Early Menopause Does Not Increase Your Risk of Heart Disease, Study Finds – Everyday Health

Posted: February 29, 2020 at 8:45 am

A new study upends the conventional belief that women who experience early menopause (45 years old or younger) have more cardiovascular health issues later on than women who develop menopause closer to the normal age. The study, published in February 2020 in the journal Heart, found that women who go through menopause at an earlier age dont later have more troublesome blood pressure levels, blood cholesterol, or other traditional heart disease risk factors compared with women who go through menopause later in life.

Doctors had previously assumed the premature cardiovascular deaths in these women were likely caused by the increase in traditional risk factors, such as weight gain, that often happen as women go through the menopausal transition and estrogen levels drop, says Tomas Ayala, MD, a board-certified cardiologist at the heart center at Mercy Medical Center in Baltimore, who was not involved in the study.

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The study, conducted by researchers at British medical centers, looked at females in Britains comprehensive UK Medical Research Council National Survey of Health and Development, which has followed participants over many years.

In roughly 1,000 women they were able to track the numbers for their blood pressure, unhealthy blood fats, body mass index (BMI), fasting blood glucose, and waist circumference (an indicator of the most dangerous fat around the abdominal organs) from midlife or even earlier, through age 69.

What they found was that by age 69, women who had gone through early menopause whether naturally or from surgery did not have unhealthier levels of these markers than women who entered the change later.

Our findings suggest that the impact of timing and type of period cessation on conventional cardiovascular disease intermediates from midlife is likely to be small, the authors conclude.

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Still, all women have a higher risk of heart disease once they reach menopause and lose the bulk of their estrogen. The clock starts ticking at menopause for increased cardiovascular disease risk, Dr. Ayala says. Thats why all women of menopausal age need to take heart disease seriously, he says.

A womans cardiovascular system is hugely impacted by the loss of ovarian hormones, agrees Felice Gersh, MD, a board-certified gynecologist and integrative medicine physician in Irvine, California, and a consultative faculty member at the University of Arizona College of Medicine. Dr. Gersh, who cowrote an editorial that accompanied the study, notes that disease and death from heart issues start happening as early as womens fifties and sixties, not only in older ages.

There are numerous theories about how estrogen in premenopausal women helps the heart, but none are proven. Most have to do with the way estrogen protects the lining of your blood vessels, known as the endothelium. According to the editorial, estrogen offers anti-inflammatory, antioxidant, and anti-proliferative pathways in the endothelium, and its steep reduction after menopause contributes to dysfunction in the vessels.

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The study presents another example of how womens heart health is different from mens, Gersh says. For example, women have different symptoms when having a heart attack, are more likely than men to die from their first heart attack, and develop heart failure through a different pathway, she observes.

Rather than labeling female symptoms as atypical, they should be labeled as what they are: female-typical symptomatology, Gersh says.

The results of this study are likely to change the way cardiologists treat womens heart risks.

Before this study, if a patient had gone through menopause early, we would have been very aggressive in treating her high blood pressure, cholesterol, and other traditional risk factors, Ayala says. Doctors should still treat these, he says, but maybe we dont have to go overboard or be super-aggressive because these factors are not impacted by the earlier age of menopause the way doctors had thought.

Regardless of a womans age when she enters menopause, getting serious about heart disease prevention is paramount. How best to do that remains controversial, but Gersh and her coauthor wrote in the editorial that hormone therapy (HT, or HRT) likely offers the best hope.

The current state of research is enough to justify the use of human-identical HRT with most women as they go through menopause, they wrote in the editorial, although they call for additional studies to document the benefits more fully.

HT had previously been used after menopause in part to aid a womans heart. But many abandoned this treatment after the famed Womens Health Initiative (WHI) trial was prematurely stopped in 2002 due to concerns about detrimental health effects. Many doctors, including Ayala, now think the panic over the results was excessive. The risks for cardiovascular disease in the study were well overblown, Ayala observes.

Gersh says the WHI shouldnt have tarnished HT the way it did, because that study included women well past their menopause transition and it used conjugated estrogens made from horse urine.

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Ayala says that he generally recommends HT to his female cardiology patients in their forties and early fifties and will continue to do so in the face of the revelation that treating traditional heart risks is not enough.

Gersh advocates that most women at the start of menopause should be offered HT with human-identical transdermal estradiol also known as bioidentical estrogen delivered by a patch or gel into the skin, along with micronized progesterone for women who have not had a hysterectomy. The key exception: women with diagnosed cancers involving estrogen receptorpositive tumors.

Much of what is viewed as the consequence of aging is actually a consequence of hormonal deficiency, especially when it comes to the heart, Gersh says. With proper informed consent, each woman can then decide for herself what path she chooses to follow.

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Early Menopause Does Not Increase Your Risk of Heart Disease, Study Finds - Everyday Health

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