Cardiovascular disease, (CVD, Heart Disease) kills more women over the age of 50 than all types of cancer combined. Before this age, (roughly when menopause occurs), women seem to be protected from CVD, and this was thought to be due to female hormones.
During menopause, your ovaries “first slow down, then shut down” production of oestrogen & progesterone, causing a hormone deficiency state. All tissues sensitive to these hormones have to adapt, and the process can cause unpleasant effects like hot flushes and depression. It is at roughly this time that a woman’s risk of heart disease seems to increase drastically.
But is this all due to menopause? What can be done to improve the situation?
Latest research shows that there is only a mild increase in CVD mortality at the time of menopause, and that it seems to approach the death rate of same-aged men mainly because the CVD death rate for men starts declining at that age. But even this mild increase is significant. And there is still no good explanation for why the CVD death rate for women is increasing while that for men is decreasing.
We now know that some of the traditional risk factors for heart disease such as smoking, high blood pressure, high blood triglycerides, diabetes, and obesity pose a greater risk for women than they do for men, and that menopause makes it worse.
Smoking, eg. triples a man’s risk of a heart attack, but for women it increases SIX-FOLD. After age 45, more women develop high blood pressure than do men, regardless of their hormone status. Diabetes and obesity in women are also greater CVD risks than in men.
Consensus opinion these days is that menopause increases CVD risk significantly only in those women who already have these risk factors present before their menopause. (Women not at risk of CVD before menopause only have a slight increase in CVD risk.)
One menopausal change has been identified: there is an increase in total blood cholesterol, which becomes predominantly LDL-cholesterol (the “bad” cholesterol), and a decrease in the heart-friendly HDL. This, together with raised blood pressure and blood triglycerides, can lead to hardened, cholesterol-laden arteries, a condition called atherosclerosis. And it is this atherosclerosis which in turn leads to heart attacks and strokes. We now know that Hormone Replacement Therapy (HRT) alone does NOT provide protection against CVD, though there is some benefit if HRT is begun very soon after menopause starts.
THE BOTTOM LINE
If you have led a heart-healthy lifestyle from a young age, menopause will add very little to your CVD risk. But even if you only start with better lifestyle choices at the time of menopause you will still benefit. HRT will, not harm you, if used in the recommended way to relieve uncomfortable menopausal symptoms, but by itself will not protect your from CVD. For this, long-term lifestyle changes are needed. Many homeopathic or “natural” remedies offer some relief of menopausal symptoms, but none is heart-protective.
With HRT, the once-feared “change of life” can become something of a non-event, freeing you to make a fresh start, and allowing you to concentrate on the more important health issues. Correct eating habits, moderate exercise and attention to your physical appearance can make this a time to be enjoyed.