When most women think about menopause, they think about symptoms like hot flashes, mood swings and weight gain. However, there's another, more dangerous side effect that's often overlooked.
"Women going through menopause are at greater risk of developing heart disease," explains Sangeeta Sinha, MD, an OBGYN at StoneSprings OB/GYN in Dulles, Virginia. This helps explain why heart disease is the leading cause of death for women over the age of 65.
But heart disease doesn't have to be your destiny, notes Dr. Sinha. Here's what women need to know.
Why menopause puts you at greater risk
The average woman goes through menopause at age 51, according to the North American Menopause Society, although starting it any time in your 40s or 50s is considered normal.
"It seems that the reproductive hormones estrogen and progesterone — both of which decline during menopause — are protective against heart disease," explains Sinha. Estrogen, for example, helps keep blood vessels flexible so they open more easily for blood flow. Estrogen has also been shown to help keep levels of HDL (aka, "good cholesterol") up and levels of LDL ("bad cholesterol") low.
Other research indicates that early menopause raises one's risk of heart disease. One 2016 Dutch analysis of more than 300,000 women — published in JAMA Cardiology — found that risk of heart disease was about 50 percent greater for women who were younger than 45 when menopause began compared to those who went through menopause later in life.
How to reduce your risk
Heart disease is by no means inevitable for women in their 50s and beyond. Taking preventive steps can help lower your risk and improve your overall health.
Stay up to date on screenings: Once you've gone through menopause, an annual visit with your primary care provider is necessary, says Sinha. You should also follow these basic guidelines from the American Heart Association:
- Blood pressure checked at least every two years
- Cholesterol checked at least every five years
- Blood glucose levels checked every three years
- BMI (a measure of body fat based on height and weight) checked during every healthcare visit
If you have existing heart risk factors — such as being overweight, having type 2 diabetes or having high blood pressure or elevated cholesterol levels — you'll need to speak to your physician about getting screened more frequently.
Lose weight: If you're carrying around extra weight, shedding it will reduce your risk of heart disease and may even improve menopausal symptoms.
Exercise: Women who are sedentary not only raise their risk for heart disease, they are also about 28 percent more likely to have severe menopausal symptoms than active women, according to a 2016 study published in Menopause.
The American Heart Association recommends getting 150 minutes of moderate physical activity every week - the equivalent of brisk walking for 30 minutes most days of the week.
Eat a heart-healthy diet: The Mediterranean diet — which emphasizes plant-based foods such as fruits, veggies, whole grains, legumes, nuts and healthy fats such as olive oil — has been shown to reduce risk of heart disease, says Sinha.
One 2013 study published in The American Journal of Clinical Nutrition found that those who followed this type of eating pattern reported fewer menopausal symptoms, including hot flashes.
Quit smoking: If you smoke, it's always a good time — and never too late — to drop the habit. Not only does smoking lower levels of HDL, harden the arteries and increase your risk of blood clots, it may also contribute to an earlier onset of menopause.
Be cautious with hormone replacement therapy: The American Heart Association does not recommend taking hormone replacement therapy (HRT) to prevent heart disease. A 2013 study published in JAMA found that HRT may slightly increase risk of heart disease among older women.
"If I do prescribe it for a patient who is really miserable from menopause symptoms, I usually do it right after menopause, and for no more than five years total," says Sinha. "We really want to see women off of it by their mid to late 50s."