How menopause increases your risk of heart disease

When your ovaries run out of viable eggs, your body stops producing high levels of the hormone oestrogen. The fall in oestrogen causes most of the symptoms of menopause, including hot flushes, night sweats and changes to your menstrual cycle.

Less well known is an increased cardiovascular risk. Here’s why, and what you can do to counteract it.

Oestrogen helps support heart health by keeping blood vessels flexible, supporting healthy cholesterol levels and reducing inflammation. As oestrogen levels decline, alongside ageing and other risk factors, the risk of fatty plaque building up in the arteries increases. This can narrow the arteries and raise the risk of heart attack and stroke.

Oestrogen levels usually start to fall before periods stop completely, so these changes can begin during perimenopause too.

Menopause is linked to several changes in the body that may increase the risk of heart disease.¹ These include:

• Weight gain: many women notice weight gain during and after menopause, particularly around the waist. Abdominal fat is linked with a higher risk of heart disease, type 2 diabetes, high blood pressure and stroke.
• High cholesterol: cholesterol levels may rise during and after menopause, increasing cardiovascular risk.
• Changes in insulin sensitivity and blood glucose regulation: menopause is associated with a higher risk of insulin resistance and raised blood glucose levels, which may increase the risk of type 2 diabetes and cardiovascular disease.
• A rise in blood pressure: oestrogen is thought to help support blood vessel function and healthy cholesterol levels. As levels decline, changes in cholesterol, blood vessel stiffness and inflammation may contribute to a higher risk of cardiovascular disease over time.

It’s easy to put small health issues down to menopause in general, but it’s important to keep your doctor informed if you experience any of these cardiovascular symptoms:²

• Racing heart or palpitations
• Shortness of breath, possibly with discomfort in your chest
• Aches and pains in your chest that feel like indigestion
• Pain or discomfort in the jaw, arms or back
• Extreme fatigue that doesn’t go away with rest.
• Anxiety and stress
• Insomnia

Perimenopause, the years before menopause, when blood pressure, cholesterol, and blood sugar levels start to change, present a window of opportunity to monitor and address your cardiovascular risk.

Healthier lifestyle choices will help to lower or maintain your blood pressure and cholesterol levels and can also help with more general menopause symptoms.³

• Maintain a healthy weight. Eating a balanced diet will help combat menopausal weight gain. Reduce your salt and saturated fat intake, eat more fruit and vegetables, swap fatty meats for lean options, fish or poultry, and swap white bread, rice and pasta for wholemeal versions.
  
  Note: During and after menopause, you should also boost your calcium intake to support bone strength. Good sources of calcium include milk and other dairy products, leafy green vegetables, pulses, beans and sardines.
• Get active. Exercise will not only improve your heart health, but it has also been shown to help with menopausal symptoms.⁴ Build exercise into your daily routine, whether it be a class you enjoy, or walking short journeys instead of using the car.
• Drink less alcohol. Excessive alcohol consumption is a big red flag for heart disease.⁵ Australian guidelines recommend no more than 10 standard drinks per week and no more than 4 in a single day.
  
  Reducing the amount you drink can also help with menopausal symptoms such as hot flushes, heart palpitations, and mood changes.⁶
• Don’t smoke. If you smoke, you are almost 3 times more likely to die from sudden cardiac death than people who don’t.⁷

Natural menopause before the age of 40 is known as premature menopause, and women who experience this face a 40 % higher lifetime risk of coronary heart disease.⁸ This is likely because the younger you are when you go through menopause, the more time you spend at a higher risk of coronary heart disease due to the fall in oestrogen levels.

Hormone replacement therapy (HRT) tops up the levels of oestrogen and progesterone.

It’s used to combat symptoms such as hot flushes, mood swings, and vaginal dryness. Some studies suggest HRT may reduce the risk of coronary artery disease⁹, while others indicate that it can actually increase the risk of stroke and blood clots.

HRT is not routinely used to prevent heart disease. It may be appropriate for managing menopause symptoms, and the risks and benefits depend on your age, health history and when treatment starts. You should discuss your own personal risks and benefits with your doctor.

The decision to prescribe HRT will be weighed up alongside other risk factors such as smoking, obesity, and family medical history.

Someone is hospitalised for a heart attack in Australia every 9 minutes, yet one in 5 of us don't know the warning signs.¹⁰

The most common signs of a heart attack are:

• Chest pain or discomfort that comes on suddenly and doesn’t go away. It may feel like pressure, squeezing or heaviness in your chest.
• Pain that may spread to either arm, or to your shoulders, neck, jaw, back or stomach.
• Feeling sick, sweaty, light-headed or short of breath.

If you think you’re having a heart attack, call 000 immediately. Follow the operator’s instructions while waiting for the ambulance.