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How does menopause affect women’s risk of heart disease?

Dr. Theodore D. Richards, MD
Cardiologist (Heart Specialist)

A decline in estrogen may be a factor in the increase of heart disease following menopause. Estrogen is believed to have a positive effect on the innermost layer of the artery walls because it helps keep blood vessels flexible. After menopause, blood pressure starts to go up. Also LDL or “bad” cholesterol tends to increase, HDL or “good” cholesterol tends to remain the same or in some cases go down. Triglycerides also tend to increase. The combination of these biological changes may be the reason we see an overall increase in heart attacks in women after menopause. The use of estrogen replacement is controversial, though, and should be discussed with your physician. Current recommendations are that if replacement is prescribed, it should be at the lowest dose possible to relieve menopausal symptoms.

Dr. Rovenia Brock, PhD
Nutrition & Dietetics Specialist

Your risk for heart disease escalates quickly as estrogen levels drop after menopause. Since recent reports have found hormone replacement therapy may do more harm than good when it comes to preventing postmenopausal heart disease, you'd do well to reduce your heart disease risk through diet and exercise. The Food and Drug Administration (FDA) recently approved a health claim that a diet including soy protein and low in saturated fat and cholesterol reduces heart disease risk. This claim, which can be found on the label of almost any food that contains soy protein, came as a result of a number of studies showing that 25 grams of soy protein a day could offer real benefits. 

Adopt a low-fat, high-fiber diet that includes a wide range of fresh fruits and vegetables, whole-grain breads and cereals, legumes (including soybeans), and nonfat dairy products. This can help you keep blood fat levels low and heart disease at bay. In addition, studies show that the sulfides found in garlic can reduce cholesterol and may make the blood less "sticky" and therefore less likely to form clots, which may provide additional protection for your heart.

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Women’s risk for heart disease climbs after menopause. In the recent past, women were prescribed hormone replacement therapy to restore estrogen levels, as it was theorized that women’s risk of heart disease increased because of the natural drop in estrogen during menopause. However, estrogen supplementation has since proven to have no effect on heart health, and combination therapies of estrogen and progesterone may actually increase the risk of heart attack or stroke.

  • So, if estrogen may not be the root cause of women’s increased risk for heart disease after menopause, what is behind it? Here are some factors that in combination may be behind heart disease risk increases in postmenopausal women:
  • Cholesterol. LDL, or bad, cholesterol rises as much as 10 percent in the years before and after menopause begins.
  • Iron after menopause. Postmenopausal women no longer lose iron when they menstruate. That iron builds up in organs such as the heart and increases the risk of heart disease. Women should check with a doctor to see if they 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.
  • 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, according to the Women's Heart Foundation.

Heart disease is the number one cause of death for women over 50, and risk goes up with menopause. More than half of the women that die after 50 have some form of heart disease. Heart disease accounts for more deaths in women than all cancers combined. Women need to know that heart disease is not just a man's disease. It is possible to improve heart health through a heart healthy diet and an active lifestyle.

There are some factors that can predict the likelihood that someone will get a disease, especially heart disease and certain types of cancer. Here are some numbers to noodle on. If a woman has been disease-free up to age 40, her remaining lifetime risk for developing any type of cardiovascular disease is 1 in 2. In contrast, her remaining lifetime risk of breast cancer is 1 in 8, and colon or lung cancer, 1 in 17. But it’s not just about numbers. It’s about you and your lifestyle, too. If you have been active as a young adult and have kept it up through middle age, you are less likely to develop heart disease. Eaten well your whole life too? Decrease your risk again. Avoided those nasty cigarettes or quit? Also a good way to avoid heart disease and cancer. Do you always drink in moderation? Great! Down your risk goes. What about sunscreen? Do you lather up even in the winter when it’s cloudy? What a superstar! So while physiologically there may be changes that increase your risk of developing heart disease or cancer, you can keep them in check, no matter how old you are, by living a healthy lifestyle.

Estrogen may play a protective role for your heart. On average, a woman's low-density lipoprotein (LDL) (bad) cholesterol climbs 10.5 points, or 9 percent, during her midlife change. While a woman's risk for heart disease increases after age 50, it may have less to do with menopause and more to do with getting older, explains Margery Gass, MD, former executive director of the North American Menopause Society (NAMS). "It's really a product of age and lifestyle," she says. However, hormonal changes during menopause can make it harder to maintain a healthy weight and may increase blood pressure—both of which are risk factors for heart disease.

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Patricia Geraghty, NP
Women's Health

The picture between heart disease and menopause is very complex and very dependent on the age of the woman when hormones are used. There is a decreased risk when hormones are used close to age of menopause. There is an increased risk when hormones are used when heart disease is already present. The use of hormones when there is a gap between the age of menopause and the initiation of hormones may also increase the risk of heart disease though the length of this gap has not been determined. Perhaps the most important information is that hormones are never recommended for heart health promotion. The evidence is strong that lifestyle is the most powerful prevention for heart disease: eat right, exercise, don't smoke and control blood pressure.

Women who don't have a lot of the risk factors or a genetic predisposition for heart disease may develop risk when their estrogen levels change, either through menopause or having had a hysterectomy, which causes women to go through menopause. If you don't have hormone replacement therapy, the lack of estrogen and hormone replacement can increase your risk of having heart disease.

That's why men get heart disease approximately 10 years earlier than women do. Women go through menopause and catch up to men 10 years later. In other words, their hormones protect them until menopause. Once they go through the menopause change and don't get on hormone replacement therapy, their risk catches up to men's. It basically means your hormone protection goes away, regardless of whether you go through a natural change or a surgical change in life.

Dr. Suzanne R. Steinbaum, DO
Cardiologist (Heart Specialist)

When menopause hits and estrogen levels decrease, a woman's risk for heart disease goes up, making lifestyle choices even more important. Watch cardiologist Suzanne Steinbaum, DO, explain how menopause and loss of estrogen impacts heart disease risk.

Heart disease is the number-one killer of women in America. As estrogen levels drop with menopause, women no longer have the same protection estrogen gives them from heart disease and high blood pressure. As a result, women's heart disease risks parallel those of men.

Donna Hill Howes, RN
Family Practitioner

The risk of heart disease increases for women after they experience menopause. Generally after the age of 50, women need to be aware of the added risks of heart disease and work toward reducing those risks. Other factors that increase the risk of heart disease in women are smoking, diabetes and high blood pressure.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.