When most women think about menopause, they think about pesky symptoms like hot flashes, mood swings and the dreaded weight gain. But there’s another, more dangerous side effect that’s often overlooked.
“Women going through menopause are at greater risk of developing heart disease,” explains Sangeeta Sinha, MD, an OBGYN at StoneSprings OB/GYN in Dulles, Virginia. This fact helps explain why heart disease is the leading cause of death for women over the age of 65.
But heart disease doesn’t have to be your destiny, notes Dr. Sinha. Here’s what women of a certain age need to know.
Why menopause puts you at greater risk
The average woman goes through menopause at age 51, according to the North American Menopause Society, although starting it any time in your 40s or 50s is considered normal. Meanwhile, an overall increase in heart attack rate is observed in women about a decade after going through the change.
“It seems that the reproductive hormones estrogen and progesterone—both of which decline during menopause—are protective against heart disease,” explains Sinha. Estrogen, for example, helps to keep blood vessels flexible so that they can more easily open up for blood flow. The hormone has also been shown to help keep levels of HDL (aka, “good cholesterol”) up and levels of LDL (“bad cholesterol”) low.
More evidence estrogen may be protective: other research has found that early menopause raises risk of heart disease.
One 2016 Dutch analysis of more than 300,000 women published in JAMA Cardiology found that risk of heart disease was about fifty percent greater for women who were younger than 45 when menopause began compared to those who went through menopause later in life.
There are other linkages between menopause and heart disease, as well.
The average woman gains about 6.4 pounds as she goes through the menopausal transition in her 40s, according to a study published in The Journal of Clinical Endocrinology & Metabolism. And it’s a trend that doesn’t slow down, either.
Women continue to put on about a pound and a half each year in their 50s and 60s, according to a review published in 2017 in the journal Mayo Clinic Proceedings. Carrying excess weight can contribute to higher levels of LDL and triglycerides and lower levels of HDL.
“Women also become more susceptible to weight gain around their abdomens after menopause, which has also been linked to an increased risk of heart disease,” notes Sinha.
How to reduce your risk
Heart disease is by no means inevitable for women in their 50s and beyond. Taking some preventive steps can help lower your risk and improve your overall health.
Stay up to date on screenings. Once you’ve gone through menopause, an annual visit with your primary care provider is a must, says Sinha. You should also follow these basic guidelines from the American Heart Association:
- Blood pressure checked at least every two years
- Cholesterol checked at least every five years
- Blood glucose levels checked every three years
- BMI (a measure of body fat based on height and weight) checked during every healthcare visit
If you have existing heart risk factors—such as being overweight, having type 2 diabetes, or having high blood pressure or elevated cholesterol levels—you’ll need to speak to your physician about getting screened even more frequently.
Lose weight. If you’re carrying around extra girth, shedding it will reduce your risk of heart disease and it may even improve menopausal symptoms.
One small study published in 2015 in the medical journal Menopause of 40 overweight and obese women found that those who went through a six-month weight loss program reported improvements in their hot flashes.
Stop being a couch potato. Women who are sedentary not only raise their risk for heart disease, they are about 28 percent more likely to have severe menopausal symptoms than active women, according to a 2016 study published in Menopause.
The American Heart Association recommends getting 150 minutes of moderate physical activity every week—the equivalent of brisk walking for 30 minutes most days of the week.
The Sharecare app (available for iOS and Android) can log your steps to help you stay on track.
Eat a heart healthy diet. The Mediterranean diet—with its emphasis on plant-based foods such as fruits, veggies, whole grains, legumes, nuts and healthy fats such as olive oil—has been shown to reduce risk of heart disease, says Sinha.
One study published in 2013 in The American Journal of Clinical Nutrition looking at roughly 6,000 Australian women found that those who followed this type of eating pattern reported fewer menopausal symptoms, including hot flashes.
Quit smoking. It’s a no-brainer, but if you smoke, it’s always a good time—and never too late—to drop the habit. Not only does smoking lower levels of HDL, harden the arteries and increase your risk of blood clots, it may also contribute to an earlier onset of menopause.
Be cautious with hormone replacement therapy. The American Heart Association doesn’t recommend taking hormone replacement therapy (HRT) to prevent heart disease. A 2013 study published in JAMA found that taking it may actually slightly increase risk of heart disease among older women.
“If I do prescribe it for a patient who is really miserable from menopause symptoms, I usually do it right after menopause, and for no more than five years total,” says Sinha. “We really want to see women off of it by their mid to late 50s.”
If you have a history of other heart disease risk factors—such as being overweight, smoking or type 2 diabetes—you also may not be a good candidate for HRT.
