Menopause and your heart

Does menopause increase the risk of heart disease?

Women tend to develop heart disease later in life than men – largely because they have been protected by the hormone oestrogen, which also plays a crucial role in reproduction.

But, during menopause, which most commonly happens to women aged between 45 and 55, the body starts to produce less of this hormone. Oestrogen helps to relax and dilate blood vessels, reduce inflammation, and improve cholesterol profiles.

The decrease in oestrogen levels, which occurs during menopause, can contribute to a higher risk of heart disease.

Menopause can affect the body in several ways that impact your heart health, including:

Changes in cholesterol levels

Menopause can lead to unfavourable changes in cholesterol levels. It is common for women to experience an increase in low-density lipoprotein (LDL) cholesterol (often referred to as 'bad' cholesterol) and a decrease in high-density lipoprotein (HDL) cholesterol (often referred to as 'good' cholesterol). These changes can increase the risk of atherosclerosis and heart disease.

Increased blood pressure

Menopause can be associated with increased blood pressure. Elevated blood pressure is a risk factor for heart disease.

Weight gain

Many women may gain weight during and after menopause due to hormonal changes, which can contribute to heart health issues. Weight gain can also be associated with lifestyle changes – for example, engaging in less exercise. Muscle mass density also decreases with age, which can affect the metabolism by slowing down the rate at which the body burns calories. Excess body weight, especially around the abdomen, is a risk factor for heart disease.

Increased risk of diabetes

The risk of developing type 2 diabetes increases with age and is further influenced by hormonal changes associated with menopause. Diabetes is a significant risk factor for heart disease.

Changes in blood vessel function

The decline in oestrogen levels can lead to changes in blood vessel function, including reduced elasticity and an increased tendency for arteries to constrict. These changes can contribute to hypertension and reduced blood flow to the heart.

Greater risk of metabolic syndrome

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, including obesity, high blood pressure, high blood sugar, and abnormal cholesterol levels. Menopausal women may be at an increased risk of developing metabolic syndrome.

Increased risk of Spontaneous Coronary Artery Dissection

SCAD heart attacks most commonly affect women aged 42-52 (a key time for menopause) and also those during pregnancy – both times where big hormonal changes are taking place. While genetics are thought to play a big role in the risk of having a SCAD heart attack, it’s also thought to be affected by changes in hormone levels.

The Institute’s scientists are undertaking vital research into the causes of SCAD but with SCAD often affecting younger and healthy women, it’s vital that anyone who experiences any symptoms associated with heart attack should seek medical treatment immediately.

Less sleep

The menopausal decline of oestrogen also affects sleeping patterns, especially in the peri-menopausal stage. It can cause night sweats and insomnia. Research has shown that poor sleeping patterns lead to an increased risk of developing heart disease. Aim to get around seven to nine hours a night.

What can you do to lessen your risk of developing heart disease during menopause?

It's important for women going through menopause to take proactive steps to maintain and improve their heart health, including:

• Regular exercise: Regular physical activity can help control weight, improve cardiovascular health, and lower blood pressure.
• Following a heart-healthy diet: Eating a balanced diet that is low in saturated and trans fats, cholesterol, and sodium can help manage cholesterol levels and blood pressure. For inspiration, consider the Mediterranean diet.
• Monitoring cholesterol levels: Heart health checks are free for anyone aged over 45, or over 30 if from a First Nations background. These yearly checks, which include blood pressure, blood sugar and cholesterol testing, are vital for maintaining good heart health.
• Managing blood pressure: Keeping blood pressure within a healthy range through lifestyle changes or medication, if necessary, is crucial.
• A healthy weight: Maintaining a healthy weight or losing excess weight can help reduce the risk of heart disease. You might want to consider eating a little less (reducing your calories by up to 200 calories a day) to mitigate the slowdown in metabolism.
• Cease smoking: If you smoke or vape, quitting is one of the most significant steps you can take to improve heart health.
• Cut back on alcohol: Alcohol can be a significant factor in weight gain. It can also cause blood vessels to dilate, leading to increased body temperature and sweating, which can affect already disrupted sleep and hot flushing.
• Try to get a good night's sleep: The American Heart Association recently added sleep as one of its 'Life’s Essential 8' for overall heart health. There are several steps you can take to try and improve your sleep patterns, but sleeping in a coolish room could prove particularly helpful.

Can Hormone Replacement Therapy (HRT) reduce the risk of developing heart disease?

Hormone replacement therapy (HRT) is a medical treatment that involves replacing the hormones oestrogen and progesterone that the body no longer produces in adequate amounts.

HRT can alleviate symptoms associated with menopause, such as hot flashes, mood swings, and vaginal dryness. Some studies have suggested that HRT may have a protective effect by reducing the risk of coronary artery disease and atherosclerosis. However, other studies have shown that HRT can increase the rates of breast cancer, stroke, and blood clots. Therefore, HRT is not typically prescribed for protective effects against heart disease, but rather, is reserved for women with severe or refractory peri-menopausal symptoms. Therefore, the decision to use HRT should be made after a thorough discussion with a healthcare provider, as it comes with its own risks and benefits.

Is HRT safe to take if I have heart disease?

The safety of HRT varies from person to person, depending on factors such as age, the type and duration of HRT, and the presence of other risk factors for heart disease, like smoking, obesity, or a family history of heart problems.

It's essential to consult with your doctor, preferably a cardiologist, to discuss the potential risks and benefits of HRT in your situation.

Are there specific heart health screenings recommended for menopausal women?

There are no specific heart health screenings for women going through menopause but annual Medicare funded heart health checks are free to anyone aged 45 or over 30 if you are from a First Nations background.

Ideally, we should all be keeping an eye on our blood pressure, blood sugar and cholesterol levels so asking your GP to perform these checks is recommended.

And of course, once you reach menopause and your risk of heart disease starts to increase, it’s even more vital to have an annual heart health check.