Women feel many of the changes that menopause brings — hot flashes, night sweats, weight gain — but they may not feel an increased risk of heart disease, the number one killer of women.
Menopause marks the end of menstrual cycles, but declining hormone levels also bring about a turning point for heart health.
“Estrogen plays an important role in protecting the heart and blood vessels,” says Mihaela Kruger, MD, cardiologist on the medical staff at Methodist Southlake Medical Center. “When those hormone levels fall, the risks go up.”
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Before menopause, estrogen helps blood vessels relax and supports a healthier cholesterol balance. It also reduces inflammation and slows the buildup of plaque in arteries.
“Once estrogen levels decrease, the arteries become stiffer and the blood vessel linings don’t function as well,” Dr. Kruger explains.
EARLY MENOPAUSE
Age also plays a factor. Women who go through menopause before age 45, either naturally or through surgery, face an even higher risk of heart disease.
“The earlier and longer estrogen is absent, the more time the body has to develop risk factors like insulin resistance, high blood pressure and unhealthy cholesterol,” says Dr. Kruger. “Over time, this can lead to heart failure, stroke and coronary artery disease.”
Cholesterol and blood sugar patterns may also worsen during this transition, and body fat shifts toward the midsection, all factors that raise the chance of high blood pressure, stroke, and heart attack.
HIGH BLOOD PRESSURE
Hot flashes and night sweats, also known as vasomotor symptoms, are more than just uncomfortable. They might signal hypertension.
“Studies show women who experience vasomotor symptoms frequently have a higher rate of high blood pressure,” Dr. Kruger says. “These changes can occur years before any signs of cardiovascular disease appear.”
That makes it critical for women to keep regular tabs on their blood pressure and visit a doctor if they have any concerns.
HORMONE THERAPY
Hormone therapy can relieve hot flashes and other symptoms, but its effect on heart health depends on age and timing.
Women who begin taking estrogen before age 60, or within 10 years of menopause, may see neutral or even beneficial cardiovascular effects.
Starting later, especially after the age of 70, hormone therapy may increase heart risks.
“It’s not the same for every woman,” Dr. Kruger says. “Decisions about hormone therapy should be individualized, weighing health history, family history, and personal goals.”
PROTECT YOURSELF
Heart disease risk isn’t inevitable as women age. Lifestyle changes and regular screenings can make a meaningful difference.
Dr. Kruger recommends that women monitor their blood pressure, cholesterol levels, and blood sugar regularly during this time.
“Early intervention during the menopausal transition is particularly effective in reducing long-term heart disease risk,” says Dr. Kruger.
She also suggests a few lifestyle modifications:
- Exercise: Aerobic activity and resistance training strengthen the heart and other muscles.
- Diet: Try a Mediterranean or DASH-style diet rich in fruits, vegetables, whole grains, and lean protein.
- Weight management: Maintain a healthy weight, especially around the waistline.
- No smoking: Quitting smoking can significantly lower your heart risk.
Menopause changes more than just hormones; it reshapes a woman’s overall health. Understanding the risks and making lifestyle adjustments can help women navigate this stage of life with confidence and protect their hearts for the future.
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