Everything You Wanted to Know About Menopause and Heart Disease

By now, you’ve probably realized that menopause affects not only your reproductive parts, but also your whole body. On top of irregular periods, you’ve likely experienced hot flashes (or hot flushes), mood swings, and possibly many more of the common 34 symptoms of menopause. You’ve got your hands full trying to tame the menopausal beast, right? But have you thought about your heart? I know! You don’t want one more thing to worry about. However, though alleviating your menopausal symptoms is important, taking care of your heart during menopause is even more crucial. I mean, heart disease is the number-one killer of women over 50 in the U.S. But don’t worry, we’ve got answers to your menopause and heart disease questions and plenty of ways of showing your heart—and body—some love.

menopause and heart disease

Why Does Menopause Increase the Risk of Cardiovascular Disease?

What’s the link between menopause and heart health? First, let’s get one thing straight: menopause itself does not cause heart disease. However, it may put you at a higher risk of developing it. Specifically, many common symptoms that show up during the stages of menopause indirectly increase people’s risk of developing caridovasular issues. To ease your mind, though, just because you’re on your menopausal journey doesn’t mean you for sure will develop heart disease. So, what is it about menopause that can indirectly increase your chances of developing heart disease? Let’s explore.

Estrogen and Heart Disease

When your estrogen levels drop off during menopause, your heart and blood vessels become stiffer and less elastic. Because of decreasing estrogen, your blood pressure may rise, causing hypertension. And that, of course, puts more strain on the heart.

The Great Estrogen Decline is also associated with a progressive increase in LDL (“bad”) cholesterol. We all have some cholesterol in our bodies; it’s a waxy substance in our blood that helps our bodies build healthy cells. However, too much of it can form plaque on damaged artery walls. Also, high triglycerides (a type of fat in your blood) may contribute to hardening of the arteries. Wouldn’t you know it, that’s also bad for the heart. Menopause is associated with not only higher total cholesterol levels, but also an increase in LDL (“bad”) cholesterol and a decrease in HDL (“good”) cholesterol. The U.S. Cardiology Review says: “There is no doubt that raised cholesterol is a significant risk factor for CVD [i.e., heart disease].”

Insulin Resistance and Heart Health

When some people go through menopause, they become more resistant to insulin. This hormone converts blood sugar and starches into energy for cells to use. People, women specifically, with insulin resistance may develop prediabetes or diabetes. As a result, they are at a higher risk for heart disease.

How does diabetes increase your risk for heart disease, you ask? Diabetes results in too much sugar circulating in the bloodstream. High blood glucose levels from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. This can eventually lead to heart disease. 

Heart Palpitations

You might think that when your heart starts to play giddy-up (otherwise known as heart palpitations), that you’re having a heart attack. In reality, you’re likely experiencing fluctuating hormone levels due to your perimenopause-to-postmenopause journey. This might be causing faster or slower heart rates, or temporary heart blockages that can cause symptoms like dizziness from lack of blood flow. 

How Weight Gain Impacts the Heart

If declining estrogen, insulin resistance, and fluctuating hormones appearing as heart palpitations aren’t enough, weight also contributes to heart health. 

We’ve all been there! Mood swings, bouts of depression, or stress makes us want to down a whole box of chocolates. Am I right? Additionally, the last thing we think of when we’re fending off hot flashes is exercising. Weight gain—or least resistance to losing weight—is typical for people in the menopausal transition. However, extra weight strains the heart and added to other risk factors, can put you at higher risk for heart disease.

Additionally, the common symptoms during menopause, namely declining estrogen, slows the metabolism. Some would say theirs stopped altogether! Raise your hand if you can relate to feeling like you can’t look at a menu without gaining five pounds! Stomach fat, especially a lot of it, can increase cholesterol and hypertension. Imagine your poor heart trying to help you get through menopause while not getting the blood it needs. This is due to the veins that feed it being blocked, weak, or rigid or the blood it does get has too much fat in it. 

What Are Some Common Heart Issues Associated With Menopause?

Now that you know how menopause symptoms can indirectly increase the risk of heart disease, let’s address the common heart issues associated with menopause that may alarm you. For example, chest pain or shortness of breath. 

For instance, say your heart all of a sudden starts to flutter to the point that your chest feels tight. Do you call 9-1-1? More than likely, it’s a palpitation, which is a common symptom of menopause. Your chest tightness, while a possible menopausal symptom, could also be caused by heartburn, gallbladder problems, sore muscles, panic attacks, or depression. So, no! It’s probably best not to call the ambulance just yet. However, visiting with a medical professional who can diagnose the root cause of potentially life-threatening symptoms is always a good idea.

