Quick answer: Yes — menopause raises cardiovascular risk, mainly because falling oestrogen levels remove a natural protective effect on the arteries and can push up cholesterol and blood pressure. Early menopause (before 40) carries a higher risk still. The encouraging part: HRT started within 10 years of menopause has been shown to reduce cardiovascular risk rather than add to it, despite what many people still believe from a widely misreported study in the early 2000s.
I would say the context I get asked about the menopause most is with regard to symptoms of palpitations, followed by the risk of heart attacks around this time in a woman’s life. More and more women are seeking advice and guidance about these topics as general public awareness grows.
As a 46 year old man at the time of writing, it’s hard to have any appreciation of the difficulties many women face around the time of the menopause, and so I have felt it important to read more around the subject, and speak to patients about how it impacts them and their heart.
Why does menopause affect heart health?
The average age for menopause is the early 50s, when the ovaries stop producing eggs and oestrogen. Periods become irregular and then stop, and this irregularity might happen for a good few years before the menopause itself, which is often now referred to as the peri-menopause. Menopausal symptoms might go on from anywhere from a few months to many years.
Oestrogen affects the heart positively, by strengthening the walls of the arteries and other blood vessels, and reduces the build-up of fatty deposits. Lower oestrogen levels related to menopause can raise blood cholesterol, increase blood pressure, reduce bone mineral density, impact mood and libido. Changing hormone levels can also cause palpitations. An early menopause (<40) puts women at increased risk of coronary disease (and osteoporosis) and should be assessed for an underlying cause before being treated with HRT or the contraceptive pill.
Who knew the menopause has such a link with the heart?!
Does HRT increase the risk of heart disease?
HRT can be highly effective at tackling symptoms of the menopause. However I expect most people (myself included) have heard negative things about it though and have worried about an increased risk of dying of heart disease or stroke, breast cancer or dementia.
The sad truth is that this whole story should be chalked up in my view to a misrepresentation of study data in the popular press. It came about in the early 2000s, when a large study suggested an increased breast cancer risk, and that message spread like wildfire. That is untrue. It would take me a few pages to explain the data, but the take away message is this:
HRT is best to commence within 10 years of menopausal symptoms, and when done so, reduces cardiovascular risk, increases lifespan, reduces long term breast cancer risk, reduces dementia risk, and improves bone health.
How much does HRT reduce heart disease risk?
The risk of coronary disease has been shown to be 44% less in those women taking oestrogen, and risk of dying of heart disease was 32% lower!
Women who start HRT 20 years after symptoms do however have a 28% increased risk of heart disease, and if 10-19 years after symptoms the risk is intermediate. For heart risk, I don’t therefore recommend HRT to be started if there has been a gap of 10 years since menopause symptoms started.
Is one type of HRT safer than another?
Newer HRT is also different to the medication studied in the old trials that caused the panic. It is important that it is in gel or patch form however, as oral tablets have been shown to increase risk of a deep vein thrombosis or stroke.
A side benefit of HRT is that if you feel better, you are much more likely to be in a position to lead a healthy lifestyle – the right amount of exercise, a good diet, and stopping smoking.
If you would like to read or hear some positive content around female mid-life, do check out Loraine Candy and Trish Halpin’s website and podcast ‘postcards from midlife’. I’ve had a listen (even as a man in his 40s) and thought it was excellent, I’ve pointed a few of my patients towards it to and they have found it well worth a listen.
Could high blood pressure be mistaken for menopause symptoms?
Symptoms of high blood pressure for example hot flushes and palpitations may be mistaken for the menopause or stress in women of that age. About half of women develop high blood pressure under the age of 60. It is also often documented that women are less often treated for high blood pressure, and this apparent gender inequality may make them at higher risk of heart failure, strokes, and heart attacks. As I often say, we should all know our own blood pressure.