Cardiovascular disease (CVD) is the leading cause of death in women, accounting for more than 20% of all deaths. The most common forms of CVD in women are coronary artery disease, arrhythmia, and heart failure. Although many research gaps remain, we know that CVD risk rises significantly during menopause. Within a few years of menopause, women completely close the risk gap that they had when they were younger compared with men. Many factors which indicate an increased CVD risk (like changes in lipid profile, vascular stiffness, metabolic parameters, advanced glycation end products, and oxidative stress) can appear suddenly during perimenopause.
Correlations exist between many of the symptoms of menopause and an increased risk of CVD. Menopause-related hot flashes and night sweats have been linked to a greater risk for high blood pressure and other CVD risk factors. Research also shows that depression during perimenopause is strongly linked to higher CVD risk. In addition, women who experience menopause before age 45 are at higher risk of CVD and death than those who enter menopause after age 50. Sleep disturbance, a common complaint during menopause, also is linked to a greater risk of CVD. Diabetes is a risk factor for CVD in women, and some studies suggest a link between menopause and higher risk of type 2 diabetes.
Some researchers have hypothesized that low sex hormones during menopause may be, either directly or indirectly, the cause of the increased CVD risk, but prescribing menopause hormone therapy (MHT) to prevent CVD remains controversial since some studies have reported benefits while others have reported concerns (e.g., a small increase in risk of blood clots in women taking MHT.) Currently, The Menopause Society, the American College of Cardiology, and the American Heart Association recommend against using menopause hormone therapy (MHT) to prevent heart disease until further research has been completed. However, as described above, hot flashes appear to be associated with higher CVD risk, and MHT is recommended for the treatment of hot flashes (also for vaginal atrophy and to prevent osteoporosis) so reduction of hot flash symptoms might lower CVD risk for some women. Talk with your doctor about whether MHT is right for you. Women with known CVD or at high risk of CVD should discuss with their doctor non-hormonal treatments as an alternative to MHT to treat their menopausal hot flashes and night sweats.
Besides menopause, other factors correlated with an increased CVD risk include a known history of CVD, high body mass index (BMI), low physical activity, smoking, poor diet, high cholesterol, high blood pressure, and high fasting glucose (diabetes). You can calculate your CVD your 10-year risk for CVD here. Talk with your doctor about your risk and what it means for you.
Research suggests the most effective ways to prevent heart disease include not smoking, being physically active, eating a healthy diet, reducing alcohol consumption, keeping a healthy weight, getting enough sleep, and keeping cholesterol, blood pressure and blood glucose levels under control. There are medical treatments (e.g., statins) that your doctor might recommend to prevent CVD, depending on your risk factors. The most effective way to prevent cardiovascular disease is to increase your physical activity. It reduces the risk for heart disease, stroke, high blood pressure, Type 2 diabetes, and cancer, and it improves bone health, weight control, sleep, and mental health. No pill or other treatment comes close to being as good for your health as regular physical activity.
In addition to increased risk of CVD, the surging and crashing of estrogen levels during perimenopause can cause heart palpitations (different than arrhythmias described above) in some women. The palpitations are typically not harmful but can cause significant discomfort and anxiety in the women experiencing them. Your heart can beat much faster, miss a beat, or the beating can be felt in your chest or neck. Other factors that can cause or worsen palpitations include stress, caffeine, alcohol, asthma, thyroid issues, low blood sugar, low blood pressure, and dehydration; therefore, you should limit your intake of caffeine and alcohol, eat a healthy diet, stay hydrated, use mindfulness and breathwork to decrease your stress, and take your medications as prescribed. If the palpitations last more than a few minutes or get considerably more often or severe, you should see your doctor. If you experience shortness of breath, chest pain or discomfort, sweating or feel dizzy or faint along with palpitations, you should call 911 and seek help at the closest emergency medical facility.
Cardiovascular disease risk increases, sometimes dramatically, for women during menopause. It's important that menopausal women take active measures to decrease their risk with lifestyle adjustments and by having regular conversations with their doctor about risk and treatments. Additionally, make sure you and your family and friends know the warning signs for heart attack in women since they differ from those experienced by men. The American Heart Association recommends that women immediately call 911 if they experience:
Uncomfortable pressure, squeezing, fullness or pain in the center of your chest that lasts more than a few minutes, or goes away and comes back. As with men, the most common heart attack symptom for women is chest pain or discomfort.
Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath with or without chest discomfort.
Breaking out in a cold sweat, nausea, vomiting, or lightheadedness.
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