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How Menopause Affects Your Heart

Menopause can wreak havoc on your body. Hot flashes, mood swings and sleepless nights are just a few of the symptoms women dread as they approach their 50s. 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 obstetrician and gynecologist Uma Ananth, MD, about the surprising effects of menopause on the heart and the steps you should take to protect yours.

Doctor using stethoscope to examine a woman's heart

Estrogen: The gender defender

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 when we think about heart disease, we tend to think about men,” says Ananth. “You don’t often hear about 40-year-old women having heart attacks; it’s something that’s more common among men.”

Ananth says experts believe the reason women tend not to have heart attacks before middle age is because 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).

“Menopause coincides with a sudden, dramatic decline in estrogen, which can lead to plaque formation, inflammation and hardening of the arteries in the heart.” says Ananth. “Ten years after menopause diagnosis, we see an increase in the incidence of heart disease in women.”

Woman checking her pulse with her finger and a wrist watch

Be proactive, not reactive

Ananth says the relationship between menopause, estrogen and heart health is complex because there could be confounding effects from other biological factors during menopause.

“We also see a remarkable increase in obesity, hypertension, insulin resistance and high cholesterol around menopause. 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.”

She says 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.

“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. Women can just have fatigue, shortness of breath, nausea or indigestion. Because of this, the diagnosis may be missed or misdiagnosed as depression or a thyroid disorder, which leads to increased mortality.”

Ananth recommends seeing your physician if you notice a sudden onset of these symptoms, and to ask if it could be a heart attack. “If a woman is between the ages of 55 and 60, I think it behooves us, as physicians, to ensure her symptoms are not cardiovascular-related.”

Closeup of someone taking a pill out of a medicine package

Seize 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 reduce the risk of cardiovascular mortality,” says Ananth. “When women take estrogen within 10 years of a menopause diagnosis, usually between the ages of 51 and 60, it has many benefits and fewer risks. We call this the window of opportunity.”

Ananth warns women not to wait too long to take estrogen if you are a candidate with no contraindications. “Once you are beyond the window of opportunity, taking estrogen increases 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.”

Ananth says the combination of a healthy lifestyle and a low dose of estrogen creates a win-win situation. “You’re treating menopausal symptoms, getting healthier and possibly preventing cardiovascular disease. Women worry about estrogen causing cancer, but heart disease kills more women. 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.