Menopause means saying goodbye to birth control, tampons, and some other “friends” women get close with during their fertile years. But it can also mean saying hello to something else: a higher risk of heart disease.
Like men, a woman’s risk for heart disease increases with age. But that risk increases even more for women when they start menopause.
Menopause Doesn’t Cause Heart Disease, But Here’s Why It Raises Your Risk
Menopause is when a woman’s menstrual period stops as she gets older. This happens because her ovaries stop producing the hormones estrogen and progesterone.
This decline in estrogen is thought to be a major factor in why women have a greater risk of developing heart disease once they are post-menopausal.
Heart disease is the leading killer of women in the United States, and it has killed more women than men each year since 1984.
It’s not that menopause causes heart disease, says Nazanin Moghbeli, MD, MPH, clinical assistant professor of medicine and associate director of women’s cardiovascular program at Penn Medicine.
Menopause causes “several things to change in a woman’s physiology, and some of those changes can lead to heart disease,” Dr. Moghbeli explains.
“The lipid profile of women actually starts to change, so that cholesterol starts to go up. And higher cholesterol can put you at higher risk for heart disease,” she says. “That happens pretty immediately after menopause.”
At the same time, blood pressure also begins to rise.
“The blood pressure is not directly related to menopause. It’s kind of related to the aging process,” Dr. Moghbeli says. “But those two factors—the blood pressure and the cholesterol rising—can increase the risk of heart disease.”
How Do You Reduce Your Heart Disease Risk During Menopause?
There are steps you can take to go through the changes of menopause without developing a heart condition. They include:
Yes, anyone can benefit from eating healthy. But that’s especially true for women in menopause because they’re at a higher risk for developing heart disease.
The American Heart Association recommends eating a healthy diet that includes lots of fruits and vegetables, whole grains, low-fat dairy products, and skinless poultry and fish. A healthy diet is also low on sodium, saturated fat and sugar-sweetened beverages.
“Aerobic exercise is really a key part as well,” Dr. Moghbeli stresses. She recommends that women get around 45 to 50 minutes of aerobic exercise most days of the week. Aerobic exercise can lower your cholesterol and blood pressure.
“That can be fast walking. It can be bicycling,” Dr. Moghbeli says. “It can be anything that really gets your heart rate up.”
One of the most effective ways to prevent heart disease is to know important numbers for your heart—like your blood pressure and cholesterol—to see if you have risk factors that need to be addressed. For instance, Dr. Moghbeli says high cholesterol can be both diet-controlled and medication-controlled, depending on the severity.
So, getting regular checkups can help you monitor the health of your heart as you go through menopause.
You should also be mindful of your stress levels. “Stress can really impact your cardiovascular well-being,” Dr. Moghbeli notes.
“Sometimes, women are running their households, taking care of their parents, working, taking care of kids—and the stress level can really be quite high,” she explains. This can worsen things like high blood pressure and overall cardiovascular stress.
Finding ways to relieve any stress you might feel—whether that be doing yoga or reading—can improve your overall cardiovascular health, Dr. Moghbeli says.
Hormone replacement therapy (HRT) can relieve some of the symptoms that occur with menopause, such as hot flashes and vaginal dryness. The medications give a woman’s body adequate levels of estrogen and other hormones.
But studies about hormone replacement therapy have found that it can also increase a woman’s chances of having a stroke or heart attack.
“We don’t recommend that women take it for prevention of heart disease,” Dr. Moghbeli explains. It might, however, still be reasonable to use it as a short-term method to treat menopause symptoms.
Smoking increases your risk of heart disease whether you’re menopausal or not, but the stakes are much higher for women in general.
“Smoking at any time in your life raises that risk much higher,” Dr. Moghbeli says. And considering that menopause already increases your risk as well, you’re better off quitting smoking or never starting.
The bottom line: Menopause might be a natural stage in a woman’s life, but heart disease doesn’t have to be.
Learn more about how you can minimize your risk for heart disease during menopause.
Schedule an appointment with a physician at the Women's Cardiology Center at Penn.