Menopause is a significant life transition that can affect various aspects of your health, particularly your cardiovascular (heart) health. Maintaining heart health during menopause is crucial. Cardiovascular disease (CVD) is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men.

"Menopause should be considered as a risk factor for the development of cardiovascular diseases (CVDs), which triggers a whole cascade of pathological changes in a woman’s body, including the development of arterial hypertension, dyslipidemia, abdominal obesity, insulin resistance, an increased sympathoadrenal tone, endothelial function disorders, and inflammatory vascular reactions.

CVD is known to be the leading cause of death among postmenopausal women associated with the loss of estrogenic protective effect on the cardiovascular system." (Siusiuka, et al, 2024)

Factors such as lifestyle, diet, and regular exercise play essential roles in managing your heart health during this time. Incorporating heart-healthy habits can positively influence how you feel during menopause.

The Role of Estrogen in Cardiovascular Health

Estrogen plays a vital role in maintaining heart health. It helps keep blood vessels flexible, which supports healthy blood flow. Lower estrogen levels during menopause can increase the risk of cardiovascular diseases.

Beginning in the perimenopausal years into menopause, the protective effects of estrogen steadily decline. This can lead to higher cholesterol levels, increased blood pressure, and a higher likelihood of arterial stiffness. Research shows that menopausal women face an increased risk of heart disease compared to premenopausal women.

Research findings underline the significance of the Menopausal Transition (MT) as a time of accelerating CVD risk, thereby emphasizing the importance of monitoring women's health during midlife, a critical window for implementing early intervention strategies to reduce CVD risk.

"The menopause transition contributes to increased cardiovascular disease risk in women, emphasizing the importance of monitoring their health during midlife for early intervention strategies." (Khoudary, S., et al, 2018)

Maintaining a healthy lifestyle during the Menopausal Transition (MT) is essential. I recommend all my patients focus on a balanced diet (optimal protein, fibre intake and low sodium intake), regular exercise (specifically resistance training and weights), and routine check-ups and regular screening for their blood work that includes cardiovascular markers, liver health, glucose and insulin as well as regular blood pressure monitoring. These actions can help manage heart health and mitigate risks associated with reduced estrogen levels.

Recognizing Early Menopause and It's Risks

Early menopause, defined as menopause before age 45, can raise your cardiovascular risk even more. Studies have found that women who experience early menopause are at a greater risk for heart disease and other cardiovascular issues as well as bone loss concerns.

"Women with premature menopause have a 33 % higher risk of heart failure and a 9 % higher risk of atrial fibrillation." (Siusiuka, et al, 2024)

Signs of a heart attack

The signs of a heart attack or cardiovascular event can present differently in women then the symptoms of a male. Common signs include:

• chest pain or discomfort,
• shortness of breath,
• nausea, and
• lightheadedness
• fatigue or discomfort in the back, jaw, or stomach.

Understanding the Link Between Menopause and Cardiovascular Disease (CVD)

• Heart Disease: The shift in hormones impacts blood vessel function and can lead to conditions like heart disease.
• High Blood Pressure: Many women develop hypertension post-menopause, which is a major risk factor for CVD. Diet and exercise play a role in health blood pressure. The "Daily Dietary Approaches to Stop Hypertension" diet (also known as the "DASH" diet) is the most studied diet for lowering hypertension. The NIH has a great 7 day diet plan I often tell patients to start with. You can find it here.
• Stroke: This risk escalates due to combined factors like high cholesterol and blood pressure. But also look at family history and medical history or use of certain medications that can increase risk.

Regular check-ups and lifestyle adjustments can enhance your cardiovascular health and lower the likelihood of serious cardiovascular events.

Lifestyle Modifications for Heart Disease Prevention in Menopausal Women

Making lifestyle changes can significantly reduce your risk of heart disease during menopause. Focusing on diet and exercise is vital, along with specific strategies tailored to address the challenges faced during this stage of life.

Understanding your body composition and the ratio of muscle versus fat is very important. Your scale weight can only give you one number.  I suggest also measuring your waist circumference and also your waist hip circumference to calculate your Waist Hip Ratio (WHR). High WHR indicated abdominal obesity and  is more common during menopause where women complain of the "meno-belly" and a risk factor for heart disease. Monitoring your waist circumference can help you assess your risk even more then your scale weight.

Keep a close eye on your blood pressure and cholesterol levels. Regular check-ups allow you to detect changes early and take action if needed.

The Mediterranean Diet 

A healthy diet plays a key role in heart health. Incorporate whole grains, fruits, and vegetables into your meals. These foods are rich in nutrients and fiber, which help lower cholesterol levels and promote good heart health. 

