As women approach menopause, the ovaries gradually produce less of the hormones estrogen and progesterone, impacting various aspects of their lives. Unfortunately, heart health often takes a backseat in discussions about these changes. This is important to note because heart disease is the primary cause of death for both men and women, which is only recognized by approximately half (56%) of women in the U.S. (1).

This article explores how hormonal changes during the menopause transition affect women's heart health. It highlights risk factors and offers proactive measures to reduce cardiovascular risk.

The Connection Between Hormones and Heart Health

The relationship between women’s hormones and heart health is intricate and multifaceted. “Estrogen, in particular, has a protective effect on the heart. It helps maintain flexibility in the arterial walls which aids with circulation and reduces the risk of atherosclerosis, a hardening of the arteries,” explains Soma Mandal, M.D., board-certified internist and women’s health specialist at Summit Health in New Providence, New Jersey, and author of Dear Menopause, I Do Not Fear You.

Elevated estrogen maintains low LDL “bad” cholesterol and triglycerides, reducing the risk of atherosclerosis. High estrogen promotes HDL “good” cholesterol, which aids in the removal of LDL cholesterol from arteries, facilitating its breakdown and excretion from the body. (2, 3)

“Estrogen also plays a role in fat distribution, and its reduction is associated with a shift in fat storage from the hips and thighs to the abdominal area,” says Michelle Routhenstein, M.S., R.D., cardiology dietitian and owner of Entirely Nourished, a nutrition private practice. Excess abdominal fat is one of several risk factors for heart disease.

Additionally, Dr. Mandal notes that progesterone supports blood vessel dilation and blood flow.

Understand Cardiovascular Risk Factors

It's essential to clarify that menopause alone does not cause cardiovascular disease. Nevertheless, women undergo various bodily changes during the menopausal transition, some of which may affect heart health. It’s crucial to know your cardiovascular risk factors, which include the following, according to the American Heart Association (4):

• Lower estrogen

• Hot flashes and night sweats

• Depression

• Sleep problems

• Increased visceral fat (fat around the organs)

• High cholesterol

• Weakening or stiffening of the blood vessels

• Increased risk of metabolic syndrome, a condition characterized by three or more of these metabolic issues: high blood sugar, low HDL, high triglycerides, large waist circumference, and high blood pressure

• Early natural menopause (before age 45)

• Surgical removal of the ovaries

Lifestyle Changes and Proactive Healthcare

To protect the heart during the perimenopause transition, it's crucial to adopt heart-healthy lifestyle habits and to prioritize regular medical checkups. Unlike age and genetics, these aspects are within your control, providing effective means to reduce the risk of heart disease.

Heart-Healthy Diet

A balanced, nutritious heart-healthy diet can help optimize blood pressure, blood sugar, and cholesterol levels and reduce waist circumference, says Routhenstein. Consider the following:

• Swap sweets and processed foods for complex carbohydrates like whole grains, vegetables, and beans. These powerhouse carbohydrates contain fiber and are like slow-burning fuel, providing sustained energy without spiking your blood sugar. (5)

•  Make smart protein choices by opting for lean sources like skinless poultry, fish, legumes, and low-fat/non-fat dairy. These options are lower in saturated fat, which may raise LDL cholesterol. (6)

• Incorporate healthy fats like those found in olive oil, avocado, nuts, seeds, fish, and soy. These good fats are loaded with unsaturated fats, which help lower LDL cholesterol. (7, 8)

• Routhenstein also highlights the importance of including vitamin and mineral-rich foods in the diet for heart and overall health. For instance, potassium (found in various fruits and vegetables), calcium (found in dairy and leafy greens), and magnesium (found in whole grains, nuts, and seeds) help keep your blood vessels healthy and relaxed, which can prevent high blood pressure. (9)

Exercise

Getting at least 150 minutes of moderate exercise per week like walking and dancing can lower the risk of heart disease and stroke, among numerous other health benefits. Choose activities you enjoy and remember, any activity is better than no activity. (10)

Adding strength or resistance training to the mix is key to slowing down age-related muscle loss, also known as sarcopenia. This type of exercise involves working against a force, like weights, resistance bands, or even your body weight (squats and push-ups), to strengthen your muscles. (11)

Stress Management

Chronic stress can take a toll on your physical and mental health, including your heart. It’s particularly common in midlife. Dr. Mandal recommends mindfulness, yoga, and meditation to help with stress. Combat stress head-on with regular exercise, restful sleep (7+ hours), strong social connections, and saying no to work overload. (12)

Limit Alcohol and Quit Smoking

For well-being, moderate alcohol intake, or avoiding it if it affects sleep or health, is crucial. Excessive alcohol can lead to elevated triglycerides and heart-related issues. Quitting smoking reduces heart disease risk and improves overall health, with one-third of heart disease-related deaths linked to smoking and secondhand smoke. (13, 14)

Healthcare Checkups and Medications

“Visiting a primary care physician regularly allows for early detection and management of any potential risk factors,” says Dr. Mandal. “Medications like statins, blood pressure medications, and aspirin can help regulate your cholesterol and blood pressure.”

Hormone therapy (HT) eases menopause symptoms. Additionally, HT should be considered at least until the normal age of menopause for cardiovascular protection for women with early or induced menopause, according to the North American Menopause Society. However, using it solely to prevent cardiovascular disease in women aged 50 and older is not recommended. (15)

When considering hormone therapy, or any medical treatment, it's crucial to weigh the potential risks and benefits, engaging in a thoughtful discussion with your provider about your medical history and current health conditions.

Healthy habits and personalized medical solutions can empower you to minimize heart disease risk. How are you actively pursuing a heart-healthy lifestyle? Let’s talk about it.

Written by: Johna Burdeos

References

1. Centers for Disease Control and Prevention. Women and Heart Disease.

2. Cleveland Clinic. Estrogen: What It Does and 5 Benefits.

3. American Heart Association. HDL (Good), LDL (Bad) Cholesterol and Triglycerides.

4. American Heart Association. Menopause and Heart Health Infographic.

5. American Heart Association. Confused about carbs? This might help.

6. American Heart Association. Protein and Heart Health.

7. American Heart Association. Monounsaturated Fats.

8. American Heart Association. Polyunsaturated Fats.

9. NIH National Library of Medicine StatPearls. DASH Diet To Stop Hypertension.

10. Centers for Disease Control and Prevention. Benefits of Physical Activity.

11. NIH National Institute on Aging. How can strength training build healthier bodies as we age?

12. National Institutes of Health. Emotional Wellness Toolkit.

13. American Heart Association. Is drinking alcohol part of a healthy lifestyle?

14. American Heart Association. How Smoking and Nicotine Damage Your Body.

15. NAMS Practice Pearl. Hypertension in Menopausal Women: The Effect and Role of Estrogen.