Women’s Heart Health and Menopause

Written by: Cameron Rosario
Medically reviewed by: Robert Philibert MD PhD

With age, a person’s risk for heart disease rises due to physiological changes within the body. However, when a woman reaches about the age of 50, the risk may be amplified as she transitions into the natural state of menopause within her cycle due to a drop in the hormone, estrogen.

It is important to note that menopause does not directly cause cardiovascular disease. Furthermore, there are numerous ways to reduce the negative effects associated with menopause that put women at a higher risk.

Estrogen

• During the onset of menopause, there are complex hormonal changes that occur; one of which is the decline in the natural hormone estrogen.
  • Estrogen along with progesterone are the two primary female sex hormones related to reproduction. It is primarily produced from a woman’s ovaries but can be produced in smaller amounts in the adrenal glands and fatty tissue.
  • There are three main types of estrogen that are produced:
    • Estradiol (E2): Prevalent in women at childbearing age (ages 12-51).
    • Estriol (E3): Prevalent in pregnant women.
    • Estrone (E1): The only estrogen found in women after menopause. It is considered the weakest of the three main types of estrogen.

Estrogen Induced Physiological Changes During Menopause

• Estrogen is commonly known for its function to bring about the physical and physiological changes that drive puberty. Some changes include the development of breasts, pubic hair, and menstruation. Some other functions of estrogen can greatly impact a woman’s cardiovascular health such as maintenance of cholesterol levels and blood pressure.
  1. Blood Pressure Increases:
     • Estrogen has a positive cardioprotective effect on the inner layer of the artery wall which maintains the flexibility of arterial walls to expand according to blood pressure.
     • As estrogen levels decrease, the age-related arterial wall stiffening process is accelerated. As a result, blood pressure rises, causing hypertension and postmenopausal women to experience higher blood pressures than men and premenopausal women.
       • According to the National Health and Nutrition Examination Survey (NHANES), hypertension (systolic blood pressure 140 mmHg and/or diastolic blood pressure 90 mmHg) is prevalent among 74% of menopausal women ages 55-64 and increases to 83.4% in women over the age of 75. This suggests a higher prevalence of hypertension in women in comparison to men due to the drop in estrogen levels in the body.
     • When estrogen levels drop, your heart and blood vessels become stiff and less elastic. Because of these changes, your blood pressure tends to rise. This elevated blood pressure, also referred to as hypertension, can place added strain on the heart.
  2. Higher Cholesterol Levels:
     • Estrogen acts on the liver to reduce the levels of harmful cholesterol, low-density lipoprotein (LDL), and increases the levels of good cholesterol, high-density lipoprotein (HDL), in the blood. With the change in levels, there is not enough HDL to remove LDL causing the cholesterol to accumulate on the blood vessel walls as deposits.
  3. Insulin Resistance:
     • Estrogen plays an important role in the metabolism and the optimization of insulin activity, the hormone that converts blood sugar and starch into energy.
     • When a woman’s estrogen levels decrease, they become less able to optimally use available insulin, t and may become insulin resistant.
       • For this reason, menopausal women may gain weight in their midsection and are at an increased risk of developing type-2 diabetes which, in turn, puts them at a higher risk for heart disease.

Common Symptoms of Heart Disease

Although menopause can be difficult to transition to, it is important to become cognizant of the symptoms that may indicate heart disease. Because some of these experiences are also experienced in people without serious illness, it is important to check in with your doctor to ensure these symptoms are not indicative of serious disease.

These symptoms of heart disease may include, but are not limited to:

• Palpitations: The unpleasant feeling of your heart pounding/racing in your chest, throat, or neck.
• Shortness of breath: Difficulty breathing.
• Pressure in the chest: The intense feeling of squeezing or dull pressure.
• Headaches: Strong tension in the head that may be felt in the shoulder and neck.
• Lightheadedness or dizziness: Feeling faint, weak, and unsteady.
• Jaw ache: The feeling of tenderness around the jaw.
• Swelling of the feet: The abnormal buildup of fluid in the ankles and feet.
• Difficulty lying flat: May feel as if fluid is pooling to the upper body.

How To Keep Your Heart Healthy After Menopause

After menopause, it is more important than ever  to take the necessary steps to maintain proper health. Though the reduction in estrogen can bring negative physiological changes, there are ways to slow down the development and process of these changes.

• Regular exercise: The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) advise at least 150 to 300 minutes of moderate-intensity physical activity (about 30 minutes a day).
• Good nutrition: The American Heart Association recommends following a dietary pattern that focuses on fruits, vegetables, whole grains, low-fat dairy products, and lean protein foods.
• Eliminating smoking: It is no surprise that smoking has negative effects on the body which includes an irregular heart rhythm, hardening of arteries, and the formation of plaque and blood clots. However, a study published in the journal of The North American Menopause Society (NAMS), found that smoking exacerbates the symptoms associated with decreases in serum estrogen. Additionally, former/non-smokers tended to live longer than women who continued to smoke.

Hormone Replacement Therapy ⎼ Can It Increase Heart Disease Risk?

Hormone replacement therapy (HRT) has been a popularized treatment program for women to compensate for estrogen loss through the intake of the hormones: estrogen and the synthetic form of progesterone, called progestin. In the late 1990’s, HRT was assumed to have potential in improving heart health due to estrogen being known to help younger women protect their body against heart disease. However, recent studies have suggested that long-term use of HRT may lead to a higher risk in developing heart attacks, strokes, and other serious diseases.

For this reason, the American Heart Association and U.S. The Food and Drug Administration has created guidelines which indicates that HRT should not be used as a long-term treatment for menopausal symptoms or with the purpose of preventing a heart attack or stroke.

Before being prescribed HRT, make sure to consult your healthcare provider to determine whether HRT is the right treatment route for you.

References:

1. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/menopause-and-heart-disease#:~:text=A%20decline%20in%20the%20natural,expand%20to%20accommodate%20blood%20flow.
2. https://www.everydayhealth.com/atrial-fibrillation/symptoms/eight-signs-of-heart-changes-during-menopause/
3. https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/estrogen
4. https://www.tandfonline.com/doi/abs/10.1080/13697130903004758
5. https://us.viveve.com/insulin-resistance-and-the-hormone-connection/
6. https://www.menopause.org/docs/default-source/2015/combined-effect-of-smoking-and-early-menopause.pdf
7. https://my.clevelandclinic.org/health/articles/16979-estrogen–hormones