How Heart Disease Is Different After Menopause

A woman’s risk for cardiovascular disease – including heart attack and stroke – increases significantly after menopause. Why? Because of a significant reduction in the reproductive hormones estrogen and progesterone.

“Estrogen is a protective hormone for cardiovascular disease. That’s why, prior to menopause, women are less likely to have a heart attack than men of similar ages,” says University Hospitals OB/GYN, Corinne Bazella, MD.

Estrogen and progesterone do much more than simply control the female reproductive system. They affect other hormones, organs and body systems. With low estrogen, blood pressure, LDL (bad) cholesterol and blood sugar levels may increase, lean muscle mass may decrease and blood vessels may become less elastic. Heart palpitations (rapid, irregular, skipped or exaggerated heartbeats) can also begin during or after menopause. Beyond these factors, severe hot flashes and night sweats may indicate a higher cardiovascular risk.

“During and after the menopause transition, all of these hormonal and physical changes bring greatly increased cardiovascular risk,” says Ewa Gross-Sawicka, MD, PhD, an internal medicine physician at University Hospitals who has a special interest in heart disease in women.

Can Hormone Replacement Therapy (HRT) Help?

Recent studies have shown that HRT is protective for cardiovascular health if it is initiated within 10 years of menopause and the woman is healthy, with no cardiovascular risk factors. HRT is also an effective treatment for menopausal symptoms such as hot flashes, mood swings, vaginal dryness, brain fog and other problems.

“I provide hormone therapy to treat and prevent problems like osteoporosis, hot flashes, night sweats and brain fog due to menopause. The reduced cardiovascular risk is an added benefit,” explains Dr. Bazella. “Women who have high cardiovascular risk or current cardiovascular symptoms are not good candidates for hormone therapy even for their menopausal issues. When I provide hormone therapy, I prefer the transdermal (skin) patch to minimize the risk of blood clots.”

“Hormone therapy is not really indicated to reduce cardiovascular risk,” says Dr. Gross-Sawicka. “A small group of women who go through premature menopause – either naturally or surgically – may benefit from it for a short period of time. But in general, I don’t recommend it to reduce cardiovascular risk.”

Both experts agree that for HRT to be safe, a woman should have no cardiovascular risk factors (high blood pressure, high cholesterol, atherosclerosis, or a personal or family history of heart attack, stroke or blood clots), and should be within 10 years of menopause. Women should be open to new information, ask questions and be certain they understand the risks and benefits of their health status and treatments.

How to Reduce Menopause-Related CV Risk

“With today’s average life expectancy, a woman will spend about 40 percent of her life after menopause,” says Dr. Gross-Sawicka. “Since we know that heart disease is the #1 killer of women and cardiovascular risk begins with the menopausal transition and gradually worsens, we recommend women pursue a heart-healthy lifestyle prior to age 40.” Dr. Gross-Sawicka recommends that from the time of perimenopause, you should watch for weight gain – especially abdominal fat accumulation – and to reduce risk, stop smoking if you smoke. Your doctor should monitor your blood pressure, weight, cholesterol and glucose, and order other tests based on your symptoms and family history.

To reduce post-menopausal cardiovascular risk, the best advice is to follow the American Heart Association’s “Life’s Essential 8” guidelines. The guidelines include a heart-healthy diet, physical activity, no nicotine exposure, good quality sleep, weight management, and healthy cholesterol, blood pressure and blood sugar levels.

“Cardiovascular disease is 80 percent preventable,” says Dr. Gross-Sawicka. “Every woman who wants to enjoy a healthy life before and after menopause should make meeting those American Heart Association target metrics a priority.”

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The board-certified gynecologists, certified nurse practitioners and women’s behavioral health specialists at University Hospitals offer expert care, education and support for women throughout all stages of menopause.

Whatever your age or stage of life, prevention is the best medicine. That's why it's important to see your primary care provider for age-appropriate screenings and vaccinations that can prevent disease.