Menopause is a natural part of aging for women that often comes with some uncomfortable symptoms. Complex hormonal changes can cause everything from hot flashes to night sweats to menopausal migraines. But that’s not all—menopause could also be contributing to your risk for heart disease.

“Although there’s no established direct link between menopause and heart disease, we do know that women’s heart health risk does increase after menopause,” explains Beverly Vaughn, MD, gynecologist at Lankenau Medical Center, part of Main Line Health. “Most women aren’t affected by heart issues until a few years after menopause (which is 12 months after your last menstrual period). So it’s really important to put healthy behaviors in place now to prevent issues down the road.”

Menopausal weight and heart disease

Menopausal weight gain is the primary culprit when it comes to increased risk of heart disease. Due to changes in metabolism along with hormonal fluctuations, many women find it difficult to achieve or maintain a healthy weight as they age. After menopause, cholesterol, triglycerides and blood pressure may also increase, all of which can contribute to heart disease.

During the years leading up to menopause and beyond, be sure to know your numbers. Having information about your health can help you make better food decisions and motivate you to get moving. Even moderate exercise, such as 20 minutes of walking per day, can greatly benefit your circulatory system, increase metabolism, decrease stress and improve your outlook on life. And those 20 minutes a day add up throughout the week. In fact, the American Heart Association recommends 150 minutes a week of walking (approximately 21 minutes per day) for optimal heart health and a host of other health benefits from sleep to bone strength.

“What matters is that you take charge of your health,” adds Maribel Hernandez, MD, a Lankenau Heart Institute cardiologist and co-director of the Women's Heart Initiative at Main Line Health. “Menopause is a great time to assess diet and lifestyle, and even how you manage stress. Making small changes now can contribute to life-changing results in the future.”

Menopause hormones and heart disease

With menopause, women produce less of the sex hormones estrogen, progesterone and testosterone. Estrogen in particular is thought to protect the heart by keeping the blood vessels “relaxed” and preventing build-up of cholesterol in the artery walls so that blood flows freely throughout the body. Because of the decline in estrogen, menopausal women are at greater risk for high cholesterol and heart disease, and the risk of stroke doubles for every decade after age 55.

Hormone replacement therapy and heart disease

Women get a lot of mixed messages about the safety and effectiveness of hormone replacement therapy (HRT), which is sometimes used to address symptoms of menopause such as hot flashes, vaginal dryness, mood, sleep and loss of sexual drive. HRT can provide supplemental estrogen or progesterone, and in some cases, testosterone, to offset the hormonal fluctuations and associated symptoms.

“As with every medicine or procedure, women should be evaluated on a case-by-case basis to determine if menopause hormone therapy is right for them,” says Dr. Vaughn, “For most women, it’s generally a safe option that doesn’t have a negative effect on heart health, as long as it’s started in the early menopausal period.”

Do I need hormone replacement therapy?

This depends on the severity of your menopausal symptoms, your health history and other factors your OB/GYN will take into consideration when discussing treatments for menopause. You may not be eligible to receive menopause hormone therapy if you have a history of breast cancer, blood clots, prior heart attack or stroke, or if you’re at increased risk for heart disease because of existing medical conditions.

Fortunately, there are other options available, such as topical estrogen, to help control hot flashes and vaginal menopause symptoms without increasing heart disease risk. If you have a pre-existing risk factor, be sure to talk to your doctor about other options.

Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (225.5654) or use our secure online appointment request form.