KEY TAKEAWAYS:
• Estrogen decline during menopause increases the risk of heart disease. The natural drop in estrogen removes important cardiovascular protection.
• Knowing your risk is important. Diabetes, high cholesterol, high blood pressure, smoking, pregnancy complications, early menopause, autoimmune diseases and family history can all increase risk for heart disease.
• Heart attack symptoms differ in women. Women may experience fatigue, shortness of breath or nausea, rather than classic chest pain.
• Lifestyle changes are the best defense. Regular exercise, heart-healthy eating and managing chronic conditions are essential.
• Hormone therapy has a “window of opportunity”. When started within 10 years of menopause, hormone therapy may provide cardiovascular benefits. After 10 years, hormone therapy may increase risk for stroke.
• Early detection saves lives. Regular check-ups and knowing your risk factors can help catch problems early.
SUMMARY:
Menopause significantly impacts heart health because of declining estrogen levels, which naturally protect the cardiovascular system. After menopause, women face increased risks of heart disease, making it crucial to recognize symptoms and take preventive steps, including maintaining heart-healthy lifestyle habits, understanding symptoms and exploring hormone therapy options. Managing heart health during menopause reduces cardiovascular risk and supports overall well-being.
Menopause can wreak havoc on your body. Hot flashes, mood swings and sleepless nights are just a few of the symptoms women experience during menopause. But most women aren’t aware of a more serious, sometimes silent symptom of menopause that can be fatal – the toll it takes on your heart.
We spoke with OhioHealth cardiologist Anne Albers, MD, about the surprising effects of menopause on the heart and the steps you should take to protect yours.
How Estrogen Protects Your Heart
Heart disease is the leading cause of death in the United States, claiming more lives each year than all forms of cancer, according to the American Heart Association. One in two women has heart disease, but people tend to think about men. You don’t often hear about 40-year-old women having heart attacks; it’s something that’s more common among men.
Experts believe the reason women tend not to have heart attacks before middle age is that they have higher levels of estrogen, a sex hormone with cardioprotective characteristics. Estrogen is an antioxidant and a vasodilator, so it helps prevent your veins and arteries from tightening and narrowing (although in some cases, it can increase the risk of blood clots – we’ll cover that later). Lower levels of estrogen are associated with rising levels of “bad” low density lipoprotein (LDL) cholesterol.
Menopause coincides with a sudden, dramatic decline in estrogen, which can lead to plaque formation, inflammation and hardening of the arteries in the heart. There tends to be an increase in the incidence of heart disease in women around year ten post-menopause. Women with diabetes do not show this protection and may have similar risk for heart disease to men even before menopause.
Protecting Your Heart During Menopause
The relationship between menopause, estrogen and heart health is complex, as there can be confounding effects from other biological factors during menopause.
There is often an increase in obesity, hypertension, insulin resistance and high cholesterol around menopause. However, it’s unclear whether these added risk factors, along with aging, contribute to women’s heart disease or whether the decline in estrogen alone is responsible.
Women should be proactive by maintaining a healthy weight through diet and exercise, limiting alcohol intake, not smoking and carefully managing chronic conditions, like diabetes and high blood pressure. But the most important thing you can do is know your heart disease risk and the symptoms of heart attack in women and openly discuss both with your physician. Consider tests for LDL cholesterol level, blood pressure and coronary artery calcium (CAC) screenings at age 45.
The presentation of heart attacks in women is different than in men. Men sweat, have chest pain, jaw pain or pain radiating toward their left arm, whereas women can just have fatigue, shortness of breath, nausea or indigestion. Symptoms are commonly described as chest tightness—you’re your bra feeling tighter than usual. Because of this, the diagnosis may be missed or misdiagnosed as depression or a thyroid disorder, which leads to increased mortality.
If you notice a sudden onset of these symptoms, it’s recommended to see your physician and to ask if it could be a heart attack. If your symptoms are severe or you notice a pattern, call 911.
Hormone Therapy and Heart Health: The Window of Opportunity
Another preventive treatment option for menopausal women to consider is estrogen therapy, which is commonly prescribed as a pill, but also available in many non-oral forms, such as a patch and gel.
While there is no consensus of medical opinion that estrogen should be prescribed solely to prevent heart disease, there is evidence from decades-long observational studies that hormone therapy may play a role in preventing heart disease and reducing the risk of cardiovascular mortality. Women who take estrogen within 10 years of a menopause diagnosis, usually between the ages of 51 and 60, experience many benefits and fewer risks, called the window of opportunity.
It’s important not to wait too long to take estrogen if you have a candidate with no contraindications, because once you are beyond the window of opportunity, taking estrogen may increase your risks. Plaque may build up in your arteries as you age, and the vasodilator qualities of estrogen can dislodge it, leading to a heart attack or blood clots.
The combination of a healthy lifestyle and a low dose of estrogen creates a win-win situation, as you’re treating menopausal symptoms, getting healthier and possibly preventing cardiovascular disease. Women often worry about estrogen causing cancer, but heart disease kills more women, and the benefits outweigh the risks for some women.
OhioHealth has many providers who can help you care for your heart and manage menopause. Find a doctor near you at OhioHealth.com.
Frequently Asked Questions
Q: At what age does menopause start affecting heart health?
A: Heart disease risk typically increases about 10 years after menopause begins, and cardiovascular changes can start during perimenopause.
Q: Can hormone therapy prevent heart attacks?
A: Hormone therapy may provide cardiovascular benefits when started within 10 years of menopause onset. Speak to your provider about what may work for you.
Q: How do I know if my symptoms are menopause-related or heart problems?
A: It is important to discuss any new or concerning symptoms with your healthcare provider, as these symptoms commonly overlap.
Q: What changes can I make during menopause for a healthy heart?
A: Focus on regular physical activity, eating fruits and vegetables, limiting processed foods, managing stress, taking medication for blood pressure of cholesterol, getting quality sleep and avoiding smoking all support heart health and help manage menopause symptoms
