking place at this time, including an increase in body weight and the way we carry this, with more weight carried centrally, around the middle, which is a riskier way to carry weight in terms of CVD.  This in turn leads to an increased risk of insulin resistance, where the body doesn’t respond as well to the insulin produced to control blood sugar levels. This can lead to diabetes, which has its own increased risk of CVD.

High blood pressure is also an important risk factor and oestrogen plays a role in regulating this, as well as other factors. There is a significant increase after the menopause, with significant numbers of women impacted before the age of 60. We naturally have fluctuating levels of blood pressure, but when levels are persistently high is when this becomes a problem. This is why we can’t rely on a one-off reading and need instead either a collection of home readings, or 24 hour monitoring.

And while we often think of blood pressure as having none or few symptoms, in women high blood pressure may present with symptoms which may be mistaken for being menopausal. With hot flushes, disturbed sleep, palpitations and fatigue, especially if this restarts again several years after the menopause.

When there is a combination of insulin resistance, raised blood pressure and changes in cholesterol this forms the condition metabolic syndrome, with combined increased risks. As well as its own symptoms, such as fatigue and weight gain, which can create a vicious cycle of increasing risk further.

And interestingly, studies have also shown that hot flushes and night sweats in themselves seem to be associated with a higher risk of a cardiovascular event, especially if these start early or continue into later life.

How can women reduce their risk?

Reducing risk means focusing on the things we can change. We can’t do anything to stop ourselves aging or being female, but prevention plays a huge role in reducing the chance of developing cardiovascular disease. And midlife is a great time to look at our lifestyles as a whole and where we can make sometimes even just make small changes. Most of these changes improve how we feel as well as safeguarding against long term health issues so it’s a win, win.

It is worth acknowledging that there are some things that we can’t change, as with all things health, and there will be some higher risk which runs within families or is linked to other health conditions. As well as some increased risk from female only issues, such as a menopause under the age of 40 (or primary ovarian insufficiency) Polycystic Ovarian Syndrome and blood pressure and gestational diabetes during pregnancy. But this just makes any changes that can be made to reduce overall risk more important.

Smoking: most of us are aware that smoking significantly increases the risk of CVD along with other health issues. The British Heart foundation attributes 15,000 CVD deaths per year to smoking. And that stopping reduces the risk by half after just one year. It’s not always easy to stop however, but there is help available through the NHS.

Alcohol: Some women do find themselves drinking more alcohol when they are struggling with menopausal symptoms, but alcohol worsens symptoms such as night sweats, sleep and anxiety. Current guidelines recommend drinking less than 14units per week and making sure you have 2-3 alcohol free days. Alcohol increases the risk of issues such as high blood pressure and Stroke, and due to the high calories in alcohol, can lead to risks through weight gain too.

Weight: managing weight can be tricky and emotive and many women find this even more so during the menopause. There are lots of factors which contribute to weight gain during the menopause and its important to find an approach which will work for you. Even losing a small amount of weight can have a big impact on blood pressure readings and reducing risk.

Diet: it is widely accepted that eating a ‘Mediterranean’ diet is good for heart health as well as reducing blood pressure and cholesterol. Studies have shown that eating this way is associated with a longer life and less chance of being overweight.

In general, the diet is based on eating more plant-based foods, vegetables, fruits, beans, pulses, nuts and seeds. Including healthy unsaturated fats such as olive oil and wholegrains and reducing overly processed foods.

Exercise: if exercise was a medication we could prescribe, it would be a wonder drug! And this is no different when it comes to our cardiovascular health. Staying active helps to maintain a healthy weight, reduces blood pressure and promotes our ‘good ‘cholesterol.

As well as helping with a good night’s sleep and improving mood and reducing stress, which have been shown to be implicated in CVD health.

Where to go from here?

As with anything relating to the menopause, understanding your risk and your options for managing this is very individual. A good starting point is to book in for a health check at your GP practice. This looks at your height, weight and blood pressure, as well as checking blood tests for your cholesterol and blood sugar levels. And then inputting these into a risk calculator, allows you to see what your current risks are.

In women who choose to take or can take HRT, as well as helping with symptoms an added benefit is that this can also provide some cardiovascular protection. But this depends on when this is started. In women starting HRT under 60, or within 10 years of their periods stopping, then studies have shown a protective benefit. Most studies have not shown this outside of this window of time and the impact then, in line with British Menopause Society guidance, is thought to be a neutral one.

Read Dr Lindsey’s previous articles on QVC Stories:


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We understand there’s a lot of information out there on the menopause. You can read through the NICE guidance on menopause management, as well as the NHS overview on the menopause.