That said, as many a doctor will probably not tell you, they may have a hard time distinguishing between your menopausal symptoms and heart issues. For example, Dr. Shalini Bobra, a cardiologist with White Plains Hospital, says: “Some common symptoms of a heart problem could mimic what we tend to think of as menopausal symptoms.” Therefore, let’s dive in and address those issues. 

Perimenopause Chest Tightening

If you’re asking yourself what the difference is between perimenopause chest tightening and heart disease, great question. “Chest tightness is not a menopausal symptom that you hear much about,” say doctors at Evexias Medical Center. So, it can be particularly unnerving if you experience it—especially during COVID times. To clarify, chest tightness by itself doesn’t necessarily mean you’ve got heart disease. However, if it continues, feels like it’s “full,” verges into pain, or comes and goes, then you might want to see your health practitioner.

Heart Palpitations

If your heartbeat has ever felt loud, racing, “flip-floppy,” fluttering, or pounding, you’re in good company. Janet S. Carpenter, PhD, RN, an associate dean of research at Indiana University School of Nursing in Indianapolis and lead author of a study that examined heart palpitations, says: 

Palpitations are not only quite common, but also underdiagnosed and understudied; when I’ve talked to some of my colleagues about heart palpitations, they’ve been a little bit shocked about what we still don’t know. It’s not clear why they happen, we don’t know if they’re associated with EKG changes, and we don’t know if they increase women’s risk for cardiovascular disease. [source]

When should you be concerned about heart palpitations during the perimenopause-to-postmenopause transition? Of course, you are your own best judge, but Dr. Carpenter advises tracking a few things before calling your doctor. So get out your handy-dandy notebook, note-taking app, or bullet journal and jot down:

  • Track the time of month and the time of day that you experience heart palpitations. Note anything that seems to bring them on, such as exercise, smoking, or drinking.
  • Record other menopause symptoms, if any, that pop up at the same time as your heart palpitations. “If you’re under a lot of stress or having insomnia, that could influence the palpitations,” she says. 
  • If you’re still having your period, track your cycle. Your hormones may be influencing when you experience palpitations. 

If you’re concerned about heart palpitations, contact your healthcare provider right away. At your appointment, share your log with the details you tracked and advocate for yourself.

High Blood Pressure 

Dr. Angela H.E.M. Maas, who is the lead author of a large study done by European cardiologists, gynecologists, and endocrinologists, said:

One thing that leads to confusion in diagnosing high blood pressure in middle-aged women is the fact that its onset often coincides with menopause. Think of hot flashes, sleeping disorders, chest pain, pain between the shoulder blades, irregular heartbeats, headaches, symptoms of fluid retention, dyspnea (shortness of breath), etc. These are all symptoms that overlap with hypertension symptoms. [source]

Additionally, headaches, ringing in the ears, and changes in concentration can also be either high blood pressure or menopause. Furthermore, they could be caused by both menopause and blood pressure, since menopause often elevates blood pressure. 

Setting realistic expectations that your health practitioner might have a hard time telling the difference between your menopause and high blood pressure symptoms is key. Still, because heart health is so important, regular doctor’s visits can give you valuable information.

Check out our comprehensive guide to blood pressure and menopause.

High Cholesterol

Menopause often raises your cholesterol levels, and higher cholesterol levels put you at higher risk for heart disease. Again (am I getting too repetitive yet?), one thing doesn’t necessarily have to follow another. Just as with high blood pressure and heart palpitations, you’ve got lots of ways to boost your heart health.

First, let’s talk about some less common heart issues that can be associated with menopause.

What Are Some Less Common Heart Issues Associated With Menopause?

 

Strokes

Interestingly, the same things that can cause or contribute to heart disease can also cause or contribute to strokes—also known as apoplexy, cerebrovascular accident, cerebral accident, and cerebral infarction. Because some of those things can mimic menopausal symptoms, you might think that menopause itself puts you at higher risk for having a stroke. Again, although there can be an indirect relationship, menopause is a life stage and doesn’t increase your risk for stroke, with one caveat. If you start menopause before you’re 40, your risk of stroke does increase 1.5 times.

Remember how I mentioned atherosclerosis earlier—where plaques build up on artery walls and limit blood flow? If that happens in your coronary arteries, that’s called heart disease. When it happens in your neck arteries, which go to the brain, that’s called a stroke. 

