How does menopause affect your heart health?

Heart disease is often more commonly associated with men and, before menopause, women do have a lower risk of heart disease than men of the same age. However, after menopause, the risk of heart disease in women rises. 

Here, we will explore how menopause affects heart health in women, symptoms to look out for and how to reduce the risk of heart disease after menopause. 

Menopause symptoms vs heart disease symptoms

Some menopause symptoms, such as heart palpitations, overlap with symptoms of heart disease. It can, therefore, be difficult to determine if such symptoms in a woman are due to menopause or a heart condition. 

In general, palpitations caused by a heart condition are more persistent than those caused by menopause and can be accompanied by other heart-related symptoms, such as breathlessness and chest pain. 

Chest pain can also be a symptom of menopause, but it is usually milder than chest pain that occurs with a heart condition (angina) and can be related to anxiety or muscle tension. Angina usually occurs on exertion eg when walking uphill or going up stairs.

Breathlessness can be a symptom of menopause too due to hormonal changes that affect the respiratory system and/or reduced fitness due to weight gain.

During menopause, palpitations tend to occur alongside other menopause symptoms that are not symptoms of a heart condition, such as hot flushes, night sweats or anxiety. 

If you’re experiencing palpitations and are concerned, see your GP. Depending on your medical history and other symptoms, they may refer you to a doctor who specialises in treating the heart (a cardiologist), who can determine if you have an underlying heart condition. 

How menopause affects your heart health

Menopause causes a drop in levels of the hormone oestrogen. Oestrogen has a protective effect on heart health by reducing levels of ‘bad’ LDL cholesterol, increasing levels of ‘good’ HDL cholesterol and reducing inflammation. 

Lower oestrogen levels after menopause can, therefore, lead to high cholesterol and increased inflammation. 

As a consequence of high cholesterol, blood vessels become stiffer and plaques accumulate along the inside of your blood vessels, causing them to narrow (atherosclerosis). Additionally, increased vessel stiffness can lead to high blood pressure, which increases the risk of heart attacks and stroke. 

Hormonal changes after menopause also cause weight gain around your abdomen. This causes increased activity of certain immune cells, which leads to higher levels of chemicals called cytokines and chemokines that cause inflammation. Higher levels of inflammation, in turn, increase the likelihood of cells in your body becoming less sensitive to the hormone insulin, which controls your blood sugar levels. 

Consequently, increased abdominal fat increases your risk of diabetes, and diabetes increases your risk of heart disease.

HRT and heart disease

Some women choose to go on hormone replacement therapy (HRT) to ease some of the symptoms of menopause. 

There may be some protective effect on heart health if HRT is taken soon after menopause, ideally within 10 years of the onset of menopause symptoms. This may include improving the balance of fats in your bloodstream and maintaining the elasticity of your blood vessels.

However, if HRT is started later or after the age of 60, it may increase your risk of blood clots and stroke.

If you are considering taking HRT, you should, therefore, speak to your GP about the risks and benefits in your particular case. 

How to reduce your risk of heart disease

Before menopause, you can reduce your risk of heart disease by following a healthy, balanced diet, exercising regularly, maintaining a healthy weight or losing excess weight, avoiding smoking, and monitoring blood pressure, cholesterol and blood sugar levels.

It is good practice to maintain these healthy lifestyle choices through and after menopause. However, during menopause, it is especially important to stay active and manage your stress levels. You should also stay vigilant to menopausal symptoms so you can take steps to manage them. You may want to discuss taking HRT with your GP. 

After menopause, it becomes even more important to monitor your cholesterol, blood sugar levels and blood pressure, and, if directed by your GP, to take medication as prescribed to maintain a healthy blood pressure, and cholesterol and blood sugar levels.