Cardiovascular Risk in Menopause: Prevention is key!

Cardiovascular disease is the leading cause of death for women. Over the course of a woman’s lifetime this risk develops a lot more slowly than in men; however, it is dramatically increased post menopause. Though cardiometabolic changes are most apparent post menopause (defined as greater than 1 year after last menstrual period), they start years prior during the menopause transition. These changes include body composition changes, increase in total cholesterol levels, increase in LDL cholesterol (bad cholesterol), decreases in HDL cholesterol (good cholesterol), as well as other markers of metabolic health like blood sugar and insulin levels. Over the menopause transition, these changes are exponential, at a rate that is independent of what happens with normal aging.

The menopause transition refers to the period of time before menopause when a woman’s menstrual cycle starts to change- coming earlier, or later (also called Perimenopause). At this time in a woman’s life, she generally seeks medical care for things such as erratic bleeding, hot flashes, insomnia, or mood changes. Although it is important to address and treat these symptoms, research shows that we should also be screening for cardiovascular disease at this time, as this may be a critical window to address changes in cholesterol or other markers of heart disease to prevent issues that usually arise post menopause. However, women that do not experience the above-mentioned uncomfortable symptoms, generally fall through the cracks.

Monitoring a woman’s cardiovascular health during the menopause transition and implementing early intervention strategies is crucial. This is because interventions that are implemented in early perimenopause (the time when a woman’s cycle first starts to change) can help decrease her risk over her lifetime.

What can be done?

1. Cardiometabolic screening should be done yearly, including monitoring blood pressure levels, BMI and waist circumference, and bloodwork assessment of cholesterol and blood sugar levels (fasting glucose and HBA1C).
2. Vitamin D levels should be tested and deficiency corrected
3. Quit smoking
4. Exercise regularly
   • the current recommendation is greater than 150 minutes of moderate aerobic exercise per week (that’s less than 30 mins of walking per day!). I recommend adding strength training to this, as maintaining muscle mass is necessary for improving body composition and essential to bone health.
5. Eat a healthy diet
   • Increase intake of fruits and vegetables
   • Decrease red meat and saturated fat
   • Limit intake of refined sugar
   • Include high fibre grains, nuts, fish and poultry
   • Be mindful of salt intake

Can menopause hormone replacement (MHT) help?

Yes, depending on when it is initiated.

Evidence suggests that MHT can affect the progression of atherosclerosis and cardiovascular disease depending on the time of initiation. Women that start before the age of 60 and within 10 years of their last menstrual period can benefit. Some studies have shown that when initiated early, MHT can decrease cardiovascular risk by up to 30%. Alternatively, in women who started MHT later, research showed, no effect or possibly negative effect. This is because, when started later, the accelerated changes to the cardiovascular system have already occurred.

The take home message here is that prevention is key. Since we know that declining estrogen levels in menopause cause accelerated cardiovascular disease risk, we should be encouraging women to start screening and implement a prevention plan BEFORE changes are able to occur. If you are in your 40’s and you have started noticing that your menstrual cycles have started getting longer or shorter, it is time for you to be evaluated.

I love to support women through this stage of their life. Support options can include hormone therapy, focused dietary strategies, supplementation and lifestyle changes. Book your appointment today to start your individual health plan that will support your health for years to come.

If you are looking for a tailored approach to your health, follow the link to book your alignment call. 

In health,

Dr. Lisa Maddalena, ND