Doctors generally support the belief that cardiovascular disease affects more men than women, but American Heart Association (AHA) recently pointed out that heart disease kills more women than all forms of cancer.

In addition, a woman’s risk of heart disease it can increase greatly in the years before and after menopausethe stage of life after the end of the menstrual cycles.

The periods leading up to, during and after the cessation of menstrual cycles are called:

• perimenopausewhich may start several years before the last period and end 12 months after the last period
• menopause, which occurs 12 months after the last period at an average age of 52 or after surgery, such as removal of the ovaries, that stops menstruation
• and postmenopausalthe years after menopause.

For some people, perimenopause and menopause may go almost unnoticed, other than the cessation of menstrual periods. But for most, time can bring a series of symptoms, which may include:

• Hot flushes
• irregular periods
• mood swings
• night sweats
• breast tenderness
• vaginal dryness
• decreased libido
• thin hair and brittle nails.

Many of these symptoms are caused by a reduction in reproductive hormones, estrogen and PROGESTERONEaccompanying menopause.

“Estrogen is very protective of heart health for women. Premenopausal women who have abundant levels of estrogen have a much lower risk of heart disease and high blood pressure than men. After menopause, when estrogen levels drop, the risk of heart disease in women increases and becomes higher than in men of the same age.”

Estrogen protects the cardiovascular system in several ways. Robin Noble, MDa board certified OB/GYN and Chief Medical Advisor for Let’s talk about menopauseexplained some of them for MNT.

“We don’t see much cardiovascular disease in women until after menopause – probably because estrogen has a vasodilating effect on the vascular system. Furthermore, estrogen has anti-inflammatory effects, and inflammation and oxidative stress appear to be the primary mechanisms of cardiovascular plaque development,” Noble told us.

Once estrogen declines, these cardioprotective effects are lost, increasing a person’s risk of heart disease.

“As estrogen levels drop in menopause, there can be an increase in cholesterol levels, higher blood pressure and increased visceral fat, leading to plaque build-up and hardening of the arteries,” she noted. Jennifer Wong, MDa board-certified cardiologist and medical director of non-invasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.

“It can also be increased inflammation that has been associated with growth atherosclerotic plaqueespecially the unstable plate. autonomy menopausal changes can lead to increased heart rate and lower heart rate variability,” she added.

right AHAsome of the common symptoms of menopause – hot flashes, night sweats, depression, sleep disturbances and increased fat around the abdomen – are associated with a higher risk of cardiovascular diseases.

And the risk of cardiovascular disease is bigger in those who have an early menopause, before the age of 40, than in those whose menopause occurs later.

Matthew pointed out a number of cardiovascular risks that can increase after menopause. These include:

• coronary artery disease — estrogen deficiency can promote atherosclerosis, the buildup of plaque in the arteries, increasing the risk of heart attacks
• high blood pressure (high blood pressure) — estrogen maintains tissue elasticity and promotes vasodilation, therefore loss of estrogen can lead to increased blood pressure
• arrhythmias — hormonal fluctuations can affect heart rhythm, potentially leading to palpitations or AFib
• cerebrovascular accident — the risk of stroke is increased due to higher blood pressure and arterial stiffness
• heart failure — reduced cardiac efficiency may develop due to weakening of the heart muscle, often as a result of untreated high blood pressure or coronary heart disease
• high cholesterol — estrogen is actually made from cholesterol, and estrogen deficiency after menopause can cause higher levels of LDL (bad) and HDL (good) cholesterol
• insulin resistance or prediabetes – after menopause, women become more insulin resistant, which increases the risk of prediabetes and diabetes, which in turn are important risk factors for heart disease and stroke.

Some pre-existing heart conditions can make menopause symptoms worse, and hormonal changes during menopause can have an impact on pre-existing conditions, as Matthew explained.

“Women with cardiovascular disease may have more severe menopausal symptoms, such as hot flashes, anxiety and fatigue. Declining estrogen with menopause can worsen existing cardiovascular conditions such as atherosclerosis, high cholesterol and high blood pressure, increasing the risk of heart attacks and strokes,” she told us.

Noble shared a similar comment:

“Menopause and the characteristic changes associated with menopause can certainly worsen (cardiovascular disease). People with obesity may have more hot flashes, sleep disturbances and sleep apnea – a serious condition that should be evaluated and treated.”

“Pre-existing cardiovascular disease and other health problems may hinder one’s ability to follow some of the recommended healthy lifestyle interventions to alleviate symptoms,” she added.

In the years around menopause, people should follow general healthy living tips to maintain heart health. Noble advised “Lifestyle changes that include increased exercise, stress management, healthy eating — with an increase in plant-based foods, whole grains.”

“A green Mediterranean diet, which incorporates fish, is probably the healthiest diet – less fat and animal protein, eliminating ultra-processed foods. Intermittent fasting can also be a healthy strategy,” she said MNT.

In addition to a healthy lifestyle, hormone replacement therapy (HRT) may be an effective way to reduce the risk of heart disease at this point in life.

A studynot yet published in a peer-reviewed journal, suggests that estrogen therapy may have long-term benefits in reducing the risk of heart disease.

They had increased levels of HDL-C (the “good” cholesterol), decreased LDL-C (the “bad” cholesterol), decreased insulin resistance, and decreased lipoproteins—all of which can be beneficial for heart health.

“Estrogen replacement, if initiated within 10 years of menopause, is associated with reduced progression of atherosclerosis and reduced risk of death from heart disease (and reduced all-cause mortality). Discussion of hormone therapy should be personalized with a woman’s doctor,” Matthew advised.

One review also suggest that transdermal estrogen (such as gels and patches) may have a greater cardioprotective effect than oral estrogen or estrogen combined with progesterone. However, only estrogen can increases the risk of endometrial (uterine) cancer, so it is generally given only after hysterectomy.

The timing of starting estrogen therapy may also be important. A 2016 study showed that there were more cardiovascular benefits when HRT was started within 6 years of menopause than when it was started later.

Although the risk of cardiovascular disease increases in women during menopause, there are several steps a person can take to help minimize this risk.

Experts advise following a healthy lifestyle, including a healthy diet and regular physical activity, not smoking and moderate alcohol consumption.

For many women, hormone therapy will not only help manage menopausal symptoms, but may also reduce cardiovascular risk.

However, experts advise that any hormone therapy should be discussed with a doctor to ensure the most appropriate type is prescribed.

So, although a person’s risk of cardiovascular disease increases with the onset of menopause, there are many ways to help keep the heart healthy later in life.