Heart Health And Menopause: What You Need To Know

A Canadian woman is diagnosed with cardiovascular disease every seven minutes. The risk of developing it increases during the menopause transition, when changes in the levels of hormones such as estrogen affect blood pressure, blood sugar and cholesterol. These changes can also lead to weight gain around the waist, another risk factor. The good news? You can reduce your risk.

The #1 question to ask about women’s heart health

“We want to make sure you’ve had that conversation with your health-care provider: ‘Am I at risk for heart disease?’” says Dr. Beth Abramson, a preventive cardiologist at St. Michael’s Hospital in Toronto. “You’re never too old or too young to make a change, but I take midlife or menopause as an opportunity.” Getting to the bottom of that question may include checking blood pressure, blood sugar and waist circumference. Abramson also measures cholesterol, as well as the molecule lipoprotein(a), which is checked only once in a lifetime but is strongly linked with risk for future heart disease if elevated. 

During her menopause consultations, Dr. Shafeena Premji—a Menopause Society–certified family doctor and a member of Calgary’s Libin Cardiovascular Institute—assesses symptoms and future health risks, including heart disease, breast cancer and osteoporosis. She then creates a personalized care plan and recommends the most evidence-based treatment options.

Premji also uses the Framingham Risk Score (FRS), which estimates the risk for heart disease over the next 10 years using factors such as age and blood pressure. Additionally, she considers women’s health conditions that are not part of the FRS but are associated with heart disease, such as high blood pressure in pregnancy, polycystic ovary syndrome and gestational diabetes.

How to reduce your risk for heart disease

“The first step is making lifestyle changes,” says Abramson (including finding a way to quit smoking, if you haven’t already). This should be followed by medications for blood pressure, diabetes and high cholesterol if needed.

Additionally, Premji advises having no more than two alcoholic drinks a week, reducing stress and aiming for 150 minutes of physical activity weekly, including strength training to build lean muscle mass.

To help build those muscles, it’s important to eat a healthy diet: including getting 20 to 30 grams of protein per meal and consuming more whole—as opposed to processed—foods. Cutting back on caffeine and salt also helps if blood pressure is a concern. 

What about menopausal hormone therapy?

Although some studies have raised concerns that MHT might increase the risk of heart disease, research suggests it is a safe and effective treatment option for menopausal symptoms affecting quality of life—such as hot flashes and night sweats—for many women who are less than 60 years old or within 10 years of menopause. Abramson says that MHT appears to help prevent heart disease in women who go through premature menopause—that is, before the age of 40—and should also be considered for heart disease prevention for women who reach menopause before the age of 45. For other women, however, starting MHT solely to protect the heart is not recommended.

You‘ll thank yourself later

“Women think: ‘I just need to get through menopause; it’s a one- to four-year deal,’” Premji says. “But they’ll spend upwards of 30 years in this chapter, and there are so many things they could be doing to keep themselves healthy and help themselves thrive during this time.”

March 5, 2024: This piece was updated to reflect the fact that MHT appears to help prevent heart disease in women who go through premature menopause (before the age of 40) and also that MHT should be considered for heart disease prevention for women who reach menopause before the age of 45.