Menopause and your heart
Menopause happens to every woman, but did you know it can affect your heart? GP and menopause expert Dr Louise Newson explains the problem and how hormone replacement therapy could help.
Menopause is a stage in every woman’s life when the ovaries stop making eggs and start producing less of the hormone oestrogen. The average age of the menopause in the UK is 51, but this can be earlier or later for some women. The menopause usually happens gradually – the time leading up to it is called perimenopause, when your periods might become more irregular, and sometimes heavier. This often starts at around 45.
Most women experience some symptoms of menopause, which can include hot flushes, tiredness, palpitations, muscle pain, fatigue, poor concentration, low mood, anxiety, vaginal dryness and sometimes urinary incontinence. These will vary a lot between individuals and may come and go. The symptoms can last for anything from three months to more than 10 years. Unfortunately, there is no way of predicting how long they will last.
Why does menopause affect your heart?
Oestrogen is important because it helps to protect a number of different parts of your body, including your heart and blood vessels, bones, brain, skin and vagina, so they can all be affected by low levels.
The symptoms of menopause can last for anything from three months to more than 10 years
Oestrogen protects the arteries of a woman’s heart in a number of ways, including by reducing build-up of fatty plaque. This means that, after the menopause, you are at an increased risk of heart and circulatory disease. Low oestrogen can increase cholesterol levels, which can further increase your risk of developing heart and circulatory disease.
Menopause can cause palpitations (feeling your heart beating faster than usual) due to the changing hormone levels. This can sometimes happen during hot flushes. Palpitations are usually harmless.
Early menopause and heart disease risk
One in 100 women experience early menopause, before the age of 40. It puts them at particularly high risk of premature heart and circulatory disease, as well as osteoporosis (a condition that weakens bones).
If you are younger than 45 when your periods stop, you may need tests to check if there is another reason behind it. Family history can play a part, but early menopause can also be associated with thyroid disease, viral infection and eating disorders. Women are also at risk following surgical or treatment induced menopause, for example, if they are undergoing treatment for cancer that requires removal of the female organs.
Treatment for early menopause is particularly important. People in this category should take hormone replacement therapy (HRT) or the combined contraceptive pill to reduce their risk of heart and circulatory disease and osteoporosis until they are at least 51 years old.
The benefits of HRT
HRT can be used to tackle the symptoms of menopause, at whatever age it occurs. This can be oestrogen on its own or combined with progesterone. HRT is the most effective treatment available to relieve symptoms caused by the menopause, such as hot flushes, night sweats, mood swings and bladder symptoms.
A lot of people think they are being healthier by avoiding HRT, but there is no evidence that this is the case and they may be suffering unnecessarily
I do find that patients have a negative opinion of HRT – they are scared of it. A lot of people think they are being healthier by avoiding HRT, but there is no evidence that this is the case and they may be suffering unnecessarily as a result. They may be more likely to engage in unhealthy lifestyle habits, such as being inactive and overeating to improve their mood, thus increasing their risk of heart disease.
There have been scare stories about HRT, but a large recent study, based on around 18 years of follow-up in 27,000 women, looked at women who took HRT versus those who took a placebo. It found no difference in overall death rates or death rates from heart disease or stroke, and no significant difference in death rates from cancer. This was the first large study to look at long-term death rates among women taking HRT.
The national health watchdog, the National Institute for Health and Care Excellence (NICE), issued guidelines on the diagnosis and management of the menopause in 2015. These can help doctors and patients make an informed choice, based on a more balanced review of the evidence.
The risks of HRT
Taking HRT as tablets can increase the risk of blood clots, including deep vein thrombosis (DVT) and stroke, but this can be avoided by having HRT through the skin (as a patch or gel).
HRT is sometimes linked with increased risk of breast cancer. Any increase in risk needs to be considered in terms of your individual risk of breast cancer before HRT – this varies from person to person and is increased by being overweight, drinking alcohol and being physically inactive. Oestrogen-only HRT is associated with little or no change in risk of breast cancer, while combined HRT with oestrogen and progesterone can be associated with an increased risk.
For some women, for example those who’ve had breast cancer, hormone treatment might not be suitable. Discuss alternatives with your doctor.
Meet the expert
Dr Louise Newson is a GP with a special interest in menopause.