Hot flashes, night sweats, difficulty sleeping, mood changes. They’re all changes synonymous with menopause. But there’s another symptom of menopause many women may not be aware of: increased risk of heart disease.
Most women experience menopause (the end of their monthly periods) in their late 40s or early to mid-50s. Certain menopause-related biological changes, including a decrease in estrogen production, can cause women to accumulate belly fat. The added weight can lead to abdominal obesity, a known risk factor of heart disease.
At the same time, as women age, they’re more likely to develop high blood pressure and have higher levels of LDL cholesterol, the so-called “bad” cholesterol. These factors can lead to coronary artery disease, which occurs when veins and arteries in the body harden and narrow due to excess plaque. Plaque is a buildup of cholesterol and other fatty deposits.
Together, these age- and menopause-related physical changes mean women face greater risks of a host of cardiovascular health concerns — including heart attack and stroke — once they reach the end of their reproductive cycle.
Estrogen as a Heart Protector
Research suggests estrogen helps promote heart health during women’s younger years. These estrogen-driven benefits partly explain why women generally have lower rates of heart disease than men — until they reach menopause.
“Estrogen has a lot of roles in our cardiovascular health,” says Erica Pivato, DO, a St. Elizabeth Healthcare cardiologist. “It lowers the bad cholesterol and raises the good cholesterol. It also enhances blood flow. And it acts as an antioxidant, meaning that it neutralizes toxic chemicals in the body that can cause heart disease.”
When women face declining estrogen during menopause, their levels of “bad” LDL tend to increase, while their “good” HDL levels tend to decrease. The buildup of “bad” cholesterol increases women’s risk of coronary artery disease, heart attack or stroke.
In fact, once women reach menopause, their rates of heart disease development quickly increase. Women essentially catch up to the rate found in men of the same age, recent American College of Cardiology research found.
Research also shows that when a woman experiences menopause matters in terms of cardiovascular risk. “Women have been shown to have an increased risk for cardiovascular disease in the future, the earlier menopause occurs for them,” Pivato explains.
Specifically, women who experience early menopause (before age 45) tend to have higher levels of heart-related disease later in life than those who experience menopause at age 50 or older.
Hormones and Heart Health
Estrogen replacement has long been a treatment for the bothersome symptoms of menopause, including hot flashes and night sweats. Some studies suggest that estrogen replacement therapy might reduce some women’s risk of developing cardiovascular disease following menopause. Other studies, however, found no significant cardiovascular benefits in women who underwent hormone replacement.
There are potential risks of estrogen replacement therapy. These risks include links to certain cancers, dementia, blood clots or stroke. Any woman interested in hormone replacement therapy should discuss such treatment with their doctor. It is important to carefully evaluate its risks and benefits.
Cardiovascular Red Flags
As women reach menopause and even perimenopause (a years-long transitional period leading up to menopause), they should be on the lookout for symptoms that could indicate a heart health problem.
Be prepared to call 911 for sudden signs of a heart attack or stroke, including:
- Chest pain.
- Confusion.
- Dizziness.
- Fatigue.
- Shortness of breath.
- Sudden numbness in the face, arm or leg.
In addition to these primary symptoms, “women are more likely to have associated symptoms such as nausea, vomiting, lightheadedness, dizziness, sudden profound fatigue or even breaking out into a cold sweat” when experiencing a heart attack,” Pivato says.
“Women are kind of our own worst enemies, unfortunately,” Pivato adds. “We’re more likely to wait to go get evaluated for chest discomfort. One study suggested women wait as long as 54 hours to seek treatment, versus 16 hours for men.”
Because of these delays, women as a whole tend to face poorer health outcomes after a heart attack than men, research has shown.
Staying Heart Healthy
Women of any age can take assertive steps to promote heart health, including:
If you’re approaching menopause, talk with your provider about specific changes you can make to keep your heart healthy.
Learn more about the unique challenges women face when it comes to heart health at Women and Heart Health.
