Love Your Heart, Cardiovascular Disease and Menopause

by WV Marshall

Heart attack/Stroke After menopause, a woman’s risk of cardiovascular disease increases. The role of estrogen in heart disease is puzzling, and research continues to better clarify it, the North American Menopause Society said.

Major risk factors associated with cardiovascular disease in women includes, among other things, tobacco, a less active lifestyle, high blood pressure or cholesterol, obesity and family history. Apart from family history, CVD risk factors are modifiable by lifestyle changes, improved diet, weight reduction or controlling blood pressure (with medication, if necessary.)

NAMS says women should visit their healthcare providers for periodic checks of blood pressure, cholesterol, weight, smoking cessation progress (if applicable) to assess risks. Also, know the symptoms of a heart attack common in women because a heart attack in women often has different cues than one in men, NAMS said, urging women to seek medical help quickly if they experience:

  • Chest pain, pressure, or squeezing
  • Jaw, arms, back, or neck pain
  • Extreme fatigue
  • Shortness of breath, nausea, and lightheadedness
  • Unusual sweating
  • Upper stomach pain

Concerning strokes, Verywell Health said women hit a statistical benchmark at age 45 because that’s when the risk of stroke begins to rise for women. Why pay attention to that milestone age? Because most women don’t even think about the possibility of a stroke until they are older.

Women can’t really do much about some risks – age, ethnicity, family history or a personal history of stroke, among them. What risks can women change? Lifestyle ones. By now, you know the drill: Watch what you eat, exercise, give up bad habits (such as smoking).

Many women are unaware of the signs of a stroke and they delay seeking emergency medical attention, Verywell Health said. The website encourages women not to poo-poo symptoms of a stroke and to seek help if one of the following occurs:

  • Sudden weakness or numbness in your arm, leg or face, particularly if it’s concentrated on one side
  • Confusion, difficulty understanding speech, or problems speaking
  • Loss of coordination, balance or ability to walk
  • Double or blurred vision
  • Sudden unexplained headache

Also, women could experience chest pain or more generalized symptoms such as weakness, nausea or fatigue – all nontraditional symptoms of a stroke.

Dr. Leslie Cho, director of the Women’s Cardiology Center at the Cleveland Clinic, said in a 2018 interview posted on the clinic’s website that women’s blood pressure and cholesterol goes up during menopause.

“Now, we used to think if we gave you hormone replacement therapy that that would lower your blood pressure and lower your cholesterol. It does lower your cholesterol, but unfortunately it doesn’t lower your risk of heart attack and stroke,” Cho said. “There is actually some data that in certain women, especially the ones with heart disease; it main increase your risk of having more heart attack and stroke.”

The Cleveland Clinic also offered this sobering reminder: Heart disease isn’t just a man’s disease; it’s the No. 1 killer of women in the United States each year.

Heart irregularities Risk of cardiovascular disease or stroke isn’t the only heart-related condition that increases at the onset of menopause.** Irregular heart rhythm also could occur.**

An arrhythmia could be “silent” and not present any symptoms, the Cleveland Clinic said. During an exam, a healthcare provider can identify an irregular heartbeat by taking your pulse, listening to your heart or by performing diagnostic tests.

Since estrogen production drops during perimenopause, the decrease is associated with an increase in both the heart rate (sinus tachycardia) and the frequency in palpitations and non-threatening arrhythmias, such as premature ventricular contractions, or PVCs, Cleveland Clinic said.

If symptoms of an irregular heartbeat are found, they could include:

  • Palpitations, those feelings of skipped heart beats, fluttering or feeling that your heart is “running away”
  • Pounding in the chest
  • Dizziness or light-headedness
  • Shortness of breath
  • Chest discomfort
  • Weakness or fatigue

Symptoms of palpitations represent between 15 percent and 25 percent of all the symptoms reported by female heart patients, the clinic said.

The decline in estrogen production continues as the menstrual cycle stops. During this time period, women between the ages of 40 years and 64 years could experience irregular heartbeats, palpitations, and intermittent chest pain, among other things.

A Heart and Estrogen/Progestin Replacement Study (HERS) in the late 1990s found no benefit in using hormone replacement therapy to reduce cardiovascular events; in fact, HRT could increase risk of a blood clot during the first year, Cleveland Clinic said on its website. On the other hand, the study indicated HRT may decrease palpitations and other symptoms such as hot flashes, insomnia, and sweating.

High cholesterol Cardiovascular disease picks up steam in women after menopause. But cholesterol levels for women also can rise to unhealthy levels, and do so often unnoticed.

Women who experience menopause before 45 years of age are at an increased risk of cardiovascular disease, while those who go through menopause at an older age have a decreased risk, University Health News reported last year. Research also indicates that cholesterol levels for women increase at menopause, along with other risk factors for heart disease. (

The online news digest said women in menopause experience an increase in LDL cholesterol (or “bad” kind) and a decrease in HDL cholesterol (“good” kind). Researchers said the reasons why the changes occur at menopause weren’t entirely known, but said they suspect there are protective factors – read, estrogen – in premenopausal women that are lost at the time of menopause.

[U.S. Cardiology] said, “Menopause is associated with a progressive increase in total cholesterol, with, in particular, an increase in low-density lipoprotein (LDL), lipoprotein-α and triglycerides and a decrease in high-density lipoprotein (HDL). Therefore, menopausal women are exposed to a more atherogenic lipid profile than pre-menopausal women.”

The journal said it was believed that a greater proportion of women are at high risk for high cholesterol than men and aren’t being effectively treated, even though there are therapies that lower cholesterol levels reduce heart disease risk in both men and women. A survey in the early 2000s indicated just one in four women associates menopause with high cholesterol.

Even if you never had a problem with cholesterol before, it is important to monitor your cholesterol at the onset of menopause, University Health News said. The news website offered steps you can take to try to lower your cholesterol and lower your risk for heart disease, such as eating a healthy diet of fruits and vegetables while cutting back on sugary foods and carbohydrates, and exercising regularly to help lower cholesterol naturally and boosts the “good” HDL cholesterol. (As always, check with your healthcare provider for a diagnosis and treatment options.)