Heart Disease and Menopause. Are you at risk?

Menopause, remember, IS NOT a disease. But, the changes your body is going through can put you at a higher risk for certain diseases.

Heart disease or more broadly, cardiovascular disease (CVD) can have many causes. It can be caused by a genetic condition, high blood pressure, smoking, high cholesterol, insulin resistance (pre-diabetes) and diabetes and various inflammatory conditions.

CVD includes:

  • Atherosclerosis (hardening of the arteries) Plaques form in the arteries—these plaques can cause increased blood pressure. They can also break off and cause heart attacks and strokes.
  • Angina (pain or tightness in the chest) There are a number of varieties of angina. Angina is often a symptom of other CVD
  • Congenital heart disease—these are something you are born with and can affect the structure of the heart, the heart valves and/or the blood vessels.
  • Congestive heart failure—when the heart loses its effectiveness at pumping your blood throughout your body.
  • Coronary Artery Disease (CAD). This is the most common form of heart disease and affects the blood vessels that supply blood to your heart. It is the leading cause of death for both men and women and is most commonly caused by atherosclerosis of the heart blood vessels.
  • Coronary microvascular disease (MVD) affects the smallest arteries that supply your heart. These small arteries get narrowed—this can result in a lack of oxygen to the heart (ischemia) and can cause angina pain and a heart attack.
  • Hypertensive heart disease is a result of high blood pressure (hypertension). Hypertensive heart disease can also be related to CAD, congestive heart failure, angina, heart attacks and arrhythmias (irregular beats from the heart)
  • Ischemic heart disease occurs when there is a reduced supply of blood and oxygen to the heart. Again, atherosclerosis is the most common cause of ischemic heart disease.
  • Inflammatory heart disease. Inflammation is one of the body’s main defenses against infections and other conditions. When inflammation goes “out of control” however, it can physically damage a number of organs including the heart.
  • Pulmonary heart disease happens when pulmonary disease (lung disorders) affect the heart

Menopause is considered a “risk factor” for CVD—in much the same way as age is a risk factor. One or more risk factors can “join forces” and increase your risk even more. One way to look at this is to realize that you can’t do much of anything to reduce the risk of menopause, but you CAN reduce the other risk factors and make a significant dent in your risk for CVD and all the associated conditions.

What is the cause for the increased risk of heart disease for menopausal women?

The increased risk for heart disease occurs around the same time as menopause—there is a larger increase about ten years after menopause.

Part of the reason may simply be aging—and the accumulation of risk factors from a poor diet, a sedentary lifestyle (not getting enough exercise) or other conditions. Early menopause (defined as occurring before a woman is 46 years old) is associated with an even higher risk of heart disease.

Estrogen however, does appear to play a role in the origin of heart disease in women. Estrogen has a number of protective effects on the blood vessels and may help to keep them more flexible and open—this can reduce the risk of damage and of high blood pressure. Estrogen also reduces HDL cholesterol (often referred to as “good cholesterol”) and increases LDL cholesterol (often referred to as “bad cholesterol”)—this may be another reason for the increased risks associated with menopause.

In fact, for many years, many doctors prescribed hormone replacement therapy (HRT) as a way to reduce the risk of heart disease. This was also based on the idea that menopause is an “estrogen deficient” condition—and if estrogen was “replaced” then everything would be back to normal.

Unfortunately, this was not the case. The most recent long term studies for the Women’s Health Initiative, conducted by the U.S. Preventive Services Task Force (USPSTF) resulted in the recommendation against using HRT to prevent heart disease (along with osteoporosis, dementia and other chronic diseases). 1, 2 Instead, what the Women’s Health Initiative found was that HRT actually increased the risk of blood clots which increased the risk of both heart attacks and strokes. The Women’s Health Initiative also found that HRT increased the risk of developing Alzheimer’s disease and other forms of dementia.

On a positive note, one study recently found that if you have hot flashes that may actually decrease your risk of heart disease!

Reducing your risk

As mentioned, there’s not much you can do to decrease your “risk” of menopause, but there IS a lot you can do to decrease the other risk factors.

How? Eat right including lots of fresh vegetables, fruit and high-quality protein (see our articles about diet and menopause), exercise every day (or nearly every day), don’t drink alcohol excessively or smoke, lose weight (the fresh fruits and vegetables will help with that), decrease the amount of processed foods and sugar in your diet (THAT will help with your weight too!) relax and find the fun in life!


  1. Rossouw JE, Manson JE, Kaunitz AM, Anderson GL. Lessons Learned From the Women’s Health Initiative Trials of Menopausal Hormone Therapy. Obstetrics & Gynecology 2013;121:172-6.
  2. Stuenkel CA, Gass ML, Manson JE, et al. A decade after the Women’s Health Initiative–the experts do agree. Menopause (10723714) 2012;19:846-7.


  1. symptoms of diabetes says:

    Though diabetes can’t be cured but that can certainly be controlled.
    With the physical exercise and taking in balanced diabetes 2 diet can certainly help you control the advancement of diabetes.
    In type 1 regular insulin shots should be made for sustenance.

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