If youre a woman in the menopause transition, hot flashes and night sweats arent the only things that should grab your attention. It turns out that the stage of fluctuating hormones leading to your final period is a risky time for your heart health.

Thats the consensus of nearly a dozen experts who reviewed the research on the topic for the American Heart Association. They published theirscientific statement on November 30 in the journal Circulation.

RELATED: 10 Ways to Beat Menopausal Belly Fat

This phase of a womans life is a time of accelerated cardiovascular risk at multiple dimensions, including changes in lipids, body fat, metabolic syndrome, and vascular health, saysSamar R. El Khoudary, PhD, MPH, an associate professor of epidemiology at the University of Pittsburgh and the chair of this AHA statement writing committee.

These changes significantly raise the potential for heart disease later in life, and this is why women and their doctors must see themenopause transitionas a crucial time for intervention, rather than wait until women are older and experiencing disease, Dr. El Khoudary says.

The AHA committee undertook their thorough review because many more studies on women going through the menopause transition are available now than previously, especially since the last AHA guidelines on treating women were written, in 2011.

Some of the best studies have followed women during their midlife years. This includes the Study of Womens Health Across the Nation (SWAN), the Melbourne Womens Midlife Health Project, and the Penn Ovarian Aging Study (POAS).

RELATED: 5 Things Weve Learned From the Most Important Menopause Study

Other, especially older, studies have tended to group women into before menopause and after, leaping over the important phase that occurs as they shift from one time of life to the other, El Khoudary says.

Still, even more research is needed, she says, especially studies testing specific cardiovascular interventions, such as medications, during this stage.

Understanding these processes is so important, because heart disease is the leading cause of death for women. If you didnt know that, youre not alone. Only 56 percent of women are aware of this fact, El Khoudary observes.

Cardiologists dont sufficiently focus on this, either. While most know that a womans risk of heart disease increases once the protective effects of estrogen cease after menopause, many dont intervene soon enough to make a difference, she says.

More cardiologists are becoming aware of this important window. But we are behind because of this notion that women dont get cardiovascular disease until later in life, and that they have different symptoms than men, says Ruwanthi Titano, MD, an assistant professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York, who was not involved with the review.

Doctors need to view the menopause transition as a risk factor akin to high cholesterol and hypertension, Dr. Titano says.

RELATED: Coping With Hot Flashes and Other Menopausal Symptoms: What 9 Celebrities Said

A woman is considered post-menopausal only after she has gone a full year without a single period. During the transition period, known as perimenopause, a woman can go months without a menstrual bleed, but then menstruate, resetting the clock.

During this time, hormones fluctuate greatly. One of the main hormones is estrogen. It is this hormone that is thought to provide the key heart protection women experience earlier in life.

Once a woman becomes post-menopausal, her estrogen level remains low.

RELATED: What Are Irregular Periods?

And that's by no means the only change that happens in the body during the menopause transition. They cumulatively raise the potential for heart troubles down the road, El Khoudary says. Its not like a button you press that quickly increases your mortality. But, accumulated together, the changes women experience increase her risks for cardiovascular disease.

During this period, blood cholesterol levels start to rise. The carotid artery begins to thicken (a subclinical measure of atherosclerosis, El Khourdary says). Excess weight moves from being stored around the thighs and buttocks to around the abdominal organs and the heart more dangerous locations. And metabolic syndrome symptoms increase, the committee found.

All these factors can set the stage for later heart attacks or strokes.

RELATED:What Experts Want BIPOC Women Know About Menopause

Even once-healthy HDL cholesterol levels seem to take a destructive turn.

HDL, or good cholesterol, is considered to be cardioprotective. But once a woman transitions to menopause, it actually seems to become bad for you, El Khoudary says, citing her own soon-to-be published research.

This has led to the hypothesis that HDL experiences some dysfunctionality as women transition through menopause, causing it to stop functioning the way it used to, she says.

Doctors erroneously think of menopause as a point of demarcation, El Khoudary says. One day youre menstruating, then youre not. But menopause is actually a lengthy and varied process, with hormonal fluctuations sometimes lasting years.

Its connection to heart disease is especially complex. Age of menopause, the stage of menopause youre in, and even your race may play a role, the paper states. For instance, women who experience menopause at an earlier age, typically before 45, have a higher risk for later heart disease.

Socioeconomic indicators, prior cardiovascular health, and other factors are associated with a younger transition. Black, Hispanic, and Native Hawaiian women tend to experience the menopause transition at a younger age.

Women whose ovaries are surgically removed when theyre younger are also more likely to face increased cardiovascular problems, the paper states.

So, too, are women who suffer severe vasomotor symptoms, including hot flashes and night sweats.

The analysis reveals the importance of monitoring womens health during midlife and using the menopausal transition as a critical window for intervention.

Women and their doctors need to understand how the body changes during this time, and the ways that can boost your heart disease risk, El Khoudary says.

Your doctor might prescribe medications to keep blood pressure, cholesterol, and blood sugar in check, critical parts of the AHAs Lifes Simple 7 heart campaign.

My message for perimenopausal women is to engage in your healthcare. Get your yearly checkup with your physician or see your cardiologist if you have one. Your doctor should be looking more closely at your lipid panel, because maybe numbers that were acceptable before arent good enough anymore, Titano says.

RELATED:Fitness After 40 and Beyond: What to Know About Midlife Exercise Needs

Sufficient physical exercise is key. El Khoudary was stunned to learn that just 7.2 percent of women past menopause are meeting physical activity guidelines.

RELATED:7 Fun Ways to Move More in Midlife

Similarly, adopting a healthy eating plan, one that becomes part of your life rather than a short-term fad, can protect your heart. But post-menopausal women dont seem to be doing this either, with only 20 percent saying they consistently maintain a healthy diet.

Other important actions to protect your heart include getting sufficient sleep, adopting stress-reduction techniques, and quitting smoking if you havent already.

RELATED: Having Multiple Severe Menopause Symptoms Is Linked to Increased Risk for Heart Disease

While it might seem that properly dosed and timed menopausal hormone therapy (MHT) could lower womens heart disease risk, this has not been proved in research.

The last major study of hormone therapy, the Womens Health Initiative, was stopped in 2002 when participants were found to have a small increase in heart disease, blood clots, cancer, and stroke. But these women were older, generally many years past their menopause transition.

We dont know what would happen in terms of heart disease if you gave hormone therapy to women during the transition, El Khourdary says. We dont have the clinical trials for women in their forties or fifties.

Still, some smaller studies, many of them observational ones, indicate that newer formulations of hormone therapy, especially those taken via skin patches or sprays rather than pills, may offer some heart protection, she says.

RELATED: Timing and Type of Hormone Therapy Impacts Its Effectiveness in Preventing Heart Disease

The Circulation paper notes the promise, but also indicates that the AHA may not be ready to recommend that women take hormone therapy for their heart.

The literature supporting a critical role for the time of initiation of MHT use relative to menopause, with initiation at <60 years of age or within 10 years of menopause appearing to be associated with reduced CVD risk, strongly calls for further research assessing MHT use, including potential contrasts by form, route, and duration of administration, on cardiometabolic effects in women traversing menopause, the paper states.

RELATED: Hormone Therapy May Prevent UTIs in Post-Menopausal Women

Read the original here:
The Menopause Transition Poses Heart Disease Risk - Everyday Health

Comments are closed.