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Effect of the menopause on cardiovascular disease
The menopause affects more than just your mood and hormones - it can have an important impact on your heart health and risk of heart disease too. While you might be aware of common symptoms like brain fog, hot flushes and mood changes, you might not be aware of the link between the menopause and cardiac health.
Dr Ghada Mikhail, Consultant Interventional Cardiologist at The Harley Street Clinic, explains how menopause affects the heart, the key risks to be aware of, and the steps you can take to protect your long-term heart health.
Is the menopause linked to heart health?
Yes, menopause does affect your heart health. The menopause is driven by a decline in the production of the hormone oestrogen. You might not know it, but oestrogen also plays an important role in keeping your heart healthy.
As oestrogen levels fall during menopause, its protective effects on the heart are reduced. This can increase your risk of heart disease, particularly if you experience early menopause or have additional cardiovascular risk factors.
How does menopause increase your risk of heart disease?
Menopause can increase your risk of heart disease in several ways, particularly by affecting cholesterol levels and metabolism.
The main ways menopause can increase your risk of heart disease is through its effects on your cholesterol levels and metabolism.
There are two types of cholesterol - LDL cholesterol (sometimes referred to as “bad” cholesterol) and HDL cholesterol (“good" cholesterol). LDL cholesterol can build up in the walls of your blood vessels over time, which can lead to heart disease. HDL cholesterol removes “bad” cholesterol from the blood and takes it to your liver to be broken down. Oestrogen plays an important role in balancing your cholesterol levels, and as oestrogen production drops during menopause, the amount of LDL in your blood tends to rise.
Alongside this, the menopause leads to your body becoming more resistant to insulin, the hormone that controls your blood sugar levels. This increases your risk of heart disease, as well as type 2 diabetes.
The menopause is often also linked to weight gain and changes in fat distribution, especially around the waist. Increased abdominal fat is a key risk factor for heart disease, meaning these physical changes can further contribute to a higher overall cardiovascular risk.
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How can I reduce my risk of heart disease during the menopause?
At any point in your life, there are simple steps you can take to protect your heart. Maintaining a healthy weight, eating a balanced diet and staying physically active are key to supporting your heart health, and become even more important during the menopause.
One of the most recommended diets for cardiovascular health is the Mediterranean diet. This approach focuses on plant-based foods such as fruits, vegetables, whole grains, beans and pulses, as well as nuts, seeds and healthy fats like olive oil. It also includes lean sources of protein, including fish, eggs and chicken, while limiting red meat and processed foods. Following a Mediterranean diet, alongside regular exercise, can help lower cholesterol levels, support a healthy weight and reduce your overall risk of heart disease.
Making other lifestyle changes can also have a significant impact. Stopping smoking, for example, can help lower blood pressure and reduce damage to your blood vessels — both of which are important for maintaining good cardiovascular health.
Together, these steps can help protect your heart during and after menopause, reducing your long-term risk of cardiovascular disease.
What to check to maintain heart health during menopause
Regular health checks with your doctor can help identify early signs of heart disease and make it easier to manage your cardiovascular risk during menopause. One of the most important first steps is checking your blood pressure to ensure it falls within a healthy range.
High blood pressure is a key risk factor for heart disease, but it can often be managed effectively with lifestyle changes, such as improving your diet, increasing physical activity or reducing stress, or through medication to help lower it.
The same also goes for your cholesterol levels. A lipid panel, which is performed using a blood test, checks your total levels of cholesterol, HDL (“good”) cholesterol and LDL (“bad”) cholesterol to assess your cardiac risk. Likewise, a blood glucose test like an HbA1c or oral glucose tolerance test can identify if you’re at risk of type 2 diabetes.
These tests are useful at any time of life if you’re concerned about your cardiac risk, and mean your doctor can recommend the best plan for you if needed, whether that’s preventative lifestyle changes or medication.
“When it comes to keeping your heart healthy during menopause, the most important thing is understanding your individual risk factors. By knowing what your risk level is, you can be empowered to make positive lifestyle changes or make an informed decision about your treatment options.”
Does hormone replacement therapy (HRT) affect heart disease risk during menopause?
Hormone replacement therapy (HRT) can alleviate the symptoms of the menopause and improve quality of life, but it isn’t routinely prescribed to help protect the heart during the menopause. There’s some evidence that HRT may be beneficial in protecting the heart, but more research is needed into the link between HRT and heart disease.
If you’re considering HRT, it is important to discuss your individual risk factors with your doctor to determine whether it is a suitable option for you.
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