Menopause is known to cause plenty of unpleasant symptoms, such as hot flashes, vaginal dryness, disrupted sleep, and mood changes. But what many women don’t know, and often aren’t told by their doctors until they’re in their 50s, 60s, and beyond, is that menopause—defined as the absence of a period for 12 consecutive months—is also a powerful driver of heart disease. 

Estrogen protects the heart

During the reproductive years, naturally high estrogen levels help keep the heart humming smoothly. Estrogen helps boost high-density lipoprotein (HDL, the heart-protective, “good” cholesterol) and decrease low-density lipoprotein (LDL, the “bad kind” of cholesterol). Estrogen keeps blood vessels and arteries supple, elastic, and dilated so blood can flow easily through them. It also absorbs free radicals, molecules in the blood that can damage the heart and other organs. For all these reasons and more, women in their 30s and 40s are less likely than men to be diagnosed with cardiovascular disease (CVD), also known as heart disease.

But in perimenopause, the eight to 10 years leading up to menopause, as well as during and after menopause itself, fluctuating and then decreasing hormone levels cause troubling changes that double a woman’s risk of heart disease.

An increase in cholesterol. As estrogen drops, LDL cholesterol rises. Not only that, but menopause seems to alter the way HDL works, turning this normally protective substance into an artery hardener.

Stiffer arteries. When arteries harden, the heart is forced to work harder to pump blood through the body. The harder the heart has to work, the more vulnerable it becomes. That stiffness accelerates in the year following a woman’s last menstrual period, according to a 2020 study published in Arteriosclerosis, Thrombosis, and Vascular Biology. This is especially true for African-American women.

A slowdown in metabolism. Estrogen helps regulate metabolism and healthy weight. When it goes down, the scale moves in the opposite direction. Many women in perimenopause and menopause notice this weight gain, which is difficult to reverse even with exercise and diet. Complicating matters, menopausal weight gain tends to accumulate around the belly, the worst kind of fat for your heart as it raises levels of triglycerides, artery-clogging fat that increases the risk of heart attack and stroke.

Preliminary research presented at the 2021 American Heart Association conference suggested that hitting menopause by age 40 increases the lifetime risk of developing coronary disease by 40 percent compared with women who didn’t go through early menopause. Coronary disease is a specific type of heart disease that occurs when plaque builds up in the arteries (atherosclerosis). This research did not include surgically-induced menopause, but other research indicates that heart disease risk doubles for women who have their ovaries removed at a young age.

This adds up to the fact that once a woman enters menopause, her heart disease risk equals a man’s. It is the No. 1 cause of death for American. women, responsible for one in every three female deaths.

Reduce Risk

Losing the cardioprotective effects of estrogen is a difficult, but not unbeatable, challenge. About 80 percent of heart disease cases can be avoided with strategic lifestyle changes. 

Follow the Mediterranean diet. This anti-inflammatory plant-based approach emphasizes produce, beans, whole grains, and heart-healthy fats like olive oil, nuts, seeds, and avocado. Small amounts of oily fish and chicken are included. Saturated fats are limited and trans fats are eliminated. Not only is the Mediterranean way of eating heart healthy, but it may also ease menopause symptoms such as hot flashes and night sweats.

Exercise regularly. Aim for 30 to 60 minutes of aerobic exercise most days of the week, alternating moderate-
intensity days with vigorous-intensity days. Add in two days of full-body strength training or resistance work a week and stretch whenever you can.

Ask your doctor about cholesterol medications. You may be a candidate for a statin, a class of cholesterol-
lowering drugs beneficial in people with coronary heart disease.

If you smoke, quit, especially if you’re considering hormone replacement therapy. Mixing the two significantly raises the risk of blood clots.

Be open with your doctor. Since your current physician likely isn’t the same one you had during your reproductive years, definitely share details of your pregnancy history, including whether you experienced high blood pressure (preeclampsia) or gestational diabetes. Both increase the risk of heart disease about 10 to 15 years after delivery. Let your doctor know if you experienced early menopause so he or she can help you create a plan for reducing various associated health risks.

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