Your Heart and Menopause


Cardiovascular disease remains the leading cause of death for both men and women in the United States. What is cardiovascular disease exactly, and how can you reduce your risk? How does it impact women, especially when we reach menopausal age? Let’s cover all the bases.

What is cardiovascular disease?

Cardiovascular disease refers to many heart-related conditions. Coronary artery disease, heart attack, stroke, congestive heart failure, arrhythmia, peripheral artery disease, and high blood pressure all fall under this larger umbrella.

What are some of the signs?

Some of the most common signs of cardiovascular disease and a heart attack include:

  • Chest pain, tightness, or discomfort

  • Shortness of breath

  • Pain in the jaw, throat, neck, upper abdomen, or back

  • Pain, numbness, weakness, or a feeling of cold in your limbs

However, some symptoms can be unique to women. Even though chest pain is the most common, it’s not always severe enough for women to seek medical attention. Women should also look for symptoms like:

  • Feeling more fatigued than usual

  • Shortness of breath

  • Pain in one or both arms

  • Nausea or vomiting

  • Sweating out of the ordinary

  • Feeling lightheaded or dizzy

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What makes women more susceptible?

Cardiovascular disease is the #1 killer of women over 50 - so much so, that twice as many women die from it than cancer. And our risk increases after menopause. In fact, postmenopausal women have a relative risk for coronary artery disease 2.7 times as high as age-matched premenopausal women. Women who start their period before age 12, or who begin menopause before the age of 45, also have an increased risk.

Other factors that increase your risk include smoking, diabetes, depression and anxiety, stress, inactivity, complications during pregnancy, certain chemotherapy or cancer medications, and poor diet. One study also found that women who experienced more frequent daily hot flashes also had an increased risk, potentially due to their link to stiffening of arteries. Postmenopausal women are also more likely to experience something called broken heart syndrome, which is a medical diagnosis in which the heart muscle temporarily fails - usually after severe emotional stress.

Do hormones play a role?

These pesky hormones always seem to be influencing something. And yes, both the natural and therapeutic, changes in sex hormones after menopause appear to be a risk factor for cardiovascular disease.

During menopause, your body may naturally undergo some changes that influence your heart health. When your estrogen levels decrease, it’s common for your blood pressure to rise, your HDL (“good”) cholesterol to drop, and your triglycerides to increase. Lower estrogen can also bring insulin resistance, which can increase your risk for diabetes and, subsequently, cardiovascular disease. Menopausal women are also more likely to gain and maintain additional weight, which can put added stress on your heart.

According to a 2018 study published in the Journal of the American College of Cardiology, the higher testosterone/estradiol ratio present in postmenopausal women was associated with an increased risk for cardiovascular disease, coronary heart disease, and heart failure-related events. Having higher estradiol levels was associated with a reduced risk for coronary heart disease.

When it comes to the impact of hormone replacement therapy (HRT), the results are mixed. It used to be thought that HRT reduced risk, but a couple of large studies in the nineties started changing the conversation. The Heart and Estrogen/Progestin Replacement Study (HERS), of over 2,700 women, found a slightly increased risk among women who used estrogen and progestin combined therapy, whereas estrogen alone had no impact. Then there was the Women’s Health Initiative (WHI). This involved over 160,000 women and was the world’s largest clinical trial looking at various health interventions for mid-life women - including hormone therapy and cardiovascular disease risk. The combined estrogen/progestin piece of the WHI was halted in 2002 because it significantly increased risk. In 2004, the estrogen-only piece was also stopped because it was increasing risk for blood clots, stroke. It also was not reducing the risk for heart attack.

Regardless, disease risk always depends on many individual factors. Many medical professionals still believe the benefits of HRT outweigh the risks for those who need it. Women are advised to talk to their physician about their risk factors and make an informed decision about HRT.

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How can you protect yourself?

As with most chronic diseases, the best protection is prevention. Experts recommend choosing a healthy lifestyle, which includes regular physical activity - around 150 minutes of each week - and a nutrient dense diet. Focus on whole grains, fruits and vegetables, healthy fats and proteins, and minimize or eliminate processed, high sugar foods. The American Heart Association recommends eating more meals.

In 2018, The Study of Women's Health Across the Nation looked at the smoking, diet, and physical activity habits of 1,143 middle-aged women. Researchers found that healthy habits are associated with less subclinical atherosclerosis, a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls. As you may guess, the researchers concluded that making healthy choices is critical during the menopause transition (and before!).

Research that the head-heart connection is also a real thing. Stress, depression, and anxiety can be additional risk factors for cardiovascular disease. Engaging in self-care activities that support your mental health plays a big role in disease prevention.

A healthy lifestyle during the menopausal transition is associated with less subclinical atherosclerosis, underscoring that midlife is a critical window for cardiovascular prevention in women.
— Dr. Melissa Young

It’s never too late to help your heart

Your heart is the most important organ for survival, as well as leading a long and healthy life. So, take care of it! Understand your risk factors - both as an individual and as a female - and be aware of lifestyle changes you can make in the name of prevention. It’s never too late to start caring better for you. Check out my blog to learn about seven lifestyle changes you can make to reduce your risk of heart disease.

Whether cardiovascular disease is part of your life today, or you’re looking for ways to help prevent it, we’re here for you! Making small changes adds up. For more information and support for your heart health during menopause, join us at Lisa Health.

Dr. Melissa Young is board-certified in Internal Medicine and is a Certified Functional Medicine specialist through the Institute for Functional Medicine. She has completed a two-year Residential Integrative Medicine Fellowship with the Arizona Center for Integrative Medicine at the University of Arizona, Tucson, studying with Andrew Weil, a pioneer in the field of Integrative Medicine. Dr. Young practices Functional Medicine at the Center for Functional Medicine at Cleveland Clinic and specializes in women’s health.