How does menopause affect risk of heart disease?

Younger, premenopausal women are not immune to heart disease (and they do worse if they have it) - especially if they smoke or have diabetes - but they do have a lower risk of heart disease than men the same age. But unfortunately that advantage does not extend beyond menopause. A woman's LDL, or “bad,” cholesterol rises as much as 10 percent in the years before and after menopause begins - the time period that coincides with a significant drop in levels of estrogen.

• Estrogen replacement. It may seem logical that estrogen replacement therapies would offer the same benefit, but recent studies have found that is not the case. Estrogen replacement therapies do not seem to lower the risk of heart disease in women after menopause, and in fact, it may cause other problems. The Women's Health Initiative, a study by the National Institutes of Health, has raised serious concerns about the risks of hormones for postmenopausal women. Because of these findings, the U.S. Food and Drug Administration (FDA) requires a warning on products used for postmenopausal women that contain estrogen.
• Iron after menopause. Another reason researchers believe the risk of heart disease is lower in younger women is because they lose iron when they menstruate. That may initially seem like a bad thing, but after menopause, when women no longer lose that iron, it builds up in organs such as the heart and increases the risk of heart disease. If you are taking iron supplements, check with your doctor to make sure you should continue to take iron after menopause.
• Blood pressure after menopause. Watch for increases in blood pressure after menopause. Some studies have shown an increase of three times what it was before menopause. High blood pressure damages the heart and arteries over time and is a contributor to heart disease.
• Early menopause. Whether it occurs naturally or as a result of surgery, menopause before age 40 is associated with an increased risk for cardiovascular disease.

Prior to menopause, women are somewhat protected from heart attacks or plaque because estrogen helps prevent the buildup of plaque. It also lowers cholesterol. After menopause, women no longer have that protection.