Menopause and Heart Health

At midlife, lower estrogen levels and personal health history pose challenges to heart health. Menopause leads to increased LDL-cholesterol and decreased HDL-cholesterol, weight gain in the abdomen, higher blood pressure, and hot flashes. Blood glucose levels may also rise, increasing the risk of diabetes, heart attack, and stroke. Health history, including pregnancy complications, may also increase the risk of heart disease. Maintaining a plant-based diet, exercising regularly, managing stress and sleep, and not smoking are important habits for heart health.

Menopause can bring about changes in the levels of cholesterol in your blood. After menopause, levels of LDL-cholesterol (the "bad" cholesterol) tend to increase, while levels of HDL-cholesterol (the "good" cholesterol) tend to decline. This can increase the risk of clogged arteries that can block the flow of blood to your heart, brain, and legs. It's important to have your cholesterol tested regularly, every 4 to 6 years, or more often if you're at higher risk. If you're over the age of 20, your total cholesterol should be under 200 milligrams per deciliter (mg/dl). You should aim for an LDL less than 100 mg/dl and HDL levels of 60 mg/dl or higher.

Another change that can occur during menopause is an increase in belly fat. This weight gain in the abdomen signals an increase in visceral fat, which is the type of fat that surrounds your internal organs and contributes to high blood pressure, elevated blood cholesterol, and type 2 diabetes. All of these conditions are risk factors for heart disease. If you carry more weight around your middle, you have a greater chance of having a heart attack than if you're just heavier overall. If your waist measures 35 inches or more, you may have extra visceral fat.

Blood pressure is also an important factor to consider during and after menopause. Even without excess visceral fat, a combination of estrogen loss and aging can result in less flexible blood vessels. Stiffer arteries contribute to higher blood pressure, which plays a role in the development of heart disease, heart failure, and stroke after menopause. Being overweight can also lead to higher blood pressure because it puts more stress on the heart to pump blood.

Hot flashes are another issue that many women experience during menopause. Fluctuating estrogen levels during perimenopause, which lasts an average of 4 years before menopause starts, can cause hot flashes. These can be annoying, embarrassing, and debilitating, and they may also be a health issue. Hot flashes are linked to higher blood pressure and cholesterol levels. Some research suggests that they're also a risk factor for cardiovascular disease. If you're experiencing frequent or persistent hot flashes, or if you did during perimenopause, it's important to talk to your doctor about them.

Blood glucose levels can also be affected during menopause. While menopause doesn't cause diabetes, research suggests that there's a link between estrogen loss and rising blood sugar levels early in the process. If you reach menopause before age 40, you're four times as likely to get type 2 diabetes by the time you're 55. High sugar levels can damage blood vessels and the nerves that control your heart and blood vessels. Prediabetes, when blood sugar is higher than normal but not yet at the level of diabetes, is also linked to an increased risk of heart attack and stroke.

Your personal health history is also important to consider. If you had certain complications during pregnancy, including high blood pressure, gestational diabetes, preterm delivery, and pregnancy loss, you're more likely to develop cardiovascular disease later in life. Other risk factors for heart disease include having a father or brother who had a heart attack before age 55, having a mom or sister who had one before age 65, being treated with certain chemotherapy drugs and radiation therapies, and being diagnosed with polycystic ovary syndrome or endometriosis.

Following a heart-healthy diet and lifestyle is crucial during and after menopause. Eating a plant-based diet that's low in saturated fat, sodium, and added sugar is the best way to help keep your cholesterol, blood pressure and overall health in check.