Why does heart disease risk increase after menopause?
While heart disease risk increases for everyone as they age, symptoms may become more noticeable after you go through menopause. Menopause doesn't cause heart disease, but the risk factors may increase during this time in life. In addition, unhealthy lifestyle habits may take a tremendous toll on heart health as you age, especially after menopause.
Why is it important to understand the correlation between menopause and heart disease risk? Heart disease is the leading cause of death in women* (assigned female at birth) in the U.S., accounting for about 1 in 5 women's deaths.1 And an overall increase in heart attacks is seen about 10 years after menopause.2
The average age for menopause is between 51 and 54 years old. Studies have shown that individuals who experience menopause before the age of 40 ("early menopause"), either naturally or due to surgical removal of reproductive organs, are twice as likely to develop heart disease than those of the same age who haven't yet gone through menopause.3
How does estrogen protect your heart? By helping the arteries to be more flexible and strengthening their interior walls. This allows the arteries to relax and expand to accommodate blood flow. In addition to a drop in estrogen, your body goes through other changes when in menopause that may increase your risk for heart disease:
- Blood pressure levels may rise, increasing strain on your heart and causing risk for other medical conditions. (Ideal: Below 120/80 mmHg)
- Low-density lipoprotein (LDL) or "bad" cholesterol levels may increase. Too much bad cholesterol leads to a buildup in your arteries. (Ideal: Below 100 mg/dL)
- High-density lipoprotein (HDL) or "good" cholesterol levels may decrease. Good cholesterol helps prevent buildup in your arteries. (Ideal: 60 mg/dL or greater)
- Triglyceride levels may increase. This type of fat circulates in your blood but is stored as body fat. (Ideal: Below 150 mg/dL)
- Waist circumference may increase, which puts you at greater risk for obesity. (Ideal: Below 35 inches)
- Body fat may increase, which increases your risk for high blood sugar and diabetes. (Ideal levels are based on your height/weight ratio.)
How to lower heart disease risk before, during, and after menopause
Many individuals today live longer and have greater expectations for an active, healthy life into their senior years. While menopause is a natural aging process, taking a regular health inventory is a good idea to see where you can improve your habits. Maintaining good heart health is of the utmost importance to those who have gone through menopause, mainly because their heart disease risk is higher than during their premenopausal years. But you don't have to wait until menopause begins! These are good strategies for heart health at all stages of life.
- Get screened – Regular heart screenings are essential to understand your risk for heart disease and maintain good heart health. The AHA recommends checking your cholesterol every five years, blood glucose levels every three years, blood pressure during regular healthcare visits, waist circumference checks as needed, and weight during every regular healthcare visit.
- Exercise regularly – You should aim for at least 150 minutes of physical activity per week to help lower your risk of heart disease. Walking, cycling, dancing, and swimming are good low-impact aerobic exercises.
- Eat a healthy diet – A heart-healthy diet can improve your heart function, energy levels, and overall well-being. Make dietary choices that include fresh fruits and vegetables, whole grains, and low-fat protein. In addition, choose foods low in sodium (salt), cholesterol, sugar, and unhealthy fats.
- Reduce stress – Sometimes, after menopause, you may suffer from increased stress levels. Stress may affect behaviors and factors that increase heart disease risk: high blood pressure and cholesterol levels, smoking, physical inactivity, and overeating. But instead of getting depressed, try to embrace this time by eating right, exercising, and socializing with friends.
- Quit smoking – If you smoke, there's no better time to quit than today. Smoking may contribute to early menopause, increase the risk of blood clots, decrease the flexibility of arteries, and lower good cholesterol levels.
What about hormone replacement therapy?
Despite the benefits of estrogen for reducing perimenopausal vasomotor symptoms (like hot flashes), most medical providers do not recommend long-term postmenopausal hormone therapy to reduce the risk of heart disease or stroke.
Questions to ask your doctor about menopause and heart health
The following questions can help you talk to your doctor about menopause and heart health. Please print out or write down these questions and take them to your next doctor's appointment. Taking notes can help you remember your doctor's response when you get home.
- Can you discuss the most recent research about hormone therapy and its safety? How do the benefits and risks apply to my health needs?
- Should I undergo a screening to determine my risk for heart disease? How often should I be screened now that I have experienced menopause?
- What lifestyle changes would be helpful for me to reduce my future risk of heart disease?
- Can you identify any alternative therapies that might be helpful?
If you have additional questions, ask them. When you and your doctors are alerted to how menopause impacts your risk of heart disease, it can be addressed earlier in the disease process. You must share your health information and medical files with your gynecologist (OB/GYN), primary care providers, and (if applicable) cardiologists to ensure your care is coordinated. Ask your doctor, "Have we checked my heart health recently?" Identifying and treating heart disease sooner rather than later will work with your doctor to slow or reverse the disease process.
*The term “women” in the context of “women’s cardiovascular health” applies to individuals assigned female at birth (AFAB) who have a female biological reproductive system, which includes a vagina, uterus, ovaries, Fallopian tubes, accessory glands, and external genital organs.
*The term “men” in the context of “cardiovascular health” applies to individuals assigned male at birth (AMAB) who have a male biological reproductive system, which includes a penis, scrotum, testes, epididymis, vas deferens, prostate, and seminal vesicles.