Take it to Heart

In honor of women’s national heart health month, and every women transitioning into menopause, this blog is for you! When women enter menopause, the risk for cardiovascular disease spikes, in many cases dramatically. It is imperative that women have a handle on this. Understanding the implications of cardiovascular disease and how to minimize the risks, it is essential for women to take action to protect themselves from the number one cause of death of all women; heart disease.

Why does this happen? And how can women empower themselves to reduce these risks? What should we know and what should we be doing to prevent heart attacks and strokes?

Why does this happen?

Perimenopause is the biological chaotic phase leading up to a women’s last period. During this time the egg producing sacs of the ovaries start to plummet in number, and the female sex hormone, estrogen, rapidly declines. This becomes problematic because estrogen is responsible for over four hundred functions in the body.

One of the most important functions of estrogen is that it protects women from cardiovascular disease. With a decrease in estrogen in post menopausal years the risk of heart disease is is the same as men.

Estrogen helps to keep skin and various tissues in the body soft and lubricated. Consider the skin, hair, and joint health of a younger woman. Estrogen helps to maintain the youthful, soft appearance of skin. As women age, their arteries also begin to lose their soft, elastic quality. We have all heard the term “hardening of the arteries”. Levels of estrogen, which helps keep blood vessels relaxed and open, start to decline markedly as women go through menopause. With less estrogen, cholesterol may build up on the arterial walls. A buildup in vessels leading to the heart and brain can increase the risk of stroke and heart disease. This hardening occurs for various reasons. In women, this is accelerated because the amount of estrogen begins to decline in menopause. Once a woman passes through menopause, she is has the same risk as men for cardiovascular and heart disease.

How can women empower themselves to reduce these risks?

Cardiovascular disease is NOT just a man’s disease. Cardiovascular disease is the Number 1 killer of women over age 25 in the United States, regardless of race or ethnicity. Once a woman reaches the age of 51, about the age of natural menopause, the risk for heart disease increases. In young women who have undergone early or surgical menopause, the risk for heart disease is also higher, especially when combined with other risk factors such as:

• Diabetes

• Smoking

• High blood pressure

• Elevated LDL (low density lipoproteins) cholesterol

• Low HDL (high density lipoproteins) cholesterol, sometimes called "good" cholesterol

• Obesity

• Sedentary lifestyle

• Family history of heart disease

There are many ways that women can minimize their risk for developing heart disease. The first step is knowing the above risk factors and also your family health and heart history. Genetics can play an important role in your health, however environmental and lifestyle factors are most important in preventing heart disease.

There are many things you can do to minimize your risks, regardless of your genetics. Risk factors includes your family history, your age, lifestyle choices including your nutrition, exercise, alcohol intake, smoking, sleep, and levels of stress.

Decreasing levels of estrogen is a risk factor. Many women experience different physical changes as they transition through menopause; hot flashes, mood issues, sleepless nights, dry skin, thinning hair, vaginal dryness and forgetfulness. Some women seem to sail through menopause with little or no symptoms. Although there are variations in experiences of physical changes, all women will experience changes that occur physiologically that they may not realize are happening. Some of these changes include increase in blood pressure, increase in cholesterol, increase in risk for dementia, increased risk for macular degeneration, glaucoma and cataracts, increased risk of osteoporosis, and heart disease. Many of these things will occur in women as a result of decreased estrogen.

Take charge of your health and do some simple things that will give you the information you need to make changes and interventions when necessary. For example, get labs to check your lipid levels, and your blood pressure level. Continue to see you gynecologist for annual exam including mammograms and ulstrasound of the breasts. Schedule a colonoscopy every 7-10 years starting at age 45, unless you have increased risk for colon cancer. In that case, it may be recommended that you do this test before the age of 45. When you turn 50, make an appointment with a cardiologist who understands the needs of women in midlife. The cardiologist should do an EKG and a calcium test. Some cardiologists will order a test called a CT scan of the coronary arteries. This non-invasive test allows the cardiologist to visualize the inside of the arteries and assess your risk for disease. One caveat is that CT scans require the use of radiations, so you must weigh the risks and benefits. This will be based on your individual risk factors. As we see from this, heart health and cardiovascular health is so much more than just knowing your blood pressure and cholesterol levels. Attention to diet, regular exercise, knowing your risks, and making small changes to reduce and improve risk factors can be an effective strategy for maintaining heart health.

Many women choose to replace estrogen at physiologic levels as they enter this transition time of life. The decision to begin supplementing with estrogen is a personal decision that should made by you along with the advice of a provider you trust. It is important to know that there is no “one size fits all” approach for estrogen replacement. Each woman has different physiology, different needs and potentially different reactions. Working with a provider you trust to be your partner in this endeavor is essential. Having patience and a willingness to make changes to regimens when necessary is also a large part of success in this process.