According to the University of Michigan Health Department, most of the risk factors for heart disease are the same for stroke. These include smoking, diabetes, high blood pressure, high cholesterol, obesity, lack of exercise, and family history. They also say that: 

“… a woman’s risk of heart disease and stroke is higher after menopause. This higher chance is not completely understood. But cholesterol, high blood pressure, and fat around the abdomen—all things that raise the risk for heart disease and stroke—also increase around this time.”

That said, the CDC shares that a stroke is a medical emergency. Therefore, even if your symptoms seem like those you might experience normally during the stages of menopause, they suggest calling 9-1-1 immediately if any of the following occur:

  • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
  • Sudden confusion, trouble speaking, or difficulty understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance, or lack of coordination
  • Sudden severe headache with no known cause

Atrial Fibrillation

While some people may associate atrial fibrillation (or Afib) with menopause, no relationship exists. The largest study of menopausal women ever done, the Women’s Health Initiative (WHI), showed no relationship between Afib and menopause.

Atrial fibrillation is abnormal electrical activity in the upper chambers (atria) of the heart. These extra signals make the atria beat very quickly and unevenly. When the atria beat that way, the heart may quiver instead of contract. If your atria don’t contract, they move less blood to the bottom part of your heart. Afib is the most common heart rhythm disorder in both men and women, say doctors at the University of Utah Health Department, and it’s definitely treatable. 

Blood Clots

As with the other heart health symptons, blood clots are not a symptom of menopause. You might experience them if you’re still menstruating during perimenopause, but they should stop when you cease menstruating. That said, taking estrogen hormone replacement therapy (HRT) during perimenopause or postmenopause increases your risk of blood clots. To clarify, the risk of blood clots forming in your legs and then dislodging and moving to your heart increases. In fact, certain types of HRT appear to double the risk of blood clots, at least according to a study in the British Medical Journal. 

So, does that mean you should abandon estrogen replacement therapy and any hope of relief from your symptoms because estrogen increases your risk of blood clots? No! But, you should ask yourself more questions, consider all the factors, and speak with a medical professional.

Does Hormone Replacement Therapy Increase the Risk of Heart Disease During Menopause?

The short answer to the question of whether HRT increases your risk of developing heart disease during menopause is no. Doctors at the Mayo Clinic say: 

  • The risk of heart disease to an individual taking hormone therapy is very low. If you are in early menopause, have moderate to severe hot flashes and other menopausal symptoms, and are otherwise healthy, the benefits of hormone therapy likely outweigh any potential risks of heart disease.
  • Your individual risk of developing heart disease depends on many factors, including family medical history, personal medical history and lifestyle practices. Talk to your doctor about your personal risks pertaining to hormone replacement therapy and cardiovascular disease. If you’re at low risk of heart disease, and your menopausal symptoms are significant, hormone therapy is a reasonable consideration. [source] 

The History of HRT and Why You Should Care

When hormone replacement therapy (HRT) was first invented, doctors and patients alike thought it was a panacea that would solve everyone’s menopausal problems. As doctors have studied it more, they’ve realized that the reality is more nuanced than that. Namely, hormone replacement therapy can be incredibly beneficial for one menopausal maven, while not so much for another. Therefore, some people in the stages of menopause choose to avoid it altogether in favor of what they consider to be more natural options. 

In the menopause hormone duo of progesterone and estrogen, you might like to think of estrogen as the party-er of the two. Progesterone is more even-keeled, calmer, whereas estrogen thinks she’s the boss of everything. If there’s any risk in your HRT plan, then estrogen’s usually to blame. But, any risks you might have of developing heart disease or other problems varies depending on:

  • Whether estrogen is given alone or with a progestin
  • Your current age and age at menopause
  • The dose, type of estrogen and how you take it, such as a pill, skin patch or vaginal cream
  • Other health risks, such as your family medical history and cancer risks

The Benefits and Risks of HRT Regarding Heart Disease

For any woman, the WHI study data clearly show that HRT offers the benefit of preventing osteoporosis. It also reduces the risk of colon cancer. If you’re worried about your risk of developing heart disease while taking HRT, discuss with your doctor these four guidelines from the American Heart Association and the U.S. Food and Drug Administration:

  1. HRT should not be used for prevention of heart attack or stroke.
  2. Use of HRT to prevent osteoporosis should be carefully considered and the risks weighed against the benefits. Women who have existing coronary artery disease should consider other options.
  3. HRT may be used short-term to treat menopausal symptoms.
  4. Long-term use is discouraged because the risk for heart attack, stroke, and breast cancer increases the longer HRT is used.

