Menopause: let’s get to the heart of the matter

WORLD Menopause Day is on Wednesday with this year’s theme being cardiovascular disease.

Helping women navigate through menopause is largely focused on symptom control.

But something else is happening to women entering midlife. Something you can’t see or feel. Something you may not even know is happening — and that is the increased risk of cardiovascular disease (CVD).

This is a general term for a group of conditions affecting the heart and blood vessels, usually associated with build-up of fatty deposits and clots inside the arteries, leading to heart disease, peripheral arterial disease and stroke. CVD is one of the main (preventable) causes of death and disability in the UK.

But why is this the hot topic around menopause this year? Cardiovascular disease is not a new discovery. We already know that as we get older, heart attack and stroke risk rise for everyone due to the ageing processes. But did you know that for women, the risk accelerates during menopause?

A woman’s risk of heart attacks is five times more after the menopause. It is only over the last few decades that more research has been carried out to identify the increased risk around menopause, of which women are still largely unaware.

This is further complicated by the fact that symptoms of heart disease present differently in women to men, making this life-threatening condition potentially underdiagnosed.

Why is this happening?

AROUND menopause, levels of oestrogen decline. This is because the ovaries, which produce the majority of oestrogen in the body, become less productive.

There are oestrogen receptors in cells throughout the body, including the heart and blood vessels.

Oestrogen has a protective effect on the cardiovascular system in several ways, including regulating blood cholesterol levels. More specifically, it helps to increase good cholesterol and reduce the bad cholesterol, which is responsible for the build-up of fatty plaques and narrowing of artery walls, a marker of future risk of CVD. Because high cholesterol is not a visible sign, it often goes undetected.

Other oestrogenic protective factors include reducing blood vessel stiffness, a risk factor for high blood pressure.

A decline in oestrogen levels results in the loss of these protective factors.

Menopause symptoms can also play their part in CVD development. Fat deposition changes from around the hips to the abdomen (belly), or “pear shaped”, to “apple shaped”.

Excess belly fat is part of a cluster of symptoms known as metabolic syndrome, where a person has at least three of the following: large waist circumference, high triglycerides, low good cholesterol, high blood pressure and high blood sugar. This is another risk for CVD.

Abdominal fat deposition also occurs inside the body around vital organs such as stomach and liver (known as visceral fat). This type of fat is associated with a higher risk of CVD and cancer.

Hot flushes and night sweats have been linked to high blood pressure.

We know that menopause- associated low mood, poor sleep, lack of motivation and lethargy can all go hand in hand with poor eating habits and lack of exercise, which are all key lifestyle risk factors for CVD.

Some women who are going through the menopause may be more aware of their heart beating or might feel as though their heart is racing (palpitations). This can be frightening but is usually harmless and often linked with hot flushes or anxiety symptoms.

However, persistent palpitations should be investigated to rule out conditions such as heart disease.

Prevention is key

I CAN feel the sighs: “Well, this is great, another concern to add to my menopause anxieties.”

Patients often say to me that publicity has been pivotal for menopause education but it seems every time we hear the word “menopause”, there’s more scaremongering with the prospect of menopause just feeling like a sense of impending doom.

But there is a reason that menopause experts are using this auspicious day as a platform to highlight the risk to the public. Although CVD is serious and potentially life-threatening, it is also largely preventable through lifestyle and we are encouraged to use this stage of life as “a window of opportunity’’ for optimising our health.

As a specialist myself, I believe we should be engaging with patients in the years leading up to menopause for early disease prevention and longevity rather than waiting for the signs and being reactive.

There are, of course, some unchangeable risk factors in our genetic make-up. For example, early menopause (prior to 45 years of age) hugely increases a woman’s risk of CVD. We know some ethnic backgrounds, such as South Asian, are at higher risk of having an early menopause. Such ethnicities also carry an independent higher risk for CVD and diabetes.

The combined effect of these risks for these women means early preparation is key.

What can we do to help ourselves?

• Get plenty of exercise/physical activity and maintain a healthy weight. I tell women this is probably the best liquor for life as it not only it reduces the risk for cardiovascular disease and diabetes but improves bone health, sleep and mental wellbeing. Women should aim for at least 150 minutes per week of moderate-intensity aerobic exercise and 75 minutes per week of vigorous aerobic exercise or a combination of both. Also keep moving in between. Staying active on your feet helps maintain motivation.

• Eating a healthy, balanced Mediterranean diet and limiting processed, high sugar and saturated fatty food can help to maintain heart function efficiency and prevent high cholesterol and diabetes. Omega oils are good for heart health as well as maintaining healthy joints and keeping the backbone mobile. You may find it helpful to keep a food diary to identify what works for you and any possible food triggers for poor eating choices.

• Quit smoking, if possible, as this is a direct risk for CVD as well as worsening menopause symptoms such as flushes and sweats.

• Focus on your mental and sleep wellbeing — good quality sleep and good mood are both critical for heart health, where both are directly linked to better blood pressure control. Both poor sleep and poor mental health can cause higher stress levels, less motivation to be physically active and unhealthy food choices, which are all risk factors for heart disease, stroke and diabetes.

• Know your risk — keep on top of health checks and screening for cholesterol, diabetes and metabolic syndrome. This should include up to date readings for blood pressure, body mass index and abdominal
circumference and blood tests for cholesterol and blood glucose levels.

• Take HRT — This can ease menopause symptoms, including lethargy, low mood and joint pains, which may encourage unhealthy lifestyle habits, potentiating the risk of CVD. There is now significant evidence that women taking HRT within 10 years of menopause or under the age of 60 have a lower future risk of developing heart disease. It is particularly important if you have early menopause (before the age of 45), as these women are at much higher risk of premature coronary heart disease and are advised to take HRT until at least the natural age of menopause (around 51 years old in the UK). Some women still fear HRT risks including an increased risk of blood clots. Taking HRT in tablet form can increase risk of blood clots but the level of risk depends on lifestyle (such as being overweight and smoking), genetics and any pre-existing risk of clots, such as previous stroke, heart attacks and blood clots. However, HRT has evolved and we also know that taking HRT through the skin (as a patch, spray or gel) does not increase this risk. Your specialist will be able to recommend the correct solution for you.

Hopefully, armed with the above, you can feel better positioned to make positive lifestyle choices for your cardiovascular health. For more support, speak with your doctor — we are here to help.

You can also find more information on the British Heart Foundation website, www.bhf.org.uk/information
support/support/women-with-a-heart-condition/menopause-and-heart-disease

Dr Shilpa McQuillan, from Emmer Green, leads the Berkshire Menopause Clinic in Henley. For more information, visit www.berkshiremenopause
clinic.com or email info@berkshire
menopauseclinic.com