Why does menopause increase the risk of heart disease?

Published: 1 May 2023

As part of our focus on women's heart health this month, our Medical Director, Dr Gerry Devlin, addresses the issue of heart disease risk factors and menopause.

The risk of heart disease rises steeply for women post-menopause, so you'll need to take extra care of your heart at this time.

The hormone oestrogen has a protective effect on the heart. Once the ovaries have ceased production, women's metabolism changes, body fat increases, particularly around the torso, and blood pressure and low-density lipids (the "bad" cholesterol) rise.

The benefit of oestrogen remains for about 10-15 years after menopause. Then, women tend to catch up and have the same heart disease risks as men.

How to keep your heart healthy  as you age

More than 50 New Zealand women die each week of heart disease, making it the single biggest cause of death for women in New Zealand.

Those women without known risk factors should get a heart check from age 55. Women with known heart disease risks should get a check at 45; Māori, Pasifika and South Asian women are advised to go from age 40; and those with severe mental illness as early as 25 years old (their mortality rate is 2-3 times higher and cardiovascular disease is a major contributor to that).

A heart check will include:

• checking your blood pressure and cholesterol levels (lipid profile blood test)

• reviewing your family history of heart disease and personal risk factors

• discussing smoking.

Your doctor will then assess your risk, and if you are at high risk of heart disease, you can think about doing something to reduce that risk. This could be improving your diet, increasing exercise, losing weight, giving up smoking or taking medication to control blood pressure or high cholesterol.

How menopause can affect blood pressure

One of the areas where we could improve our preventive care is the management of high blood pressure. We are familiar with the link between high blood pressure and stroke. But it's also a significant risk factor for heart attacks, heart failure and heart rhythm problems.

Hormones and body changes during menopause can increase a person's risk of having high blood pressure.

The only way to find out if you have high blood pressure is to get it checked by your doctor, nurse or pharmacist. Or you can buy your own blood pressure monitor to use at home.

The ideal blood pressure is 120/80 or lower for most people. However, the blood pressure that is 'ideal' for you depends on many factors, including your overall risk of heart attack and stroke.

Are these menopause symptoms or heart attack symptoms?

Too many women die from heart attacks after the warning signs are not recognised.

When women have heart attacks, they don't always experience them in the same way as men do.

Rather than the classic symptom of crushing chest pain, they may have less obvious signs – feeling a bit off-colour or dizzy, tired, breathless, sweaty or nauseous.

Some of these symptoms are also menopausal symptoms, and it can be easy for women and their doctors to miss what is happening.

Women are also less likely to ask for help. They're busy and often looking after others, so they tend to ignore their symptoms.

If you're feeling off-colour, very fatigued, things are harder to do than before, or you're experiencing a little chest discomfort, please don't ignore it, as these could be early warning signs.

While you may not have typical symptoms, it's about looking at the constellation of things happening and talking to your doctor if you're concerned.

Try our free online heart check

Whether you have experienced menopause or not, knowing where you sit regarding your risk of heart disease is a good idea. Try My Heart Check to determine your heart age compared to your actual age. It also estimates your risk of having a heart attack or stroke and shares tips on how to reduce the risk.

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