The bottom line, say physicians at the Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic: weigh the benefits of HRT against the risks and discuss it  with your physician to make an informed decision.

You might also want to consider another factor when trying to decide whether to take HRT: what your actual risk of developing blood clots or other heart-related problems is. For example, the people at Heart Matters magazine say that the majority of women taking HRT did not have a doubled risk of developing blood clots. The doubled risk was only found with a particular type of combined HRT tablet (equine estrogen with medroxyprogesterone acetate). Only a relatively small proportion of women in the study took that kind. That risk also depended on:

  • Whether you’re taking estrogen only or estrogen with progestin
  • Whether you’re taking equine estrogen (such as Prempro) as opposed to synthetic estrogen (estradiol), if you’re taking any kind of estrogen
  • Whether you’re taking HRT orally or via gels, patches, or creams (Women going the latter route had no increased risk.)

Three other very important factors to remember, pertaining to both the common and less-common conditions sometimes associated with menopause and heart disease are:

  1. In and of themselves, none of them guarantee you’ll develop heart disease. 
  2. If you’re worried about any of them, it doesn’t hurt to see a cardiologist. They can establish a baseline of your heart function and blood pressure.
  3. If you’re still concerned, check out these symptoms of heart disease to help you determine when to see a cardiologist. 

Heart Disease During Menopause Is Preventable 

The good news is that you can protect your heart during menopause!  “A lot of this is reversible or preventable,” says JoAnne Foody, MD, Medical Director of Brigham and Women’s Hospital Cardiovascular Wellness program and a Harvard Medical School associate professor of medicine. Likewise, cardiologist Leslie Cho, MD, Director of the Women’s Cardiovascular Center at the Cleveland Clinic, says: “The number one thing I want women to know is that heart disease is preventable.” Even if you have a terrible family history of heart disease, it’s preventable.”

3 Ways to Protect Your Heart During Menopause

The best ways to protect your heart during menopause include the tried-and-true basics: diet, exercise, etc. Additionally, as good as downing a good glass of wine or soda might sound, you’ll do your heart better by choosing healthier beverages and not smoking. But what specifically does that mean? How much should you exercise? What kinds of foods serve you better in mid-life? It’s time to pull out your note-taking device again? Take the following steps to improve your heart health during the menopause transition:

Get to or maintain a healthy weight. That means having a body mass index (BMI) of between 18.5 and 24.9 and a waist smaller than 35 inches (90 cm), according to the National Library of Medicine. Realize that all weight loss helps. 

1. Know your heart disease risk. 

Assessing your heart risk and “knowing your numbers” (BMI, blood pressure, blood sugar, cholesterol) is the first step in protecting your heart during menopause. To clarify, BMI and blood pressure can be monitored at home. In fact, doctors at Healthline.com recommend self-monitoring. Specifically, they say that these measurements are more representative of your true blood pressure. Remember that good blood pressure is when the top number is at or below 120 and the bottom number is around 80. On the other hand, testing blood sugar levels and cholesterol is often better done by a professional.

2. Be strategic about your diet. 

Eating a healthy diet doesn’t mean yo-yo dieting. Rather, it means cutting out some foods and adding others, such as:

  • Watch your whites. Avoid bread, white-flour foods, and white rice. Instead, choose brown rice and multigrain versions, but eat them in moderation.
  • Flip your fruits. Go for strawberries, blueberries, and raspberries instead of high-sugar bananas and grapes. They can quell your cravings just as well.
  • Spice up instead of sweetening your food. For instance, use vanilla or cinnamon to flavor oatmeal and other foods instead of brown sugar and fatty cream. Try a dash of cinnamon in black coffee, too.

    Suzane Somers, author of I’m Too Young for This! The Natural Hormone Solution to Enjoy Menopause, also suggests adding in these “perimenopausal power foods:”

3. Exercise regularly. 

Women who need to lose weight or maintain their weight should get at least 60 to 90 minutes of moderate-intensity exercise on most days. To maintain your health, get at least 30 minutes of exercise a day, preferably at least 5 days a week.

It’s a Wrap!

Worries about menopause and heart disease might keep you up at night, but you’ve got this. I mean, all those worries about weight gain, heart palpitations, blood clots, high blood pressure, high cholesterol, and stroke can be pretty strident. But really, you can control more than you think and you’re stronger than you may give yourself credit for. With education and daily efforts to get your healthy heart numbers in check, you will rock your menopausal transition while showing your heart lots of love. 

Sources

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