February is American Heart Month and the first Friday of February is Go Red for Women Day to raise awareness of women’s cardiovascular health risks. Since 2004, the American Heart Association’s signature women's initiative, Go Red for Women, has addressed the awareness and clinical care gaps of women’s greatest health threat, cardiovascular disease (CVD). As America ages, a significant portion of this message is targeted at women entering their late 40s and early 50s who are experiencing menopause and don’t realize their CVD risks are automatically rising with this life transition.
Cardiovascular disease claims more women’s lives than all forms of cancer combined. According to a 2022 American Heart Association Presidential Advisory, investing in and improving research, awareness, and equity in women’s heart health are critical for the health and well-being of women. Women, who typically develop CVD several years later than men, are largely unaware of their risk for heart disease.
Menopause is a normal part of aging that occurs when a woman's menstrual periods stop. It's usually a natural change that happens between the ages of 45 and 55. Menopause occurs when the ovaries stop releasing eggs for fertilization. In a woman’s 40s, menstrual periods begin to change and may become longer or shorter, heavier or lighter, and more or less frequent. On average, by age 51, the ovaries stop releasing eggs, and a woman has no more periods. While menopause itself is not a direct cause of heart problems, the hormonal changes associated with menopause can have various impacts on heart health.
Changes in Cholesterol Levels: Throughout the period before, during, and after menopause, also known as the menopause transition, midlife women are at a heightened risk for cardiovascular disease with changes in their lipid levels, such as a sharp increase in LDL-C or “bad” cholesterol. A study published in the Journal of Clinical Lipidology identified a link between a lesser-known hormone called anti-Müllerian hormone (AMH) and lipid, or cholesterol, levels in midlife women. Through this study, it was found that, while a high estrogen level was important for lowering LDL-C or bad cholesterol levels, high AMH was responsible for lowering HDL-C or good cholesterol. This means that as women traverse the menopause transition, they lose estrogen and AMH, increasing both their bad and good cholesterol levels.
Increased Risk of Heart Disease: After menopause, the risk of heart disease tends to increase. Estrogen, a hormone that decreases during menopause, is believed to have a protective effect on the cardiovascular system, as it has an anti-inflammatory effect on the lining of the blood vessels and increases the levels of chemicals that protect your heart and the blood vessels. The decline in estrogen levels may contribute to an elevated risk of heart disease.
Changes in Blood Vessels: Hormonal changes during menopause can affect the flexibility and function of blood vessels as arteries get thicker and stiffer and become more vulnerable to disease. This can lead to an increase in blood pressure and contribute to cardiovascular issues.
Weight Gain: Many women experience weight gain during and after menopause, along with changes in body composition, particularly an increase in abdominal fat. Excess abdominal fat is part of a cluster of symptoms that become more common after menopause, known as metabolic syndrome. It is when a person has at least three of the following: abdominal obesity; high triglycerides; low "good" HDL cholesterol; high blood pressure or high blood sugar all of which contribute to cardiovascular issues.
Metabolic Changes: Menopause is often accompanied by changes in metabolism. Insulin sensitivity may decrease, increasing the risk of diabetes, which is itself a risk factor for heart disease.
Effects on Blood Clotting: Estrogen has an influence on blood clotting factors. Reduced estrogen levels during menopause may affect the balance of clotting factors in the blood, potentially increasing the risk of blood clots and related cardiovascular events.
Increased amount of fat around the heart: A higher volume of a certain type of fat surrounding the heart is significantly associated with a higher risk of heart disease in women after menopause and women with lower levels of estrogen at midlife, according to research led by the University of Pittsburgh Graduate School of Public Health. The findings revealed a previously unknown, menopause-specific indicator of heart disease risk.
Problems sleeping: Sleep problems during and after menopause are linked to heart health risks. Consistently getting a good night’s sleep is one of the most beneficial things you can do for the health of your mind and body. And it’s particularly important for your heart, as during normal sleep, your blood pressure goes down. Having sleep problems means your blood pressure stays higher for a longer period of time.
Hot flashes and night sweats: The common gripes of hot flashes and night sweats most women going through the menopausal transition phase have been linked to a greater risk for high blood pressure and other cardiovascular risk factors.
It's important to note that individual experiences can vary, and not all women will experience the same impact on heart health during and after menopause.
Heart-Related Symptoms Experienced During Menopausal Transition Phases
Many women report during perimenopause and menopause that they become particularly aware of their heart beating and that their heart rate can feel irregular or particularly fast. This sensation of the heartbeat being more noticeable or beating irregularly or fast is called ‘palpitations’. Heart palpitations, which can last from a few seconds to a few minutes can coincide with a hot flush or a night sweats, a dizzy spell, or happen on their own.
Palpitations can be due to changing or declining levels of estrogen, which can affect the pathways in your heart through which electrical impulses travel. While they can feel alarming, in most cases they are usually harmless.
Prevention Prior to Menopause
Women would benefit from intensifying cardiovascular prevention efforts in the years leading up to menopause. The lifestyle changes driving prevention efforts are well-known to those who are sensitive to heart health as well as overall general health. They are the usual suspects: not smoking, being physically active, eating a healthy diet, maintaining a healthy weight, getting enough sleep, and keeping cholesterol, blood pressure, and blood glucose levels under control. Doctors typically agree the most impactful preventive advice is increasing physical activity because it can affect multiple heart risks – heart disease, stroke, high blood pressure, Type 2 diabetes, and cancer. Additionally, physical exercise improves bone health, weight control, sleep, and mental health. While it's never too late to add or increase physical activity levels the earlier you do it in life, the greater the health benefits. Also, maintaining good habits is easier than reversing bad ones.
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