Specialist Advice — 7 minutes
Cardiovascular disease: Menopause may be the cause
The incidence of cardiovascular disease often increases in post-menopausal women. How do we explain this? What signs should women watch for? And how can they prevent it?
- Hot flashes
- Changes in the menstrual cycle
- Sleep disorders
- Mood disorders
- Dryness of the skin, hair and vagina
- Urinary incontinence, headaches, fatigue, weight gain...
The list of symptoms women experience during menopause is long. However, missing from this list are the less visible consequences of menopause, including osteoporosis and, especially, cardiovascular disease.
In Quebec, among women aged 65 and over, the death rate from cardiovascular disease is double that of women under 40, rising from 9.4% to 18% of all deaths.[1] Scientists have been quick to draw a link with menopause, when menstruation definitively ends, which generally occurs between the ages of 45 and 50.
But what happens at menopause for this risk to increase so much?
The key role of estrogens
In women, the majority of hormones, called estrogens, are produced by the ovaries, while the rest are produced by peripheral tissues. Menopause happens when “aging” ovaries stop producing estrogen, responding progressively less to stimulation by FSH and LH, two hormones released by the pituitary gland.
Estrogens are not only important for reproductive function and pregnancy. From puberty onwards, they are responsible for the appearance of sexual characteristics, such as breast development. They also have an influence on numerous organs and tissues. At menopause, tissues that were sensitive to estrogen undergo atrophy, leading to, among other things, vaginal dryness and weaker bones (osteoporosis).[2]
According to a number of studies, estrogens also have a cardioprotective effect. They are thought to prevent the inflammation that plays a role in the formation of cholesterol plaques on blood vessel walls (atherosclerosis), as well as reduce triglyceride levels, thereby stimulating the production of good cholesterol (HDL) and consequently lowering bad cholesterol (LDL).[3]
But the picture is not quite so simple. In fact, hormone replacement therapy, aimed at compensating for the drop in estrogens, can in some cases increase the risk of heart attack and stroke.[4] How do we explain these seemingly contradictory results? Some have pointed to cell ageing, the time between menopause and the beginning of treatment, individual genetics or previous risk factors. Research is currently underway to provide more precise answers.
Is hormone therapy helpful?Hormone replacement therapy is recommended for controlling the major symptoms of menopause, but not for protecting the heart.[4] The decision to follow this type of treatment should be based on individual needs and risks, after discussion with a doctor.
Distinctive signs to watch for
Heart attack is one of the best known signs of heart disease. In women, the most common symptom is intense chest pain. However, many women experience less intense or atypical symptoms (see box). As these signals are not always recognized and treated promptly, the correct diagnosis is delayed,[5] increasing the risk of after-effects and even death.
Warning signs in womenThese less typical precursor symptoms of heart attack [6] may delay a proper diagnosis:
- Shortness of breath
- Sensation of tightness or widespread pain in the chest
- Pain in the neck or jaw
- Nausea
- Dizziness
- Clammy skin
- Extreme or unusual fatigue when walking or during an episode of stress
Another problem in detecting a heart attack in women is that many of them do not involve the typical blockage of an artery supplying the heart. Heart attacks in women are often caused by dysfunction of the tiny arteries in the heart, or by spasms or ruptures of dynamic plaques that disappear upon examination.[5] In the absence of these diagnostic signs, doctors may be more inclined to attribute the symptoms to anxiety or stomach problems.
How can cardiovascular disease be prevented during menopause?
For many doctors, raising awareness among women of the risks of cardiovascular disease is the first step in reducing the number of deaths. By recognizing the signs of a heart attack, women can act more quickly and seek medical attention before it is too late.
Adopting a healthy lifestyle can reduce the risk of heart disease and stroke. It is estimated that up to 80% of cardiovascular disease can be prevented through behaviours such as healthy eating, regular exercise and not smoking. Here are a few tips on how to achieve this.[7]
- Quit smoking or vaping and avoid second-hand smoke.
- Achieve and maintain a healthy body weight.
- Engage in moderate to intense aerobic physical activity for at least 150 minutes per week, in segments of 10 minutes or more.
- Be active regularly as part of your daily routine.
- Maintain a healthy blood pressure by changing lifestyle habits and, if necessary, taking medication.
- Adopt a healthy, low-fat, high-fibre diet that includes foods from each of the four food groups, with an emphasis on plant-based foods. Avoid highly processed foods.
- Take medications that reduce the risk of heart disease and stroke as prescribed by your doctor, such as those for high blood pressure, high cholesterol and diabetes.
For professional support, we’re here for you.
We offer services that can help your doctor diagnose heart problems and related health conditions, and determine the appropriate treatment.
Sources7
- Institut national de santé publique du Québec (INSPQ). “Répartition des cinq principales causes de décès selon le groupe d’âge, femmes, 2016,” Principales causes de décès, https://www.inspq.qc.ca/santescope/syntheses/principales-causes-de-deces [accessed on February 8, 2024].
- CHU Toulouse. “Qu’est-ce que les œstrogènes et à quoi servent-ils ?” November 10, 2004, https://www.chu-toulouse.fr/qu-est-ce-que-les-oestrogenes-et-a.
- Vivien Williams. “Mayo Clinic Minute: Women, estrogen and heart disease ,” Mayo Clinic, February 17, 2020, https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-women-estrogen-and-heart-disease/.
- B.L. Abramson, D.R. Black, M.K. Cristakis et al. “Directive clinique no 422e : Ménopause et maladies cardiovasculaires,” JOGC, vol. 43, #12, pp. 1444-1449.E1, December 2021, https://www.jogc.com/article/S1701-2163(21)00764-7/fulltext.
- Kathy Katella. “How is heart disease different in women?” Yale Medicine, February 10, 2023, https://www.yalemedicine.org/news/heart-disease-women.
- Fédération des médecins spécialistes du Québec. “Santé cardiovasculaire au féminin,” https://fmsq.org/fr/dossiers-sante/sante-cardiovasculaire-au-feminin [accessed on February 8, 2024].
- Heart and Stroke Foundation of Canada. “Women’s unique risk factors,” https://www.heartandstroke.ca/heart-disease/risk-and-prevention/womens-unique-risk-factors [accessed on February 8, 2024].
