As if the mood swings and hot flashes aren’t enough, postmenopausal women also have to deal with an increased risk for heart disease and heart attack, so we bring you the bottom line on menopause and heart disease.

Bottom Line/HEALTH:Dr. Suzanne, can you explain why it is that when hormones decline during menopause, our risks for heart disease suddenly skyrocket?
Dr. Suzanne Steinbaum:When women go into menopause, estrogen decreases, and estrogen is naturally protective to the arteries of the heart. The other thing that happens is that the LDL, the bad cholesterol, goes up, and the HDL, the good cholesterol, goes down. Those three things actually are what leads to heart disease in women who are postmenopausal, especially 10 years after they go into menopause.
Bottom Line:But the answer isn’t necessarily to just supplement estrogen, right?
Dr. Steinbaum:I wish it was that easy! It really depends on the woman, whether or not she has had a hysterectomy…whether she has a uterus, which makes a big difference in this scenario…and it also depends on her history of breast cancer. Also if it is right for her and her symptoms, there’s the possibility of bio-identical hormones, which have actually been shown to be a safer alternative, but this is one that you’re going to have to talk to your doctor about because each woman is an individual.
Bottom Line:What can older women do to reduce their risks for heart disease?
Dr. Steinbaum:What I always tell all women is train for menopause like you’re training for a marathon. It’s really about prevention. Again, exercise is one of the best ways to prevent the hot flashes and difficulty sleeping and actually the mood swings. Menopause, oftentimes, is really about these issues, but if you exercise, you’re not only preventing those things, you’re preventing heart disease. So really it comes down to diet and exercise and taking care of yourself.

The bottom line on postmenopausal women and heart disease is that exercise may be your best strategy. Nutrition matters, too, as does stress management. But take care of yourself, and put yourself first.