Limit red meat to once a week, and instead opt for poultry (chicken, turkey), fish, seafood, tofu, beans or lentils instead. Lean protein options are better for maintaining a healthy weight, which is important as obesity can increase the risk of heart disease.

For dairy products, choose low-fat options to support bone health without excess fat. Good options are: cottage cheese and greek yogurt which are also great sources of protein.

Monitoring portion sizes is crucial to manage body fat and avoid abdominal obesity, which can further impact heart health.

The most researched diet is the Mediterranean diet (MedDiet), abundant in minimally processed plant-based foods, rich in monounsaturated fat from extra virgin olive oil, but lower in saturated fat.

You can download my MED Diet checklist here.

Exercise and movement

Exercise and movement is equally important. Aim for a minimum of 150 minutes of moderate physical activity each week. Activities like walking, swimming, or cycling can help you maintain a healthy body composition. Of these 150 minutes a week, 3 of these weekly sessions needs to include resistance training and or weights.

Regular exercise helps control weight and reduces your risk of cardiovascular disease. If weight loss is a goal, incorporating up to 300 minutes a week is the recommendation. 

Manage your stress

During menopause, hormonal changes can affect your heart health. Understanding these changes can help you tailor your lifestyle choices.

Focus on managing stress through activities like yoga or meditation. High stress levels can contribute to heart disease, so finding ways to relax is essential.

Hormone Therapy and Cardiovascular Health

Hormone therapy can play a significant role in managing menopausal symptoms and protecting cardiovascular health. Estrogens are known to influence various factors related to heart health, including cholesterol levels and blood pressure.

Studies suggest that Hormone Replacement Therapy (HRT) might lower the risk of heart disease in some women, especially those who go into early menopause (menopause prior to age 45). However, it's crucial to discuss your personal health history with a healthcare provider.

Monitoring and Managing Cardiac Health

After menopause, regular monitoring of heart health becomes vital. You'll want to keep an eye on key indicators like blood pressure, cholesterol panel, liver function tests, insulin levels, kidney function tests and blood sugar levels. I also recommend my patients annually check their Vitamin D levels (25-hydroxy Vitamin D) as Vitamin D is an important pro-hormone that functions in many areas of the body.

Consider lifestyle changes as part of your management plan. A heart-healthy diet and regular exercise can significantly impact your overall well-being.

Annual check-ups with your primary healthcare provider will also ensure that any changes in your health are monitored and addressed. This proactive approach is essential for maintaining cardiovascular health during the menopause transition and in the post menopausal years.

If you would like to learn more about Dr. Amy's approach, you can book a free discovery call with her here.

Wishing you health,

Dr. Amy Tung, ND

Naturopathic Doctor

Menopause Society Certified Practitioner

References:

Colditz, G., Willett, W., Stampfer, M., Rosner, B., Speizer, F., & Hennekens, C. (1987). Menopause and the risk of coronary heart disease in women.. The New England journal of medicine, 316 18, 1105-10 . https://doi.org/10.1056/NEJM198704303161801.

Khoudary, S., Aggarwal, B., Beckie, T., Hodis, H., Johnson, A., Langer, R., Limacher, M., Manson, J., Stefanick, M., & Allison, M. (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.. Circulation, CIR0000000000000912 . https://doi.org/10.1161/CIR.0000000000000912.

Khoudary, S., & Thurston, R. (2018). Cardiovascular Implications of the Menopause Transition: Endogenous Sex Hormones and Vasomotor Symptoms.. Obstetrics and gynecology clinics of North America, 45 4, 641-661 . https://doi.org/10.1016/j.ogc.2018.07.006.

Siusiuka, V., Vizir, V., Serhienko, M., Demidenko, O., & Deinichenko, O. (2024). Perimenopause period and menopause: cardiovascular and metabolic risks. Zaporozhye Medical Journal. https://doi.org/10.14739/2310-1210.2024.5.303438.

Yoshida, Y., Chen, Z., Baudier, R., Krousel‐Wood, M., Anderson, A., Fonseca, V., & Mauvais-Jarvis, F. (2021). Early Menopause and Cardiovascular Disease Risk in Women With or Without Type 2 Diabetes: A Pooled Analysis of 9,374 Postmenopausal Women. Diabetes Care, 44, 2564 - 2572. https://doi.org/10.2337/dc21-1107.

Disclaimer:

The information in this blog is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health professional with any questions regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking treatment because of something you have read in this blog.

Individual results may vary, and the strategies discussed here are not guaranteed to work for everyone. This content does not create a patient-client relationship and should not be used as a replacement for personalized medical care.