The years in a woman’s life leading to menopause are a critical time for heart disease prevention, according to a new report that summarizes the latest science on this midlife transition and its relationship to cardiovascular risks.
The latest data on the years approaching menopause – a time when cardiovascular risks are accelerating – includes a look at when to start hormone replacement therapy, the age at which menopause begins, and the lifestyle factors that put a woman at risk affect this time.
“Over the past 20 years, our understanding of how the transition to menopause can contribute to cardiovascular disease has grown dramatically,” said Samar R. El Khoudary, associate professor of epidemiology at the university’s Clinical and Translational Science Institute Pittsburgh in a press release. She chaired the American Heart Association’s Scientific Commentary Writing Committee, published Monday in its journal Circulation.
Monitoring a woman’s health and lifestyle is especially important in midlife to help prevent heart disease and stroke. “Health professionals might consider an aggressive, preventative approach to women at this stage in their life,” said El Khoudary.
The transition from reproductive to non-reproductive life is characterized by changes in menstruation and typically begins when women are in their late 40s to early 50s.
Before this transition, women produce estrogen, the female sex hormone that can also protect the heart. However, during natural menopause, the ovaries no longer produce as much estrogen. This can also be done surgically after a partial or full hysterectomy, which involves removing one or both ovaries.
Some research, according to the new statement, has shown that certain combinations of hormone replacement therapy have potential cardiovascular benefits when started in early menopause. Some studies have also shown that therapies can lower the risk of type 2 diabetes and protect against bone loss. More research is needed to evaluate the role of other hormone therapies and their health effects, the statement authors said.
In addition to summarizing the hormone therapy research, the statement includes the following highlights:
• The characteristic hot flashes and night sweats of menopause are associated with a lower risk of cardiovascular disease. Depression and sleep disorders, which in some studies are linked to an increased risk of heart disease, are also common in menopausal women.
• Women who are through menopause at an earlier age are at greater risk of heart disease. The onset of menopause can be affected by the length of the menstrual cycle, poorer cardiovascular health during the reproductive years, and socio-economic factors. Race and ethnicity also play a role, as many Hispanic and black women experience menopause at a younger age.
• Physical activity and diet can affect the timing of menopause for all women. Women who drink little to moderate amounts of alcohol may experience later menopause, and cigarette smokers are likely to start about a year earlier than non-smokers.
• Only 7.2% of menopausal women get the recommended amount of physical activity, and less than 20% consistently maintain a healthy diet.
• Cholesterol levels, the risk of developing metabolic syndrome, and changes in the structure of blood vessels appear to increase with menopause beyond the effects of normal aging. Metabolic syndrome occurs when a person has three or more of the following symptoms: obesity in the abdomen; high triglycerides; low “good” HDL cholesterol; high blood pressure or high blood sugar.
While healthy lifestyle changes are critical to maintaining a healthy heart, there is a lack of research specifically testing these interventions during the transition into menopause, said Dr. Matthew A. Allison, vice chairman of the statement drafting committee.
“Similarly, we need randomized clinical trials of therapeutic interventions such as cholesterol-lowering drugs and menopausal hormone therapy in women who are going through menopause,” Allison said in a press release. “This population at risk has not been the focus of previous clinical studies, so we have questions how the results of these studies might apply to women at this earlier stage of menopause.”